A survey of national and multi-national registries and cohort studies in juvenile idiopathic arthritis: Challenges and opportunities

Background: To characterize the existing national and multi-national registries and cohort studies in juvenile idiopathic arthritis (JIA) and identify differences as well as areas of potential future collaboration. Methods: We surveyed investigators from North America, Europe, and Australia about existing JIA cohort studies and registries. We excluded cross-sectional studies. We captured information about study design, duration, location, inclusion criteria, data elements and collection methods. Results: We received survey results from 18 studies, including 11 national and 7 multi-national studies representing 37 countries in total. Study designs included inception cohorts, prevalent disease cohorts, and new treatment cohorts (several of which contribute to pharmacosurveillance activities). Despite numerous differences, the data elements collected across the studies was quite similar, with most studies collecting at least 5 of the 6 American College of Rheumatology core set variables and the data needed to calculate the 3-variable clinical juvenile disease activity score. Most studies were collecting medication initiation and discontinuation dates and were attempting to capture serious adverse events. Conclusion: There is a wide-range of large, ongoing JIA registries and cohort studies around the world. Our survey results indicate significant potential for future collaborative work using data from different studies and both combined and comparative analyses

De behandeling van impetigo contagiosa: Een systematisch overzicht

Background and aim: Impetigo contagiosa is a common disease in general practice, especially among children. Little is known about the relative merits of the many therapeutic options. Our aim was to review all published studies, to see what drugs have been studied to assess the quality of these studies and the effectiveness of the drugs. Method: We performed a systematic review of randomised clinical trials with respect to treatment of impetigo contagiosa. Medline and the Cochrane Controlled Trials Register were searched for relevant publications. Methodological quality was assessed by applying the Jadad scoring system. Results of trials studying the same drugs were pooled. Mean effect and confidence interval were calculated by using Peto's method. Results: The search resulted in 22 published studies. A broad variety of drugs has been studied for their effectiveness in the treatment of impetigo. Heterogeneity of the studies hinders comparison. Effect measures were often described in vague terms. The effect of only desinfecting has never been assessed. Few placebocontrolled studies were found. Only for mupirocine the effect has been compared to that of placebo, mupirocine turned out to be more effective. Studies comparing the effect of mupirocine and fusidine acid showed no difference. Conclusion: This systematic review reveals that published evidence of therapeutic trials in impetigo is insufficient to guide the choice of general practitioners. Mupirocine, although effective, should not be used in primary care because of resistance considerations and for it's role in treating MRSA carriership. Further studies are necessary into the effectiveness of only desinfecting measures, and of fusidine acid

Facioskeletal changes in children with juvenile idiopathic arthritis

OBJECTIVE: To investigate the facioskeletal morphology in patients with juvenile idiopathic arthritis (JIA) with and without temporomandibular joint (TMJ) involvement. METHODS: Eighty five patients were included. TMJ involvement was defined by orthopantomogram alterations. Lateral cephalograms were used to determine linear and angular measurements and occlusion. RESULTS: Patients regardless of their TMJ status had a 67% chance for retrognathia and a 52% chance for posterior rotation of the mandible and, respectively, 82% and 58% if TMJ involvement were present. Changes were not uniformly distributed among the different subtypes. CONCLUSION: Patients with JIA have an altered facial morphology, especially in the presence of TMJ involvement

Disease activity patterns in juvenile systemic lupus erythematosus and its relation to early aggressive treatment

This study aimed to determine disease activity patterns in juvenile systemic lupus erythematosus (jSLE) and its relation to early treatment. All jSLE patients who visited the outpatient departments of three Dutch university hospitals for at least 6 months were included. Data were retrospectively collected from each patient visit and hospitalization. Patient characteristics, clinical and laboratory findings categorized in organ systems, flare rate, medication use and disease course were analysed. Included were 35 patients (female 77%; White 47%) with a total follow-up of 142 years. Median age at diagnosis was 12.8 years. Flare rate was 0.45/patient-year. An organ system not earlier involved was affected in 34% of flares. Identifiable disease activity patterns were: chronic active (49%), relapse remitting (14%) and long quiescence (37%), with no significant difference in organ involvement at diagnosis. Positive anti-Sm and non-White ethnicity were significantly associated with a chronic active pattern. In 14 patients with severe symptoms at diagnosis, treatment with intravenous cyclophosphamide and/or biologics and/or intravenous methylprednisone in the first 6 months resulted in a long quiescence pattern in seven patients. In conclusion, distinct disease activity patterns are identifiable in children. Suppression of disease with early aggressive treatment may decrease the rate of progression. Lupus (2010) 19, 1550-155

Children referred for specialist care: a nationwide study in Dutch general practice.

