PHYSICAL ACTIVITY IN CHILDREN WITH RHEUMATIC DISEASES

Reumatske bolesti djece postaju sve veći problem modernog svijeta. Napredak znanosti je doveo do razvoja metoda kojima se ove bolesti sve češće i ranije dijagnosticiraju, ali i sve uspješnije lijeće. Danas postizanje kliničke i laboratorijske remisije bolesti nije jedini cilj. Kada se remisija postigne, otvara se pitanje održavanja što boljeg stanja lokomotornog sustava, unapreðenja kvalitete života i sprečavanja invalidnosti. Dobro osmišljeni progami vježbanja bazirani na znanstveno potvrðenimčinjenicama mogu to i osigurati. U ovom članku donosimo pregled etiologije, kliničke slike i danas dostupne terapije najčešćih reumatskih bolesti u dječjoj dobi, te preporuke i stavove o bavljenju tjelesnom aktivnosti. Takoðer donosimo literaturne podtake o testovima koji se koriste u evaluaciji bolesnika prije i nakon uključivanja u programe tjelesne aktivnosti, te koje sportovi i aktivnosti su najpogodniji za reumatološke bolesnike. Iako postoji sve više radova, još uvijek nema jasnog i ujednačenog stava o vrsti i intenzitetu fizičke aktivnosti koja se preporučuje bolesnicima. Ipak, sudjelovanje u sportskim programima i fizička aktivnost ostaju najbolji način očuvanja kondicije, opsega pokreta u zglobovima i mišićne snage, te samim time i samopouzdanja djece s reumatskim bolestima.Rheumatic diseases in children are increasingly becoming a contemporary problem. Scientific advances have led to the development of diagnostic methods that allow for early diagnosis and successful treatment. Today we do not only aim to achieve clinical and laboratory remission, but also to enable our patients to lead full, normal lives. Physical activity plays an important role in the achievement of this outcome. This article provides an overview of the etiology and clinical features of the most common rheumatic diseases in children, as well as therapeutic possibilities regarding these conditions. This study provides an overview of recently published tests for evaluating patients before and after their inclusion in exercise programs, as well as recommendations regarding a number of sports and physical activities. Even with the increased number of publications, there is still no general agreement with regard to these recommendations. Indeed, the participation of children suffering from rheumatic diseases is the best way for them to maintain a satisfactory range of motions, strength, power, and physical fitness and also to increase their self-esteem

THE IMPORTANCE OF TRANSITION IN RHEUMATOLOGY

Reumatske bolesti jedne su od najčešćih kroničnih bolesti dječje dobi. Otprilike 30 – 70% pedijatrijskih reumatoloških bolesnika ulazi u odraslu dob s određenom aktivnosti bolesti, odnosno s određenim stupnjem funkcionalnih ograničenja i psihosocijalnih teškoća. Tranzicija je svrhovito i planirano prevođenje kroničnoga pedijatrijskog bolesnika na adultnu zdravstvenu skrb. To je proces u kojem se adolescenti s kroničnim bolestima pripremaju za samostalnu brigu o svojem zdravlju i životu. Uspostavom koordinirane tranzicijske službe omogućit će se bolja kontrola bolesti, smanjiti dugotrajne posljedice, radna nesposobnost i nepotrebni zdravstveni troškovi, a bolesnicima omogućiti kvalitetan život.Rheumatic diseases are among the most common chronic diseases of childhood. Between 30 and 70% of pediatric rheumatology patients reach adulthood with some disease activity, functional limitations, or psychosocial problems. Transition is the purposeful, planned move of chronic pediatric patients from pediatric to adult care. It is a process in which adolescents with chronic conditions prepare for independent care for their health and life in general. Th e establishment of transitional services will ensure better disease control, limit long-term complications, work loss, and unnecessary health care costs, and increase quality of life

High intensity interval training in comparison to constant load training in obese children

Procjenjuje se da deset posto svjetske djece školske dobi ima višak tjelesne masti s povećanim rizikom za razvoj kroničnih bolesti. Četvrtina te djece je pretila, a dio njih ima višestruke čimbenike rizika za dijabetes tipa 2, bolesti srca i niz drugih komorbiditeta prije ili tijekom rane odrasle dobi. Prevalencija prekomjerne tjelesne mase dramatično je veća u gospodarski razvijenim regijama, ali se značajno povećala u ostalim dijelovima svijeta. Kliničko liječenje pretile djece zahtijeva vrijeme, financijske troškove i multidisciplinarni tim i individulani pristup. U radu se prikazuju rezultati istraživanja provedenog u Klinici za pedijatriju KBC Sestre Milosrdnice u Zagrebu u kojem su ispitane razlike u utjecaju visoko intenzivnog intervalnog treninga -VIIT (eng. High intensity interval trening, HIIT) uz dijetu u odnosu na konvencionalni način aerobnog treninga (KAT) uz dijetu na poboljšanje aerobnih sposobnosti mjerenih indirektno submaksimalnim testom kod djece s prekomjernom tjelesnom masom. U istraživanju je sudjelovalo 15-ero pretile djece u kontrolnoj i 15-ero u eksperimentalnoj skupini, prosječne dobi 13,93 (SD = 1,74) godina, od čega je 50 % sudionika bilo muškog spola. Sudionici u ovom imali su prosječan inicijalni indeks tjelesne mase (ITM) 34,83±3,95, što ukazuje na pretilost. Također, dnevno su prosječno unosili 1700 kilokalorija kontrolirnom prehranom na kliničkom odjelu. Rezultati pokazuju statistički značajnu razliku između inicijalnog i finalnog mjerenja na gotovo svim varijablama, tjelesna masa (t(29) = 19,11, p < 0,001), ITM(t(29) = 17,73, p < 0,001), VO2max (t(29) = -9,88, p < 0,001), vrijeme modificiranog Astrand testa (t(29) = -10,29, p < 0,001) u obje skupine. Također, mora se spomenuti ipak da su nešto bolji rezultati ostvareni kod VIIT grupe u procijenjenom maksimalnom primitku kisika (VO2max) u odnosu na KAT grupu (p=0,045). U zaključku, VIIT nije bio manje učinkovit od KAT-a u poboljšanju aerobnih sposobnosti kod pretile djece i može biti relevantna zamjena tradicionalnim metodama treninga kod pretile populacije jer je često djeci zanimljiviji i zahtijeva manje vremena.It is estimated that almost 10% of children of school age worldwide have increased body weight and subsequently higher risk for developing different chronic conditions. One quarter of children are obese, some have multiple risk factors for diabetes type 2, cardiovascular diseases and other comorbidities development before and during adulthood. Prevalence of obesity is dramatically higher in developed countries but is also on the rise in other parts of the planet. Clinical management of overweight children demands time, financial resources, multidisciplinary team and individualized approach. In this paper the results of research conducted in Pediatric Clinic at University Clinical Hospital Sestre Milosrdnice, Zagreb are presented. The goal was to search for differences in effects of high intensity interval training (HIIT) combined with dietary regime and conventional aerobic training (CAT) and diet on aerobic capacity in obese children measured indirectly using submaximal test were compared. There were 15 participants in experimental and control group respectfully, median 13,93 (SD = 1, 74) years of age, 50 % of them male. Average participant body mass index (BMI) 34,83±3,95. The average controlled daily dietary intake was 1700 kcal. Results show statistically significant difference between initial and final measurement in almost all variables; body weight (t(29) = 19,11, p < 0,001), BMI (t(29) = 17,73, p < 0,001), VO2max (t(29) = -9,88, p < 0,001), modified Astrand test time (t(29) = -10,29, p < 0,001) in both groups. The somewhat better results were also observed in experimental group in VO2max values estimated by Astrand test (p=0,045) as opposed to control group but probably due to small sample size the differences in other aerobic capacity imation variables was not statistically significant. HIIT was not less efficient than CAT in aerobic capacity improvement in obese children and might represent a good alternative to more traditional training methods in such children, especially as childern often perceive it as more interesting

Aberrant expression of shared master-key genes contributes to the immunopathogenesis in patients with juvenile spondyloarthritis

Association of juvenile spondyloarthritis (jSpA) with the HLA-B27 genotype is well established, but there is little knowledge of other genetic factors with a role in the development of the disease. To date, only a few studies have tried to find those associated genes by obtaining expression profiles, but with inconsistent results due to various patient selection criteria and methodology. The aim of the present study was to identify and confirm gene signatures and novel biomarkers in highly homogeneous cohorts of untreated and treated patients diagnosed with jSpA and other forms of juvenile idiopathic arthritis (JIA) according to ILAR criteria. For the purposes of the research, total RNA was isolated from whole blood of 45 children with jSpA and known HLA genotype, 11 children with oligo- and polyarticular forms of JIA, as well as 12 age and sex matched control participants without diagnosis of inflammatory disease. DNA microarray gene expression was performed in 11 patients with jSpA and in four healthy controls, along with bioinformatical analysis of retrieved data. Carefully selected differentially expressed genes where analyzed by qRT-PCR in all participants of the study. Microarray results and bioinformatical analysis revealed 745 differentially expressed genes involved in various inflammatory processes, while qRT-PCR analysis of selected genes confirmed data universality and specificity of expression profiles in jSpA patients. The present study indicates that jSpA could be a polygenic disease with a possible malfunction in antigen recognition and activation of immunological response, migration of inflammatory cells and regulation of the immune system. Among genes involved in these processes TLR4, NLRP3, CXCR4 and PTPN12 showed almost consistent expression in study patients diagnosed with jSpA. Those genes and their products could therefore potentially be used as novel biomarkers, possibly predictive of disease prognosis and response to therapy, or even as a target for new therapeutic approaches

MICROARRAY AND GENE EXPRESSION ANALYSIS

Analiza genskog izražaja s pomoću sitnopolja visokopropusna je metoda u kojoj je mnoštvo molekula DNA različite duljine pričvršćeno za čvrstu podlogu u točno određenim točkama i s pomoću njih se otkriva prisutnost odgovarajućih označenih molekula RNA koje se izoliraju iz ispitivanih bioloških uzoraka. Temeljni princip na kojem počiva sitnopolje jest sparivanje komplementarnih nukleotida (A-T i C-G), što dovodi do stvaranja nukleinskih kiselina s dvostrukom uzvojnicom. Razlike u genskom izražaju između dvije skupine uzoraka otkrivaju se i kvantificiraju usporedbom vrijednosti intenziteta signala točaka na skupinama pločica na kojima se ispitivani uzorci hibridiziraju. Za sistematsku analizu rezultata dobivenih mjerenjem genskog izražaja na sitnopolju rabi se analiza grupa i analiza obilježja te analiza mreža i putova. Usporedbom izražaja svih gena u različitim stanicama iste jedinke ili u istim stanicama različitih jedinki može se dobiti uvid u mehanizme odgovorne za razvoj nekog stanja ili bolesti.Microarray gene expression analysis is high-throughput method in which many different sized DNA molecules are attached to solid surface in designated spots. These molecules are used for the discovery of specific RNA molecules isolated from various biological samples of interest. Core principle of this method is hybridization of complementary nucleotides (A-T and G-C), which leads to creation of double stranded nucleic acids. Gene expression differences in two groups of samples are discovered and quantificated by comparison of signal intensity values in microarray spots. Systemic analysis of data gathered in microarray gene expression measurement is performed by various bioinformatic methods such as group analysis, annotation analysis as well as network and pathway analysis. Expression comparison of all genes in different cells of the same individual or same cells of different individuals provides an insight into the mechanism responsible for development of a certain condition or disease

PATHOGENESIS OF UNDIFFERENTIATED SPONDYLOARTHRITIS

Spondiloartritis ili spondiloartropatija (SpA) multifaktorijalna je bolest u kojoj dolazi do poremećenog međudjelovanja imunološkog sustava i čimbenika okoliša u ljudi s predisponirajućim genotipom, što dovodi do upale i strukturnih oštećenja ciljnog tkiva. Mnoga nedavno provedena istraživanja pokazala su da u razvoju spondiloartritisa uz prirođeni i stečeni imunološki sustav vrlo važnu ulogu ima i prominentno remodeliranje koštanog tkiva koje vodi k osteoproliferaciji i ankilozi. Kao moguća sijela upale danas se najčešće spominju enteze, sinovija i crijevo. Na osnovi spoznaja o patogenezi upale i oštećenja, možemo zaključiti da je SpA bolest u kojoj do poremećaja dolazi na više razina. Prvu razinu predstavlja poremećaj u prepoznavanju patogena i aktivaciji imunološkog odgovora, drugu poremećaj u migraciji upalnih stanica, a treću poremećaj u regulaciji imunološkog sustava. Tijek bolesti stoga ovisi o opsegu opisanih poremećaja pa sama bolest može biti kratkotrajna, kao što je slučaj u bolesnika s reaktivnim artritisom, ili može trajati godinama i prouzročiti znatna strukturna oštećenja, kao što je slučaj u bolesnika s ankilozantnim spondilitisom. Nažalost, do danas nisu razvijeni pouzdani pokazatelji na temelju kojih bi se mogao odrediti tijek bolesti, pa se na samom početku bolest najčešće opisuje kao nediferencirana.Spondyloarthritis or spondyloarthropathy (SpA) is a multifactorial disease in which a disturbed interplay occurs between the immune system and environmental factors on a predisposing genetic background, which leads to infl ammation and structural damage of target tissue. Many recent researches on development of SpA showed important role of innate and adaptive immunity as well as of prominent bone tissue remodeling which leads to osteoproliferation and ankylosis. It is believed that possible sites of infl ammation in SpA are entheses, sinovium and gut. Current knowledge on infl ammation and tissue destruction leads to conclusion that SpA is disease characterized by disorders on diff erent levels. Disorder on the fi rst level is disturbed pathogen recognition and immune response activation, on second level disturbed infl ammatory cells migration and on third level disturbed immune response regulation. As follows, disease progress depends on range of disturbances: disease course can be short, as in reactive arthritis, or long-lasting with substantial structural damage, as in ankylosing spondylitis. Unfortunately, there are still no confi dent markers of disease progression, so at the mere beginning disease is oft en described as undiff erentiated