Pediatric Rheumatology Practice Research Articles

Physician and Parent Perspectives on Psychosocial and Emotional Data Entry in the Electronic Medical Record in a Pediatric Setting.

Objective:This pilot study was conducted to evaluate physician and patient preferences for documentation of emotional and psychosocial information in the electronic medical record (EMR).Methods:Pediatricians from an academic medical center and parents of patients in an academic pediatric rheumatology practice were surveyed on 10 different elements using Likert-type scale items (1 = not at all important, 10 = extremely important). The importance of the proposed categories was evaluated by means testing and pairwise comparisons of the responses.Results:Responses were obtained from 45 physicians and 35 parents. The overall mean scores for physicians and parents were 7.70 and 7.44, respectively. Scores on personality, friends, and school differed between physicians and parents, but those differences were not significant after adjustment for multiple comparisons (P = .13, .17, and .26, respectively). Fears, special requests, and special needs were in the high-score group for both physicians and parents.Conclusion:Physicians and parents reported that the incorporation of emotional and psychosocial information into the EMR added value to the health care of children.

Toward Standardized Musculoskeletal Ultrasound in Pediatric Rheumatology: Normal Age‐Related Ultrasound Findings

The Outcome Measures in Rheumatology Ultrasound Task Force has recently started to work on the validation and standardization of musculoskeletal ultrasound (MSUS) examination in children in order to improve its applicability to joint examination. This was a prospective multicenter study performed by 4 experts in pediatric MSUS, who independently collected representative images using predefined scanning procedures of 4 joints (knee, ankle, wrist, and second metacarpophalangeal joint) in different predefined age groups. Researchers were allowed to use their own settings (B-mode and Doppler) in order to get the best quality image and highest sensitivity for low blood flow. Images were evaluated for quality parameters and an atlas was created with the best images. An equipment comparative study was performed by a single examiner using 2 different types of machines. Sixty-four healthy children were scanned. The quality of evaluated images, obtained by predefined scanning positions, was highly comparable among the examiners. The B-mode images clearly showed age-related variations of joint findings, while Doppler images showed the presence of blood flow, particularly within the epiphyseal cartilage of the children at a younger age. There was a high to good level of consistency between images obtained from the 2 different ultrasound machines. The study shows a systematic method for ultrasound examination of children at different age groups. Additionally, a baseline collection of images was developed, showing blood vessels in the joints examined. The present study could provide a framework for ongoing MSUS studies as well as for clinical practice in pediatric rheumatology.

Autoantibodies and their Judicious Use in Pediatric Rheumatology Practice.

Autoantibody testing forms an important part of diagnostic workup of patients in Pediatric rheumatology practice. However it is important to understand that the mere presence of autoantibodies does not necessarily mean the presence of an underlying autoimmune disease. Autoantibodies may be present decades before the development of clinical manifestations of an autoimmune disease and may be viewed as harbingers of Autoimmune disease. On the other hand, low-affinity autoantibodies may be present in normal healthy individuals; these natural autoantibodies serve an important function in immune regulation and tolerance. Autoantibody testing in pediatric practice mainly includes testing for anti-nuclear antibodies, anti-dsDNA antibodies, anti-neutrophil cytoplasmic autoantibodies and antiphospholipid antibodies. Rheumatoid factor and anti-CCP do not have much significance in the diagnostic schema in pediatric rheumatology, except perhaps for classification of juvenile idiopathic arthritis (JIA) and prognostication in late-onset polyarticular JIA. The positive predictive value (PPV) of any laboratory test depends on the prevalence of the disease in the population being tested. Hence, test ordering practices greatly impact the performance characteristics and positive predictive value of any laboratory test. A restricted test ordering only in patients with clinical signs and symptoms suggestive of autoimmune disease would thus greatly increase the PPV of tests such as antinuclear antibody used for diagnosing autoimmunity.

Внутривенный иммуноглобулин в детской ревматологической практике

Modern successful treatment of rheumatic diseases is impossible without the use of intravenous immunoglobulin. The use of intravenous immunoglobulin is based on strict indications developed as a result of long-term multicenter controlled studies. The article highlights the issues of using immunoglobulin in pediatric rheumatology practice, and provides the review of literature with the results from the evaluation of the efficiency of intravenous immunoglobulin confirming the efficiency of the drug only for certain rheumatic diseases.

AB1045 Development and Validation of Juvenile Autoinflammatory Disease Multidimensional Assessment Report (JAIMAR)

BackgroundThere are a lot of effects of auto-inflammatory diseases (e.g. fear of attack, pain, fever, fatigue, problems at school) that are quite important to patients but have not been measured...

Progress made towards enhancement of rheumatology education and practice in Zambia: review of an ILAR-supported project.

The burden of non-communicable diseases such as musculoskeletal diseases in the developing world is often overshadowed by the more prevalent infectious diseases. Generally, there is gross underestimation of the burden of rheumatologic disease in the backdrop of scanty or indeed non-existent rheumatology services in these countries. Local studies conducted in the last two decades in Zambia have documented the increasing burden of rheumatologic conditions in the country. There are unfortunately negligible rheumatology services in the country both at tertiary or primary health-care facility levels. There is thus an urgent need to build capacity for these services so as to improve the care and management of rheumatic conditions. Here, we review progress made by an International League of Associations for Rheumatology (ILAR)-supported project that has run for the past 2 years (2012–2013) with the objective of enhancing paediatric and adult rheumatology education and practice so as to stimulate positive change in practice and related care services in Zambia. During this short time of the project, substantial progress has been made in the areas of paediatric and adult rheumatology services enhancement at the University Teaching Hospital, Lusaka: streamlining of referrals and follow-ups of rheumatology patients, laying foundations for short- and long-term medical education in rheumatology and raising public awareness of rheumatic diseases. The progress made by this grant underscores the suitability of the ILAR mission statement “think global, act local” demonstrating that even with minimum resources and networking, improvement of rheumatology care in developing countries is attainable.

A163: Alternative Mechanisms of Care Delivery in Pediatric Rheumatology: To What Extent Do They Expand the Reach of Pediatric Rheumatologists?

Background/Purpose:Pediatric rheumatology (PR) practitioners are concentrated in academic centers, rather than being evenly distributed throughout the US. Alternative mechanisms of care delivery, such as secondary clinic sites and telemedicine, may function as a bridge between PR practitioners and children who live far from academic centers. The objective of this study was to determine the prevalence and distribution of alternative mechanisms of care delivery in US PR practices.Methods:PR practices were identified using the American College of Rheumatology member directory and the Children's Hospital Association hospital directory. Practice websites were reviewed to obtain data regarding secondary clinic sites and use of telemedicine. Practices were then called to confirm website data and obtain data not available on websites. Distance between each main and secondary clinic site was calculated. Geographic information system (GIS) was used to integrate study data with census data.Results:77/90 PR practices participated in phone calls and were included in analyses. 46 practices (60%) reported using secondary clinic sites; the number of secondary sites per practice ranged from 1–6 (total 96 sites). Frequency of clinics at secondary sites ranged from weekly to once per year; >80% of sites held clinics at least once each month. Distance from the main practice site to secondary clinic sites ranged from 6.2 to 2265 miles, with 65% (62/96) <60 miles from the main practice site and almost half (47/96) <30 miles from the main practice site. Census data indicate that 39% of US children live >60 miles from a main practice site and 30% of US children live >60 miles from any PR clinic site. Of the 12 states without a PR practice, 3 were served by secondary clinic sites. Seven practices (9%) reported telemedicine capability, but only 3 (4%) reported ever using it.Conclusion:Though most PR practices utilize secondary clinic sites, nearly 2/3 of those sites are <60 miles from the main practice site and nearly 1/3 of US children live far (>60 miles) from any PR clinic site. Few practices currently use telemedicine. Therefore, it is not clear that secondary clinic sites and telemedicine, as currently employed, significantly expand the reach of PR practitioners. Future studies should investigate the efficiency and effectiveness of alternative mechanisms of care delivery, to determine how best to serve children who live far from academic centers.

PReS-FINAL-2012: Introducing a new approach to clinical care of juvenile dermatomyositis: the juvenile dermatomyositis multidimensional assessment report

In recent years, there has been an increasing interest in parent/child-reported outcomes (pcros) in pediatric rheumatology practice. Incorporation of these measures in patient assessment is deemed important as they reflect the parents' and children's perception of the disease course and the effectiveness of therapeutic interventions. Although several measures of single pcros have been developed, to date a clinical measure that groups all pcros used in the assessment of children with juvenile dermatomyositis (JDM) does not exist. Such measure would provide a physician with a thorough and systematic overview of the patient status to be scanned at the start of the visit. This would facilitate focus on matters that require attention, leading to more efficient and effective clinical care.

Paediatric rheumatology practice in the UK benchmarked against the British Society for Paediatric and Adolescent Rheumatology/Arthritis and Musculoskeletal Alliance Standards of Care for juvenile idiopathic arthritis

To describe current clinical practice against the BSPAR/ARMA Standards of Care (SOCs) for children and young people (CYP) with incident JIA. Ten UK paediatric rheumatology centres (including all current centres nationally accredited for paediatric rheumatology higher specialist training) participated in a retrospective case notes review using a pretested pro forma based on the SOC. Data collected per centre included clinical service configuration and the initial clinical care for a minimum of 30 consecutive new patients seen within the previous 2 years and followed up for at least 6 months. A total of 428 CYP with JIA (median age 11 years, range 1-21 years) were included, with complete data available for 73% (311/428). Against the key SOCs, 41% (175/428) were assessed ≤10 weeks from symptom onset, 60% (186/311) ≤4 weeks from referral, 26% (81/311) had eye screening at ≤6 weeks, 83% (282/341) had joint injections at ≤6 weeks, 59% (184/311) were assessed by a nurse specialist at ≤4 weeks and 45% (141/311) were assessed by a physiotherapist at ≤8 weeks. A median of 6% of patients per centre participated in clinical trials. All centres had access to eye screening and prescribed biologic therapies. All had access to a nurse specialist and physiotherapist. Most had access to an occupational therapist (8/10), psychologist (8/10), joint injection lists (general anaesthesia/inhaled analgesia) (9/10) and designated transitional care clinics (7/10). This first description of UK clinical practice in paediatric rheumatology benchmarked against the BSPAR/ARMA SOCs demonstrates variable clinical service delivery. Considerable delay in access to specialist care is evident and this needs to be addressed in order to improve clinical outcomes.

Pediatric-onset Behçet disease

Behçet disease has recently been classified as a variable vessel vasculitis. This disease is variable not only in the vessel type it selects, but also in its clinical presentation. In fact, the heterogeneity of the disease has been a drawback in understanding the etiopathogenesis of the disease. This review will address the recent developments in our understanding of the genetic background and pathogenesis of Behçet disease, as well as the analysis of clinical features. Recent genome-wide association studies mainly confirm the association with HLA-B51 and highlight the association with IL23/IL17 pathway and IL10, and a molecule that functions in the loading of peptides to HLA Class I molecules. Immunological studies also support the role of IL17 in the disease pathogenesis. Clinical studies in Behçet disease have provided us with clearer definitions of the vascular and central nervous system involvement in Behçet disease. An international effort to delineate the characteristics of pediatric patients has shown us that we need pediatric classification criteria in children with higher sensitivity. As to the treatment of the disease, new biological drugs seem to offer promising results in resistant cases. The new pathways defined in the disease will not only help us better understand the pathogenesis, but also help us in more targeted therapy. Although pediatric cases are being increasingly recognized, the heterogeneity of the disease presents an obstacle for studies. Thus, we can reach conclusive results with multicenter studies only.

The application of laboratory tests in pediatric rheumatology practice

Rheumatologic diseases in children are an important group of disorders that may lead to severe complications and growth retardation. There are no specific diagnostic tests for rheumatologic diseases, except for anti-nuclear antibody and anti-dsDNA for systemic lupus erythematosus and c-ANCA for Wegener’s disease. Because of, taking a detailed patient’s medical history and performing a good physical examination most probably can provide a diagnosis, and there is no specific test or “test panel” to diagnose or exclude rheumatologic disorders; it is imperative to choose laboratory tests selectively, based on a good clinical knowledge. Another important point is the existence of false positive test results in normal healthy population. In this review, the use laboratory investigations and their importance in diagnosis and follow up of disease in pediatric rheumatology practice has been discussed.

Perception of transition readiness and preferences for use of technology in transition programs: teens’ ideas for the future

Efforts to facilitate transition of care to adult providers for adolescents with chronic disease are not uniformly successful and many patients encounter challenges. The goal of this study was to assess transition readiness and preferences for tools to aid in the transition process with an emphasis on technology and social media. We surveyed and performed focus groups on patients aged 13-21 years from a pediatric university-based rheumatology and general pediatric practice. Demographics and transition readiness were assessed using a questionnaire. Transition readiness was assessed by examining patient knowledge and independence with care. Focus groups were conducted to elicit perspectives about desirable features of a transition program and useful tools. Thirty-five patients completed surveys; and 20 patients and 13 of their parents participated in a focus group. The median patient age was 17 years and 74.3% were female. A Likert scale (0-10, 10=most) was used to evaluate concern over changing to an adult medical provider, (mean=6.4, SD=2.6), preparedness for disease self-management (mean=6.0, SD=2.8), and perceived importance of self-managing their condition (mean=7.1, SD=3.1). Themes that emerged from focus groups included a desire for support groups with other teens, a preference for using text messaging for communication and a desire for an online health management program. Teens with chronic disease are able to identify health maintenance tasks and strategies that will aid in developing independence with healthcare management. These findings support the idea that developing engaging applications and support groups will assist teens in the transitioning.

Prevalence of depression and concomitant risk factors in pediatric patients with rheumatic disease

Participants were children, 8-17 years old, followed by a pediatric rheumatology practice and identified at a routine follow-up appointment. Children completed the Childhood Depression Inventory (CDI) and parent-child pairs completed a series of standardized measures documenting demographics, symptoms, health-related quality of life, coping mechanisms and psychosocial variables. The primary rheumatologist documented a global assessment of disease severity as well as disease activity scores for children with the diagnosis of juvenile idiopathic arthritis (JIA), juvenile dermatomyositis (JDMS) or systemic lupus erythematosus (SLE). One-way ANOVAs were completed to determine if demographic variables were significantly associated with depression. Pearson product moment correlations were run to determine relationships between the depression, pain, coping, quality of life, family conflict, physical functioning and disease severity. Hierarchal multiple regression analyses were run to determine which medical and psychosocial variables were significant predictors of depression in children with rheumatic disease, while controlling for demographic variables. Results At this time, 96 patients have been screened (78% female) and only data regarding demographics, length of diagnosis and physician documented disease activity has been examined. Five percent of the population was found to have clinically significant symptoms of depression while 15% of the population was found to be “at risk” for symptoms of depression. Seven percent of participants were receiving medication for depression and an additional 7% were involved in therapy at screening. Medication usage significantly correlated with increased CDI scores (increased depressive symptoms) whereas those in therapy had CDI scores comparable to their non-depressed peers. Total CDI score also significantly correlated with female gender and an increased number of children in the home. Neither years since diagnosis, active joint count, total SLEDAI score, JDMS disease activity score nor physician global assessment correlated with increased CDI scores. Additional analyses of psychosocial factors are in progress. Conclusion The prevalence and risk of depression among children with rheumatic diseases is comparable to previously reported data for a healthy population of children. Female gender and number of siblings are associated with increased risk of depressive symptoms. Early data suggests that medications appear to be less efficacious at controlling depressive symptoms than intervention with therapy.

Developing a standardized approach to the assessment of pain in children and youth presenting to pediatric rheumatology providers: a Delphi survey and consensus conference process followed by feasibility testing

BackgroundPain in children with rheumatic conditions such as arthritis is common. However, there is currently no standardized method for the assessment of this pain in children presenting to pediatric rheumatologists. A more consistent and comprehensive approach is needed to effectively assess, treat and monitor pain outcomes in the pediatric rheumatology population. The objectives of this study were to: (a) develop consensus regarding a standardized pain assessment tool for use in pediatric rheumatology practice and (b) test the feasibility of three mediums (paper, laptop, and handheld-based applications) for administration.MethodsIn Phase 1, a 2-stage Delphi technique (pediatric rheumatologists and allied professionals) and consensus meeting (pediatric pain and rheumatology experts) were used to develop the self- and proxy-report pain measures. In Phase 2, 24 children aged 4-7 years (and their parents), and 77 youth, aged 8-18 years, with pain, were recruited during routine rheumatology clinic appointments and completed the pain measure using each medium (order randomly assigned). The participant's rheumatologist received a summary report prior to clinical assessment. Satisfaction surveys were completed by all participants. Descriptive statistics were used to describe the participant characteristics using means and standard deviations (for continuous variables) and frequencies and proportions (for categorical variables)ResultsCompleting the measure using the handheld device took significantly longer for youth (M = 5.90 minutes) and parents (M = 7.00 minutes) compared to paper (M = 3.08 and 2.28 minutes respectively p = 0.001) and computer (M = 3.40 and 4.00 minutes respectively; p < 0.001). There was no difference in the number of missed responses between mediums for children or parents. For youth, the number of missed responses varied across mediums (p = 0.047) with the greatest number of missed responses occurring with the handheld device. Most children preferred the computer (65%, p = 0.008) and youth reported no preference between mediums (p = 0.307). Most physicians (60%) would recommend the computer summary over the paper questionnaire to a colleague.ConclusionsIt is clinically feasible to implement a newly developed consensus-driven pain measure in pediatric rheumatology clinics using electronic or paper administration. Computer-based administration was most efficient for most users, but the medium employed in practice may depend on child age and economic and administrative factors.

The effectiviness of an innovative web-based application to monitor HRQOL problems in paediatric rheumatology clinical practice

The use of Patient Reported Outcomes (PROs) in daily clinical practice receives increasing attention. Former studies suggest that discussing PROs improves communication between physicians and patients and facilitates early recognition of HRQOL problems. Especially in paediatrics, there is a need to address HRQOL in daily clinical practice in the context of a child’s development; repeated measurement of HRQOL in different developmental stages can be valuable. With the use of PROs, HRQOL problems can be detected early and tailored intervention can be provided to the child, before the HRQOL problems increase. However research of PROs in paediatrics is still scarce. Children with Juvenile Idiopathic Arthritis (JIA) are at risk for HRQOL problems. Therefore, it is important to monitor their HRQOL during doctor’s visits. The aim of this study is to investigate the effectiveness of a web-based PRO about HRQOL (KLIK PROfile) in paediatric rheumatology practice.

Parent Satisfaction With the Electronic Medical Record in an Academic Pediatric Rheumatology Practice

BackgroundPatient satisfaction has not been widely studied with respect to implementation of the electronic medical record (EMR). There are few reports of the impact of the EMR in pediatrics.ObjectiveThe objective of this study was to assess the impact of implementation of an electronic medical record system on families in an academic pediatric rheumatology practice.MethodsFamilies were surveyed 1 month pre-EMR implementation and 3 months post-EMR implementation.ResultsOverall, EMR was well received by families. Compared with the paper chart, parents agreed the EMR improved the quality of doctor care (55% or 59/107 vs 26% or 26/99, P < .001). More parents indicated they would prefer their pediatric physicians to use an EMR (68% or 73/107 vs 51% or 50/99, P = .01).ConclusionsTransitioning an academic pediatric rheumatology practice to an EMR can increase family satisfaction with the office visit.

A New Approach to Clinical Care of Juvenile Idiopathic Arthritis: The Juvenile Arthritis Multidimensional Assessment Report

To develop and test a new multidimensional questionnaire for assessment of children with juvenile idiopathic arthritis (JIA) in standard clinical care. The Juvenile Arthritis Multidimensional Assessment Report (JAMAR) includes 15 parent or patient-centered measures or items that assess well-being, pain, functional status, health-related quality of life, morning stiffness, disease activity, disease status and course, joint disease, extraarticular symptoms, side effects of medications, therapeutic compliance, and satisfaction with illness outcome. The JAMAR is proposed for use as both a proxy-report and a patient self-report, with the suggested age range of 7-18 years for use as a self-report. From March 2007 to September 2009, the questionnaire was completed by the parents of 618 children with JIA in 1814 visits and by 332 children in 749 visits. The JAMAR was found to be feasible and to possess face and content validity. All parents and children reported that the questionnaire was simple and easy to understand. Completion and scoring appeared to be quick, requiring < 15 minutes. There were very few missing data. Parents' proxy-reported and children's self-reported data were remarkably concordant. The JAMAR provided thorough information for the study patients about recent medical history and current health status. It performed similarly across different children's ages and characterized the level of disease activity and disability well. The development of the JAMAR introduces a new approach in pediatric rheumatology practice. This new questionnaire may help enhance the quality of care of children with JIA.

