PRINTO scholarships: the Italian experience

The increasing availability of the internet allows physicians to access actualized medical information quickly and easily, but it is not comparable with the possibility of working in a well known international medical centre

Revisión: ¿Qué hacer con un test positivo para anticuerpos antinucleares en Pediatría?

La presencia de anticuerpos antinucleares (ANA) es el denominador común de muchas enfermedades autoinmunes sistémicas. Su presencia puede ser indicativa de una enfermedad reumática; sin embargo, estos autoanticuerpos también pueden estar presentes en individuos sanos o con infecciones. El objetivo del presente trabajo es presentar un paciente con dolor musculoesquelético y ANA positivos. En ausencia de una sintomatología que haga sospechar una enfermedad reumática, la positividad de los ANA no tiene significado diagnóstico

Predictors of poor response to methotrexate in polyarticular-course juvenile idiopathic arthritis: analysis of the PRINTO methotrexate trial

Objectives To determine whether baseline demographic, clinical, articular and laboratory variables predict methotrexate (MTX) poor response in polyarticular-course juvenile idiopathic arthritis. Methods Patients newly treated for 6 months with MTX enrolled in the Paediatric Rheumatology International Trials Organization (PRINTO) MTX trial. Bivariate and logistic regression analyses were used to identify baseline predictors of poor response according to the American College of Rheumatology pediatric (ACR-ped) 30 and 70 criteria. Results In all, 405/563 (71.9%) of patients were women; median age at onset and disease duration were 4.3 and 1.4 years, respectively, with anti-nuclear antibody (ANA) detected in 259/537 (48.2%) patients. With multivariate logistic regression analysis, the most important determinants of ACR-ped 70 non-responders were: disease duration >1.3 years (OR 1.93), ANA negativity (OR 1.77), Childhood Health Assessment Questionnaire (CHAQ) disability index> 1.125 (OR 1.65) and the presence of right and left wrist activity (OR 1.55). Predictors of ACR-ped 30 non-responders were: ANA negativity (OR 1.92), CHAQ disability index> 1.14 (OR 2.18) and a parent's evaluation of child's overall wellbeing <= 4.69 (OR 2.2). Conclusion The subgroup of patients with longer disease duration, ANA negativity, higher disability and presence of wrist activity were significantly associated with a poorer response to a 6-month MTX cours