Nail fold capillaroscopy: Normal findings in children and adolescents

Objectives: Capillaroscopy is a simple diagnostic method that permits noninvasive in vivo study of the capillary network. Studies designed to standardize capillary normality in children are limited. This article presents the capillaroscopic findings in healthy children and adolescents, thus making the application of this methodology viable for patients in this age range.Material and Methods: Healthy children were recruited from a private elementary school and junior high school. Nail fold capillaroscopy was performed using a stereomicroscope at 16 times magnification, addressing the following parameters: capillary morphology, capillary enlargement, devascularization, microhemorrhage, and subpapillary venous plexus visibility (PVS). These parameters were related to age, sex, ethnicity, and local periungal conditions.Results: the sample comprised 329 individuals with mean age of 8.2 years. We observed atypical capillary morphology in 118 of the studied cases (36%), mainly bizarre capillaries in 90 (27%), meandering capillaries in 32 (10%), and bushy capillaries in 20 (6%). the enlarged capillary phenomenon was uncommon, being observed in 30 cases (9%). the number of capillaries per millimeter varied from five to nine. Deletion areas were detected in only seven individuals (2%). the subpapillary venous plexus was not visualized in 13 (4%) cases. Younger children presented higher PVS scores and fewer capillaries/mm as compared with older children. PVS scores were lower in males and in nonwhite children. Other variables were not associated with sex or ethnicity.Conclusions: the normal nail fold capillary network in children resembles that observed in adults with some differences, such as a lower number of loops per millimeter, a higher PVS score, and a higher frequency of atypical loops. This information is important for the diagnostic evaluation of children in the context of autoimmune rheumatic diseases. Semin Arthritis Rheum 29:36-42. Copyright (C) 1999 by W.B. Saunders Company.UNIFESP, Escola Paulista Med, Dept Pediat, Div Allergy Clin Immunol & Rheumatol, BR-04040004 São Paulo, BrazilUNIFESP, Escola Paulista Med, Dept Med, Div Rheumatol, BR-04040004 São Paulo, BrazilUNIFESP, Escola Paulista Med, Dept Pediat, Div Allergy Clin Immunol & Rheumatol, BR-04040004 São Paulo, BrazilUNIFESP, Escola Paulista Med, Dept Med, Div Rheumatol, BR-04040004 São Paulo, BrazilWeb of Scienc

Serum copper in juvenile rheumatoid arthritis

Univ Fed Sao Paulo, Dept Pediat, Paulista Med Sch, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Pediat, Paulista Med Sch, Sao Paulo, BrazilWeb of Scienc

Ultrasonography in the early diagnosis of hip joint involvement in juvenile rheumatoid arthritis

Objective. To determine the value of ultrasonography in detection of early alterations and subsequent evolution of hip joint disease in patients with juvenile rheumatoid arthritis (JRA).Methods. Hip joints of 53 patients were evaluated clinically, by conventional radiography and ultrasound. Ten children free of signs/symptoms related to rheumatic diseases were chosen as a control group. Nine patients were followed up 28 months after baseline examinations. The clinical, radiological, and ultrasound evaluations were repeated.Results. Conventional radiography showed alterations in 10 patients (18.9%) who had shown clinical manifestations of advanced disease of the hip joint while ultrasound detected abnormalities in asymptomatic patients who had had normal radiographs. Ultrasound revealed the occurrence of 47.2% involvement in the hips of patients with JRA. Thus, ultrasound was apparently more sensitive than conventional radiographs in diagnosing changes in the hip joints of patients with JRA. Further, such involvement was found with greater frequency in the systemic and polyarticular types of JRA, in children less than 5 years of age, in those with longer duration of disease, and in those who belonged to a poorer functional class. In 3 of 9 patients who initially had normal radiographs and altered ultrasound, we found severe hip alterations upon reevaluation by radiograph, after a period ranging from 21 to 39 months.Conclusion. Ultrasonography is a method of diagnosis that must be considered in hip joint evaluation of patients with JRA.SANTA CASA MISERICORDIA,DEPT PEDIAT,DIV RHEUMATOL ALLERGY & CLIN IMMUNOL,SAO PAULO,BRAZILSANTA CASA MISERICORDIA,DEPT PEDIAT,DIV RHEUMATOL,SAO PAULO,BRAZILESCOLA PAULISTA MED,DEPT PEDIAT,DIV RHEUMATOL ALLERGY & CLIN IMMUNOL,BR-04023 SAO PAULO,BRAZILESCOLA PAULISTA MED,DEPT DIAGNOST IMAGING,BR-04023 SAO PAULO,BRAZILHOSP SERVIDOR PUBL ESTADUAL,SAO PAULO,BRAZILUNIV FED SAO PAULO,ESCOLA PAULISTA MED,DEPT PEDIAT,DIV RHEUMATOL ALLERGY & CLIN IMMUNOL,SAO PAULO,BRAZILESCOLA PAULISTA MED,DEPT PEDIAT,DIV RHEUMATOL ALLERGY & CLIN IMMUNOL,BR-04023 SAO PAULO,BRAZILESCOLA PAULISTA MED,DEPT DIAGNOST IMAGING,BR-04023 SAO PAULO,BRAZILUNIV FED SAO PAULO,ESCOLA PAULISTA MED,DEPT PEDIAT,DIV RHEUMATOL ALLERGY & CLIN IMMUNOL,SAO PAULO,BRAZILWeb of Scienc