Minocycline for Acne and Autoimmune Disease

Senior Members| December 01 2008 Minocycline for Acne and Autoimmune Disease AAP Grand Rounds (2008) 20 (6): 61–62. https://doi.org/10.1542/gr.20-6-61 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Minocycline for Acne and Autoimmune Disease. AAP Grand Rounds December 2008; 20 (6): 61–62. https://doi.org/10.1542/gr.20-6-61 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: acne vulgaris, autoimmune diseases, minocycline, autoimmunity Source: El-Hallak M, Giani T, Yeniay BS, et al. Chronic minocycline-induced autoimmunity in children. J Pediatr. 2008;153(3):314–319; doi:10.1016/j.jpeds.2008.03.013 To assess the association of minocycline with autoimmunity, investigators at the Boston Children’s Hospital and Harvard Medical School report a case series of patients who developed a variety of symptoms suggestive of rheumatologic disease while receiving minocycline for acne vulgaris. Study children were identified by reviewing the medical records of children undergoing ANCA (antineutrophil cytoplasmic antibody) testing at a pediatric rheumatology practice between 1996 and 2006. Minocycline-induced autoimmunity (MIA) was defined as a history of minocycline usage and clinical and laboratory findings suggestive of autoimmunity. Patients with MIA were divided into three categories on the basis of disease duration after discontinuation of minocycline: transient (if they responded to minocycline withdrawal or required less than one month of nonsteroidal antiinflammatory drugs [NSAIDs] or corticosteroids); intermediate (if they required one month to one year of treatment); or chronic (if they had active disease by clinical or laboratory criteria after the use of immunosuppressive medications for at least one year). Of 583 children tested, 33 met criteria for a diagnosis of MIA. Of these, data on 27 children (19 female) were analyzed. The mean age of study patients at onset of symptoms was 16.5±1.4 years and the mean duration of minocycline use before diagnosis was 13±10.8 months. Clinical manifestations were present for a mean of 4.3 months before a diagnosis of MIA was made. All patients presented with constitutional symptoms such as fever, weight loss, and malaise. Twenty-two study patients had polyarthralgia (81.4%) and 17 had polyarthritis (62%), primarily affecting hands and feet. Laboratory features included elevated sedimentation rate in 50% of patients and elevated C-reactive protein in 56%. Leukopenia was present in 26%, ANA was positive in 74%, and ANCA was positive in 67%. Fourteen patients had transient, six intermediate, and seven chronic disease. All seven patients with a chronic course had arthritis at presentation and required long-term immunosuppressive therapy with agents such as corticosteroids, methotrexate, and anti-tumor necrosis factor-α agents for treatment of symptoms, primarily arthritis. Most of the six patients with an intermediate course required therapy with corticosteroids and NSAIDs. The authors conclude that prescribing physicians should be aware that minocycline-induced autoimmunity may be associated with debilitating chronic symptoms. Drs. Schiff and Barton have disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Minocycline, introduced in 1972 as a treatment for acne vulgaris, is prescribed for an estimated 15 million pediatric patients annually in the US.1 In addition to its usefulness for acne, studies have demonstrated additional characteristics, including immunomodulatory, antiinflammatory, antiangiogenic, and antiapoptotic effects.2 Most side effects of minocycline are minor such as transient and self-limited rashes and gastrointestinal intolerance.3 Potentially more serious adverse effects, such as hypersensitivity reaction, pseudotumor cerebri, pancreatitis, and autoimmune manifestations including hepatitis, lupus, arthritis, and vasculitis, have been reported.1,4 Autoimmune manifestations... You do not currently have access to this content.

Chronic Minocycline-Induced Autoimmunity in Children

To report our experience with minocycline-induced autoimmunity (MIA) in children, with an emphasis on the potential for chronicity. Retrospective cohort study of patients with development of rheumatologic symptoms while receiving minocycline between 1996 and 2006. Twenty-seven children were diagnosed with MIA at a single pediatric rheumatology practice. The mean age at onset was 16.5 +/- 1.39 years. The mean duration of minocycline use before diagnosis was 13.0 +/- 10.8 months. All patients presented with constitutional symptoms. Twenty-two had polyarthralgia, and 17 had polyarthritis, mostly affecting hands and feet. On the basis of disease duration after discontinuation of minocycline, we divided subjects into 3 categories: transient, intermediate, and chronic. Seven patients had development of chronic autoimmune disease that was still active at last follow-up, a mean of 31.6 +/- 13.0 (13-48) months after onset. Six patients followed an intermediate course, with resolution of symptoms within 12 months, and 14 patients had symptoms that resolved rapidly on discontinuation of minocycline. All patients with a chronic course had evidence of arthritis at presentation. A substantial proportion of children with MIA had development of chronic symptoms with the potential for significant morbidity. Physicians who prescribe minocycline should be aware of its propensity for inducing potentially serious autoimmune phenomena.

Fiver syndrom in pediatric rheumatology practice: from symptom to diagnosis

Система комплексной поддержки и сопровождения научного журнала Elpub позволяет запустить двуязычный сайт журнала со встроенной системой электронной редакции в соответствии с лучшими издательскими практиками, а так же предусматривает техническую и методическую поддержку со стороны специалистов НЭИКОН.