Current information about vaccination practice in pediatric rheumatic diseases and recommendations for future applications

Pediatric patients with autoinflammatory or rheumatic diseases are at increased risk of infections; therefore, safe and effective immunizations are crucial in the management of these group of patients. Current aggressive treatments involving the early use of immunosuppressive drugs and biological agents have further increased the susceptibility to infections in this group of patients. Therefore, effective and safe vaccination with adequate serological responses is important. In patients with rheumatic diseases, immunogenicity of a vaccine can differ from the healthy population, because of the disease itself or the immunosuppressive treatment received. Moreover, possible effects of vaccination on the underlying disease should be considered. In general, live attenuated vaccines should not be administered when high-dose immunosuppressive drugs are used for immunosuppressed patients. Inactivated vaccine agents have proven to be generally safe in patients with RD. The immune-modulating of biologic agents effects can last for weeks to months after discontinuation, depending on their half lifes. Also, live virus vaccines are contraindicated during therapy and for weeks to months following discontinuation of the biologics. The aim of this review is to cover the current information about vaccination practice in pediatric rheumatologic diseases and to give recommendations for future applications

Current information about vaccination practice in pediatric rheumatic diseases and recommendations for future applications

Pediatric patients with autoinflammatory or rheumatic diseases are at increased risk of infections; therefore, safe and effective immunizations are crucial in the management of these group of patients. Current aggressive treatments involving the early use of immunosuppressive drugs and biological agents have further increased the susceptibility to infections in this group of patients. Therefore, effective and safe vaccination with adequate serological responses is important. In patients with rheumatic diseases, immunogenicity of a vaccine can differ from the healthy population, because of the disease itself or the immunosuppressive treatment received. Moreover, possible effects of vaccination on the underlying disease should be considered. In general, live attenuated vaccines should not be administered when high-dose immunosuppressive drugs are used for immunosuppressed patients. Inactivated vaccine agents have proven to be generally safe in patients with RD. The immune-modulating of biologic agents effects can last for weeks to months after discontinuation, depending on their half lifes. Also, live virus vaccines are contraindicated during therapy and for weeks to months following discontinuation of the biologics. The aim of this review is to cover the current information about vaccination practice in pediatric rheumatologic diseases and to give recommendations for future applications

Treatment of systemic JIA: When do we need a biologic? Real world data of a single center

Objective

Evaluation of Cardiovascular Involvement in Pediatric Behcet's Disease: Case Report and Literature Review with Intracardiac Thrombus

Behcet's Disease (BD) is an inflammatory vasculitis with multisystem involvement. Typical manifestations such as oral-genital ulcerations, joint, skin, and ocular involvement usually occur during the initial period of the disease, whereas cardiac and vascular involvement may be seen in the later stages and in a more severe form of the disease. A 17-year-old male with a history of intracranial thrombosis due to BD was admitted with dyspnea and cough. A CT angiography revealed bilateral consolidation areas that were possibly compatible with pulmonary embolism. Further investigations conducted to find the origin of the embolism revealed one thrombus of 3x2 cm dimensions in the right ventricular apex (by echocardiography) and another one in the superficial branches of the right saphenous vein in the lower extremity. He responded well to early-onset immunosuppressive and steroid therapy. This case-based literature review was presented to emphasize the need for careful and detailed evaluation of thrombosis and vascular involvement in Behcet's Disease

Pediatric mesenteric panniculitis: three cases and a review of the literature

Mesenteric panniculitis is an inflammatory and fibrotic process in the mesenteric adipose tissue with unknown etiology. It is rarely seen in general, particularly in children. Etiology is unknown, and pathophysiology is not clear. Factors that trigger the disease are malignancy, tuberculosis, trauma, medications and past surgical interventions. There is no pediatric case series in the literature except single case reports. This paper consists of 3 cases: The first case is a 5-month-old girl, the youngest patient in the literature, who was referred to a pediatric surgeon with vomiting and abdominal distention. She had diffused intraabdominal fluid and mesenteric panniculitis documented by perioperative biopsy. The second case had acute abdominal pain with perforated appendicitis, who eventually had mesenteric panniculitis in the evaluation of the pathological specimen. The last case had a diagnosis of polyarticular juvenile idiopathic arthritis (JIA), successfully treated with etanercept, and has been in remission for 2 years. Interestingly, in one of her routine visits, she had pallor, anemia and renal failure. Bilateral hydronephrosis was detected. Magnetic resonance imaging (MRI) of the abdomen revealed retroperitoneal fibrosis, and mesenteric panniculitis was the histopathological diagnosis

Yoga versus home exercise program in children with enthesitis related arthritis: A pilot study

Purpose: The aim was to compare the effects of yoga and home exercise program on lower extremity functional status, pain, and quality of life in children with enthesitis related arthritis (ERA). Methods: Twenty-one children with ERA were divided into two groups as yoga (n = 11) and home exercise (n = 10). Yoga group performed supervised yoga exercises twice a week for eight weeks. Home exercise group performed video-based exercises for the same period. Pain in rest and activity, lower extremity functional status, and quality of life were evaluated at baseline and following eight weeks. Results: The groups were similar at baseline (p > 0.05). All the parameters, except parent reported quality of life, significantly improved in yoga group (p < 0.05), where only stair climb test times significantly improved in home exercise group (p < 0.05). Conclusions: Yoga seems promising for improving lower extremity functional status, pain, and quality of life as an exercise intervention in rehabilitation programs of children with ERA

RISK FACTORS OF INTRAVENOUS IMMUNOGLOBULIN RESISTANCE AND CORONARY ARTERIAL LESIONS IN TURKISH CHILDREN WITH KAWASAKI DISEASE

Kawasaki disease (KD) is the most common cause of childhood coronary artery disease. The incidence of coronary artery lesions (CALs) has declined with the routine use of intravenous immunoglobulin (IVIG) treatment, but there is still considerable risk for resistance to IVIG treatment and development of CALs. The present study was aimed to determine the risk factors in Turkish children with IVIG resistant KD and coronary artery involvement. Clinical, laboratory and echocardiographic data were retrospectively analyzed in 94 Kawasaki patients. IVIG resistant and responsive groups were compared. The IVIG resistant group had a higher rate of CALs compared to the IVIG responsive group (p= 9.5 days, C-reactive protein (CRP) >= 88 mg/L and Neutrophil/lymphocyte ratio (NLR) >= 1.69 were the best cutoff values for predicting IVIG resistance before treatment. The criteria for at least two of these three predictors were considered to be statistically significant risk factors for detecting IVIG resistance in KD before treatment (76.47% sensitivity, 71.05% specificity and 95% CI were 50.1-93.19% and 59.51-80.89%, respectively). Based on the clinical and laboratory features, we established a new risk-scoring system for predicting IVIG resistance in a cohort of Turkish children with KD. This may be useful for choosing optimal treatment for KD to prevent coronary artery involvement

Comparison of Different Pharmaceutical Preparations of Colchicine in Children with Familial Mediterranean Fever: Is Colchicine Opocalcium a Good Alternative?

Background: Colchicine is an anti-inflammatory agent used for preventing familial Mediterranean fever (FMF) attacks and amyloidosis. A significant number of patients are non-responsive or intolerant to the domestic drug colchicum dispert