Juvenile polyarteritis: Results of a multicenter survey of 110 children

Objective To characterize pediatric patients who had been diagnosed with polyarteritis nodosa (PAN) through necrotizing vasculitis of the small and mid-size arteries or those with characteristic findings on angiograms data were collected.Study design Pediatricians were asked to classify their patients in to one of the four suggested groups for juvenile PAN. Twenty-one pediatric centers worldwide participated with 110 patients.Results the girl:boy ratio was 56:54, with a mean age of 9.05 +/- 3.57 years. the cases were classified as: 33 (30%) cutaneous PAN; 5 (4.6%) classic PAN associated with hepatitis B surface antigen (HBs Ag); 9 (8.1%) microscopic polyarteritis of adults associated with antineutrophil cytoplasmic antibodies (ANCA); and 63 (57.2%) systemic PAN. Cutaneous PAN was disease confined to the skin and musculoskeletal system. All patients with HBs Ag-associated classic PAN were diagnosed with renal angiograms. Antiviral treatment was administered in most cases. Microscopic PAN patients had pulmonary-renal disease, in combination or separately. ANCA was present in 87%, and 2 patients progressed to end-stage renal failure. Patients classified with systemic PAN had multiple system involvement, almost all had constitutional symptoms, and all had elevated acute phase reactants. Corticosteroids and cyclophosphamide were the first choices of immunosuppressive treatment. the overall mortality was 1.1%.Conclusions There were remarkable differences among pediatric patients with PAN, with different clinical manifestations and overall better survival and lower relapse rates when compared with adults.Hacettepe Univ, Fac Med, Dept Pediat, TR-06100 Ankara, TurkeyHacettepe Univ, Dept Pediat Rheumatol, Ankara, TurkeyIstanbul Univ, Istanbul, TurkeyHosp Sant Joan Deu Barcelona, Barcelona, SpainHosp Univ La Paz, Madrid, SpainGreat Ormond St Hosp Sick Children, London, EnglandUniv Coll Med Sch, London, EnglandKinderklin MHH Hannover, Hannover, GermanySch Med, Ribeirao Preto, BrazilUniv São Paulo, BR-14049 Ribeirao Preto, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilUniv Fed Rio de Janeiro, Rio de Janeiro, BrazilUniv Estado Rio de Janeiro, Rio de Janeiro, BrazilUniv Utrecht, Utrecht, NetherlandsHosp Special Surg, New York, NY 10021 USASanford Weill Med Ctr, New York, NY USACharles Univ, Prague, Czech RepublicState Univ Rigshosp, Copenhagen, DenmarkUniv Louisville, Louisville, KY 40292 USAUniv Padua, Padua, ItalyUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc