Resistencia a la insulina y perfil de adipoquinas en una población de niños con artritis idiopática juvenil

Justificación: El papel de la inflamación en el desarrollo de síndrome metabólico (SM), y concretamente de la resistencia a la insulina (RI), ha sido ampliamente demostrado en otras enfermedades autoinmunes, principalmente en adultos. Determinadas formas de artritis idiopática juvenil (AIJ) suponen un estado de inflamación sistémica que podría condicionar el desarrollo de este factor de riesgo cardiovascular. Resultaría interesante dilucidar los mecanismos implicados en su desarrollo, para poder establecer medidas preventivas que eviten complicaciones futuras. Objetivos: Conocer la prevalencia de la RI en nuestros pacientes con AIJ y su relación con factores como la adiposidad central, las citoquinas proinflamatorias (TNF-α e IL-6), las adipoquinas (leptina, resistina y adiponectina), la actividad clínica de la enfermedad y el tratamiento que reciben. Material y Métodos: Estudio observacional de corte transversal en una cohorte de pacientes con AIJ. Criterios de inclusión: niños ≥ 4 y ≤16 años con diagnóstico de AIJ según los criterios de ILAR (excluyendo las formas monoarticulares), activos o en remisión, independientemente del tratamiento que reciban. Variable principal: resistencia a la insulina (RI) medida por HOMA-RI; variables secundarias: RI medida por HOMA-β, sensibilidad a insulina medida por QUICKI y McAuley, adipoquinas (leptina, adiponectina y resistina) y citoquinas proinflamatorias (IL-6 y TNF-α). El protocolo de estudio también incluyó medidas antropométricas, valoración clínica de la enfermedad, encuesta sobre actividad física y dieta mediterránea, así como factores de riesgo cardiovascular clásicos. Análisis estadístico: Descriptivo, comparaciones de medias entre 2 grupos (χ2, T-student o test de Mann Whitney) o más (ANOVA de un factor); asociación entre variables cualitativas mediante tablas de contingencia (“ji-cuadrado” o test exacto de Fisher). Para estimar la correlación entre variables cuantitativas, se usó el test de correlación de Pearson (variables normales) y la correlación de Spearman para las no normales. Finalmente, tras identificar las posibles variables implicadas en el objetivo del estudio, éstas se incluyeron en un modelo de regresión lineal multivariante con estrategia stepwise forward. Resultados: Se incluyeron 80 pacientes, 70% mujeres. La duración media de la AIJ fue de 6,5 (± 3,7) años; el 47,5% AIJ oligoarticular persistente. El 26,3% presentaban actividad de la enfermedad, el 50% se encontraban en remisión o inactividad con tratamiento y el resto en la misma situación pero sin tratamiento. El 6,3% cumplían criterios de SM, el 7,5% de obesidad, el 23,7% de dislipemia y el 16,5% de HTA. La única diferencia entre los subtipos de AIJ fue en el tipo de tratamiento empleado, siendo la AIJs la que recibió más y durante más tiempo corticoides sistémicos, la AIJ oligoarticular persistente FAMEs y la AIJ oligoarticular extendida/poliarticular fármacos biológicos. La prevalencia de RI medida mediante índice HOMA-RI fue del 20%. Las variables predictoras de RI en el análisis multivariante fueron el tiempo de actividad clínica de la enfermedad, los triglicéridos, la leptina y la hemoglobina glicosilada. Conclusiones: Nuestros datos sugieren que los pacientes con AIJ presentan una prevalencia de RI del 20%, similar a la de la población pediátrica general de nuestro país, tras ajustar por edad, sexo y estadio puberal. La frecuencia de la RI no parece estar influida por el grado de actividad clínica o analítica, el subtipo de AIJ ni el tratamiento, aunque esto podría deberse al escaso número de pacientes con enfermedad activa de nuestra cohorte. El único factor que influyó directamente en el grado de RI fue el tiempo total que los pacientes pasaron con actividad clínica

