Juvenile idiopathic arthritis

Scheibel I, Veit T, Neves AG, Souza L, Prezzi S, Machado S, Kohem C, IcareUi M, Xavier R, Brenol JC, Chies JA (2008) Differential CCR5Delta32 aUehc frequencies in juvenile idiopathic arthritis subtypes evidence for different regulatory roles of CCR5 in rheumatological diseases. Scand J Rheumatol 37 13-17... 

Wedderbum LR, Robinson N, Patel A, Varsani H, Woo P. Selective recruitment of polarized T cells expressing CCR5 and CXCR3 to the inflamed joints of children with juvenile idiopathic arthritis. Arthritis Rheum 2000 43(4) 765-774. 

Gattomo M, Prigione I, Morandi F, et al. Phenotypic and functional characterisation of CCR7+ and CCR7 CD4+ memory T cells homing to the joints in juvenile idiopathic arthritis. Arthritis Res Ther 2005 7(2) R256-267. 

Saxena N, Aggarwal A, Misra R. Elevated concentrations of monocyte derived cytokines in synovial fluid of children with enthesitis related arthritis and polyarticular types of juvenile idiopathic arthritis. J Rheumatol 2005 32(7) 1349-1353. 

Brinkman D, de Kleer I, ten Cate R, et al Autologous stem cell transplantation in children with severe progressive systemic or polyarticular juvenile idiopathic arthritis. Arthritis Rheum 2007 56 2410-2421. 

The compound is approved for the treatment of rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, juvenile idiopathic arthritis, plaque psoriasis, and Crohn s disease. It decreases the rate of formation of new erosions. It is effective both as monotherapy and in combination with methotrexate and other DMARDs. 

Specific criteria for the diagnosis of rheumatoid arthritis in adults are listed in Table 16-1. In addition to the adult form of this disease, there is also a form of arthritis that occurs in children known commonly as juvenile rheumatoid arthritis, or by the more recent term juvenile idiopathic arthritis (JIA). Juvenile arthritis differs from the adult form of this disease—the age of onset (younger than 16 years) and other criteria help to differentiate these two types of rheumatoid joint disease.69,109 Drug treatment of adult and juvenile rheumatoid arthritis is fairly similar, however, with the exception that children may not respond as well to certain medications (e.g., hydroxychloroquine, gold compounds, penicillamine) compared to adults.79 80 Consequently, in this chapter most of the discussion of the management of rheumatoid arthritis is directed toward the adult form. 

Weiss JE, Ilowite NT. Juvenile idiopathic arthritis. Pediatr Clin North Am. 2005 52 413-142. 

Barlow, J. H., Wright, C. C., Shaw, K. L., Luqmani, R., and Wyness, I. J. (2002b). Maternal stressors, maternal wellbeing and children s wellbeing in the context of juvenile idiopathic arthritis. Early Child Dev. Care 172,358-367. 

Band keratopathy was first described in 1848 and is a chronic degenerative condition characterized by the deposition of calcium carbonate salts in the superficial corneal layers, most frequently in the interpalpebral area. Although there are many reported cases of idiopathic band keratopathy, some of which seem to have a hereditary component, the most common causes are associated with chronic ocular inflammation and systemic conditions resulting in altered calcium metabolism. Band keratopathy is typically seen in eyes with chronic uveitis, severe superficial keratitis, corneal ulcers, chemical burns, interstitial keratitis (IK), trachoma, phthisis bulbi, and prolonged glaucoma. The chronic anterior uveitis of juvenile idiopathic arthritis is frequently associated with band keratopathy, with one study reporting its development in 66% of patients with juvenile idiopathic arthritis. 

Juvenile idiopathic arthritis ESR (-I-) Antinuclear antibody (-) Rheumatoid factor Joints Rheumatologist, pediatrician ... 

The most common types of arthritis in the UK are osteoarthritis (UK prevalence 23%) and rheumatoid arthritis (1%). The less common t3 es of inflammatory arthritis include juvenile idiopathic arthritis spondylarthritis (ankylosing spondylitis, Reiter s syndrome, psoriatic arthritis, arthritis associated with inflammatory bowel disecise) and reactive arthritis associated with infection. Joint pains (arthralgia) are common in many other diseases, for example the connective tissue diseases (systemic lupus erythematosus, scleroderma), endocrine conditions (hypo-and h5 erthyroidism) and malignancies, but in these, joint inflammation and damage do not usually occur. 

Skytta E, Pohjankoski H, Savolainen A. Etanercept and urticaria in patients with juvenile idiopathic arthritis. Clin Exp Rheumatol 2000 18(4) 533. ... 

Prieur AM, Quartier P. Comparative tolerability of treatments for juvenile idiopathic arthritis. Biodrugs 2000 14 159-83. 

Indications Rheumatoid arthritis, Juvenile idiopathic arthritis, Castleman s disease... 

Becker ML, Leeder JS (2010) Developmental pharmacogenetics in pediatric rheumatology utilizing new paradigm to efficiently treat patients with juvenile idiopathic arthritis with methotrexate. Hum Genomics Proteomics 2010 257120... 

Based on the work of Tadamitsu Kishimoto on the properties of interleu-kin-6, the Japanese pharmaceutical company Chugai developed the interleukin-6-receptor-blocker tocUizumab (RoActemra ) for the treatment of rheumatoid arthritis, Castleman s disease, systemic juvenile idiopathic arthritis and other chronic inflammatory indications. [208]... 

TNF blocker for moderate-to-severe rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis,... 

Observational studies Anakinra has been studied as a first-line disease-modifying therapy in an international multicenter study in 46 patients with systemic juvenile idiopathic arthritis [17. Associated adverse events included bacterial infections in two patients and hepatitis in one patient tachyphylaxis was not observed. 

Placebo-controlled studies In a multicenter, double-blind, randomized, placebo-controlled trial of anakinra in patients with systemic-onset juvenile idiopathic arthritis there were 14 adverse events per patient-year in the treatment group and 13 in the placebo group [18 ]. There were no serious adverse events and the rates of infection were similar in the two groups. 

Hematologic Macrophage activation syndrome during anakinra treatment, which is specific for systemic juvenile idiopathic arthritis, occurred in three of 140 patients followed for a mean of 10 months [20 ]. 

Liver Acute hepatitis was reported in three patients with active systemic juvenile idiopathic arthritis treated with anakinra, without positive serology for hepatitis viruses [20 ]. In two cases, the raised aminotransferase activities resolved within 1 week of withdrawal of anakinra and in a third improved dramatically within 1 month. Two of these three patients were given anakinra again without further liver problems, so the association is in doubt. 

Skin Pain and erythema at the injection site are the most common adverse events during anakinra administration in systemic juvenile idiopathic arthritis (in up to 90% of patients) in 41% of these patients, the injection site reactions improved with continued daily use [20 ]. 

Infection risk Serious infections in patients treated with anakinra for systemic juvenile idiopathic arthritis included one case each of an adenovirus infection, leading to chronic cough and clubbing, gastroenteritis with pre-renal failure, varicella pneumonitis, visceral leishmaniasis, and an acute Epstein-Barr virus infection [20 ]. A 32-year-old patient with severe juvenile-onset tophaceous gout developed HlNl influenza after taking anakinra [2T ]. 

Quartier P, Allantaz F, Cimaz R, Pillet P, Messiaen C, Bardin C, Bossuyt X, Boutten A, Bienvenu J, Duquesne A, Richer O, Chaussabel D, Mogenet A, Banchereau J, Treluyer JM, Landais P, Pascual V. A multicentre, randomised, double-bfind, placebo-controlled trial with the interleukin-1 receptor antagonist anakima in patients with systemic-onset juvenile idiopathic arthritis (ANAJIS trial). Ann Rheum Dis 2011 70(5) 747-54. 

Swart JF, Barug D, Mohlmann M, Wulffraat NM. The efficacy and safety of interleukin-1-receptor antagonist anakinra in the treatment of systemic juvenile idiopathic arthritis. Expert Opin Biol Ther 2010 10 1743-52. 

Zeft A, Costanzo D, Alkhouri N, et al. Metabolomic analysis of breath volatile organic compounds reveals unique breathprints in children with juvenile idiopathic arthritis. Arthritis Rheumatol. 2014 66 S159. 

Adult indications osteoarthritis, rheumatoid arthritis, acute musculoskeletal pain, post-operative pain. Pediatric indications juvenile idiopathic arthritis. 

Pediatric dosing (ages 2-17) for juvenile idiopathic arthritis dosing is weight-based at 0.125 mg/kg PO qd with a maximum pediatric dose of 7.5 mg per day [1,5] (Table 59.1). 

Uses Daclizumab has been studied in cases of active posterior uveitis [206°] in children with refractory and steroid-resistant/depen-dent graft-versus-host disease [207°, 208°] for recalcitrant ocular inflammatory disease [209°] in multiple sclerosis [210° 211°] and in patients with moderate to severe persistent asthma [212 ]. Daclizumab has been used as induction therapy before liver transplantation [213°, 214 ] and renal transplantation [215°], as well as in active anterior uveitis associated with juvenile idiopathic arthritis [216°]. 

Skin One participant among six studied in a trial of high-dose daclizumab for the treatment of juvenile idiopathic arthritis-associated active anterior uveitis developed a rash possibly induced by daclizumab [216 =]. 

Gerloni V, Pontikaki I, Gattinara M, FantiniF. Focus on adverse events of tumour necrosis factor a, blockade in juvenile idiopathic arthritis in an open monocentric long-term prospective study of 163 patients. Ann Rheum Dis 2008 67(8) 1145-52. 

Susceptibility Factors Immunocompromised Juvenile Idiopathic Arthritis... 

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