BACKGROUND: Insight into referral patterns provides general practitioners (GPs) and specialists with a frame of reference for their own work and enables assessment of the need for secondary care. Only approximate information is available. AIM: To determine how often, to which specialties and for what conditions children in different age groups are referred, as well as how often a condition is referred given the incidence in general practice. METHOD: From data of the Dutch National Survey of Morbidity and Interventions in General Practice, 63,753 new referrals (acute and non-acute) were analysed for children (0-14 years) from 103 participating practices (161 GPs) who registered. Practices were divided into four groups. Each group of practices participated for three consecutive months covering a whole year altogether. We calculated referral rates per 1000 children per year and referability rates per 100 episodes, which quantifies the a priori chance of a condition being referred for specialist care. RESULTS: The referral rate varied by age from 231 for children under 1 year old to 119 for those aged 10-14 years (mean 159). The specialties mainly involved were ENT, paediatrics, surgery, ophthalmology, dermatology and orthopaedics. Referrals in the first year of life were most frequently to paediatricians (123); among older children the referral rate to paediatricians decreased (mean 36). Referrals to ENT specialists were seen particularly in the age groups 1-4 (71) and 5-9 (53). For surgery, the referral rate increased by age from 19 to 34. Differences between boys and girls were small, except for surgery. The highest referral rates were for problems in the International Classification of Primary Care (ICPC) chapters: respiratory (28); musculoskeletal (25); ear (24) and eye (21). Referability rates were, in general, low for conditions referred to paediatrics and dermatology and high for surgery and ophthalmology. The variation in problems presented to each specialty is indicated by the proportion of all referrals constituted by the 10 most frequently referred diagnoses: from 35% for paediatrics to 81% for ENT; for ophthalmology, five diagnoses accounted for 83% of all referrals. CONCLUSIONS: The need for specialist care in childhood is clarified with detailed information for different age categories, specialties involved and variation in morbidity presented to specialists, as well as the proneness of conditions to be referred

Is oral lornoxicam effective in the treatment of acute migraine attacks? : a randomized-controlled study

The aim of this study was to assess the efficacy of lornoxicam (LNX) in the treatment of acute migraine attacks. Material and Methods: This prospective, randomized, double-blind, placebo-controlled trial was conducted administering either LNX or placebo to patients who were diagnosed with migraine without aura according to the International Headache Society (the year 2004) criteria between 2010 and 2012 Results: Of 44 patients with 120 migraine attacks, 38 were female and rest were males. Mean age was 37.75 ± 9.28 years. Patients recorded using LNX in 87 migraine attacks and placebo in 33 migraine attacks, respectively. Pain intensity scores of the patients were found similar between LNX and placebo groups, statistically. Conclusion: Although oral LNX was found to have efficacy similar to placebo statistically in the treatment of acute migraine attacks, further studies are needed to evaluate appropriately the efficacy of LNX for treatment of acute migraine attacks

Growth hormone treatment in children with rheumatic disease, corticosteroid induced growth retardation, and osteopenia

Background: In children with severe rheumatic disease (RD), treatment with corticosteroids (CS) is frequently needed and growth retardation and osteopenia may develop. A beneficial effect of human growth hormone (hGH) has been reported but mostly in trials without a control group. Aims: To study the effect of hGH on growth, bone mineral density (BMD), and body composition, taking the disease activity and CS use into account. Methods: Randomised controlled trial on 17 prepubertal RD patients with growth retardation and/or decreased BMD. The hGH group (n = 10) received treatment with hGH 4 IU/m2/day (∼0.045 mg/kg/ day) during two years. The controls (n = 7) received no GH treatment. Results: During the two year study period the disease activity, and use of CS and methotrexate (MTX) did not differ between the groups. There was a significant mean increase in height standard deviation score (HSDS) in the hGH group (0.42±0.16 SDS) and a non-significant decrease in the controls (-0.18±0.11 SDS). Change in BMD did not differ significantly between the groups, although the increase in BMD for lumbar spine within the hGH group was significant. Lean body mass improved significantly in the hGH group compared to controls (0.64±0.19 SDS versus -0.20±0.17 SDS), while the decrease in percentage fat was not significant. Conclusions: There was a significant effect of hGH on growth and lean body mass, but a longer duration of treatment might be necessary to evaluate the effect of hGH on BMD