Position statement on infection screening, prophylaxis, and vaccination in pediatric patients with rheumatic diseases and immunosuppressive therapies, part 2: infection prophylaxis

This study aims to provide practical recommendations on prophylaxis for infection in pediatric patients with immune-mediated rheumatic diseases receiving/scheduled to receive immunosuppressive therapy. A qualitative approach was applied. A narrative literature review was performed via Medline. Primary searches were conducted using MeSH terms and free text to identify articles that analyzed data on infections and vaccinations in pediatric patients with immune-mediated rheumatic diseases receiving immunosuppressive therapy. The results were presented and discussed in a nominal group meeting comprising a committee of 12 pediatric rheumatologists from the Prevention and Treatment of Infections Working Group of the Spanish Society of Pediatric Rheumatology. Several recommendations were generated. A consensus procedure was implemented via a Delphi process that was extended to members of the Spanish Society of Pediatric Rheumatology and the Vaccine Advisory Committee of the Spanish Association of Pediatrics. Participants produced a score ranging from 0 (completely disagree) to 10 (completely agree). Agreement was considered to have been reached if at least 70% of participants voted ≥ 7. The literature review included more than 400 articles. Overall, 63 recommendations were generated (23 on infection prophylaxis) and voted by 59 pediatric rheumatologists and other pediatric specialists, all of whom achieved the pre-established level of agreement. The recommendations on prophylaxis of infection cover vaccination and prophylaxis against varicella zoster virus, tuberculosis, Pneumocystis jiroveccii, and invasive fungal infections in pediatric patients with immune-mediated rheumatic diseases receiving/scheduled to receive immunosuppressive therapy. Conclusion: Based on current evidence and a Delphi process, we provided consensus and updated recommendations on prophylaxis and treatment of infections to guide those caring for pediatric rheumatology patients.Funding for open access charge: Universidad de Málaga/CBU

Interferon-Gamma Release Assays Differentiate between Mycobacterium avium Complex and Tuberculous Lymphadenitis in Children

Spanish Pediatric TB Research Network (pTBred) and the European NontuberculouS MycoBacterial Lymphadenitis in childrEn (ENSeMBLE) Study.[Objectives] To assess the performance of interferon-gamma release assays (IGRAs) in the differential diagnosis between Mycobacterium avium complex (MAC) and tuberculosis (TB) in children affected with subacute/chronic submandibular/cervical lymphadenitis.[Study design] Multicenter observational study comparing children with microbiologically confirmed MAC lymphadenitis from the European NontuberculouS MycoBacterial Lymphadenitis in childrEn study with children with TB lymphadenitis from the Spanish Network for the Study of Pediatric TB database.[Results] Overall, 78 patients with MAC and 34 with TB lymphadenitis were included. Among MAC cases, 44 out of 74 (59.5%) had positive tuberculin skin test (TST) results at the 5-mm cut-off, compared with 32 out of 33 (97%) TB cases (P < .001); at the 10-mm cut-off TST results were positive in 23 out of 74 (31.1%) vs 26 out of 31 (83.9%), respectively (P < .001). IGRA results were positive in only 1 out of 32 (3.1%) patients with MAC who had undergone IGRA testing, compared with 21 out of 23 (91.3%) TB cases (P < .001). Agreement between TST and IGRA results was poor in MAC (23.3%; κ = 0.017), but good in TB cases (95.6%; κ = 0.646). IGRAs had a specificity of 96.9% (95% CI 84.3%-99.8%), positive predictive value of 95.4% (95% CI 78.2%-99.8%), and negative predictive value of 93.9% (95% CI 80.4%-98.9%) for TB lymphadenitis.[Conclusions] In contrast to TST, IGRAs have high specificity, negative predictive value, and positive predictive value for TB lymphadenitis in children with subacute/chronic lymphadenopathy, and consequently can help to discriminate between TB and MAC disease. Therefore, IGRAs are useful tools in the diagnostic work-up of children with lymphadenopathy, particularly when culture and polymerase chain reaction results are negative.Peer reviewe

Prevalence and Clinical Characteristics of SARS-CoV-2 Confirmed and Negative Kawasaki Disease Patients During the Pandemic in Spain

Introduction: COVID-19 has a less severe course in children. In April 2020, some children presented with signs of multisystem inflammation with clinical signs overlapping with Kawasaki disease (KD), most of them requiring admission to the pediatric intensive care unit (PICU). This study aimed to describe the prevalence and clinical characteristics of KD SARS-CoV-2 confirmed and negative patients during the pandemic in Spain. Material and Methods: Medical data of KD patients from January 1, 2018 until May 30, 2020 was collected from the KAWA-RACE study group. We compared the KD cases diagnosed during the COVID-19 period (March 1-May 30, 2020) that were either SARS-CoV-2 confirmed (CoV+) or negative (CoV-) to those from the same period during 2018 and 2019 (PreCoV). Results: One hundred and twenty-four cases were collected. There was a significant increase in cases and PICU admissions in 2020 (P-trend = 0.001 and 0.0004, respectively). CoV+ patients were significantly older (7.5 vs. 2.5 yr) and mainly non-Caucasian (64 vs. 29%), had incomplete KD presentation (73 vs. 32%), lower leucocyte (9.5 vs. 15.5 × 109) and platelet count (174 vs. 423 × 109/L), higher inflammatory markers (C-Reactive Protein 18.5vs. 10.9 mg/dl) and terminal segment of the natriuretic atrial peptide (4,766 vs. 505 pg/ml), less aneurysm development (3.8 vs. 11.1%), and more myocardial dysfunction (30.8 vs. 1.6%) than PreCoV patients. Respiratory symptoms were not increased during the COVID-19 period. Conclusion: The KD CoV+ patients mostly meet pediatric inflammatory multisystem syndrome temporally associated with COVID-19/multisystem inflammatory syndrome in children criteria. Whether this is a novel entity or the same disease on different ends of the spectrum is yet to be clarified

Proceedings of the 24th Paediatric Rheumatology European Society Congress: Part three

From Springer Nature via Jisc Publications Router.Publication status: PublishedHistory: collection 2017-09, epub 2017-09-0

Evaluación del impacto del Documento de Consenso español sobre el abordaje de las infecciones osteoarticulares en nuestro medio a través de la Red de Infecciones Osteoarticulares Pediátricas (RIOPed).

In 2014 the Consensus Document produced by the Spanish Paediatric Societies (SEIP-SERPE-SEOP) was published to help in the diagnosis and treatment of osteoarticular infections (OAI). In 2015 the RIOPed was considered as a multidisciplinary national network for the investigation into OAI. The aim of this study was to assess the level of adaption to the recommendations established in the Consensus during one year of follow-up. A prospective, national multicentre study was carried out in 37 hospitals between September 2015 and September 2016. The study included patients >16years-old with a diagnosis of OAI, confirmed by microbiological isolation, or probable: septic arthritis (SA) with >40,000 white cells in synovial fluid, or osteomyelitis (OM)/spondylodiscitis (SD) with a compatible imaging test. The results were compared with those obtained in a retrospective study conducted between 2008 and 2012. A total of 235 cases were included, of which 131 were OM, 79 SA, 30 OA, and 15 SD. As regards the complementary tests that the Consensus considered mandatory to perform, radiography was carried out on 87.8% of the cases, a blood culture on 91.6%, and culture of the synovial fluid in 99% of SA. A magnetic resonance (MR) was performed on 71% of the OM cases. The choice of intravenous empirical antibiotic treatment was adapted to the recommendations in 65.1% of cases, and in 62.3% for the oral treatment. Surgery was performed in 36.8% of SA cases (85.7% arthrotomy), with a significant decrease compared to the retrospective study (P=.014). Only 58.5% of cases followed the recommendations on the duration of the treatment; however, a lower duration of intravenous treatment was observed. In general, the level of adaptation to the recommendations that were set by the Expert Group, is good for the complementary tests, and acceptable as regards the choice of antibiotic treatment, although inadequate in almost 40% of cases. A decrease in hospital stay was achieved