Complementary and alternative medicine (CAM) in pediatric rheumatology: an European perspective

To analyse the use of complementary and alternative medicine (CAM) in children with rheumatic diseases, treated at a paediatric rheumatology centre in Italy

Torpedo maculopathy: a morphofunctional evaluation.

To describe the optical coherence tomography (OCT), the standard short-wavelength fundus autofluorescence (SW-FAF) and near-infrared fundus autofluorescence (NIR-FAF), and the microperimetric findings in a child with a unique unilateral lesion of the temporal macula previously called torpedo maculopathy. A 4-year-old female with torpedo maculopathy was evaluated with spectral-domain OCT (SD-OCT), standard SW-FAF (excitation 488 nm, emission >500 nm) and NIR-FAF (excitation 787 nm, emission >800 nm). Microperimetry was performed to assess retinal sensitivity changes correlated to the macular lesion. SD-OCT showed an abnormally thin retinal pigment epithelium signal and an increased signal transmission in the choroid corresponding to the torpedo lesion with no neuroretinal changes. SW-FAF resulted in normal fluorescence of the lesion except for a small hyperfluorescent area at the tail level. NIR-FAF showed hypofluorescence corresponding to the lesion. Macular microperimetry showed reduced retinal sensitivity along the pigmented margins of the lesion with normal values over the lesion. The patient was re-evaluated 12 months later and no change was documented with all diagnostic techniques. This case supports a congenital defect of retinal pigment epithelium. The absence of both functional changes at lesion level and neuroretinal changes at OCT may depend on the very early detection of this lesion

Grade III lipaemia retinalis in a newborn

Lipaemia retinalis, first described in 1880 and recently recognized as a paediatric disease, occurs rarely in patients with hyperlipidaemia. In typical cases, opthalmoscopy evidences creamy-white retinal vessels. Although the picture is graded clinically (table 1), grade III cases are extremely rare

Sudden visual loss in a child with juvenile idiopathic arthritis-related uveitis.

none7Educational cases of BritishJournal of OphthalmologyAn 8-year-old Italian girl with early-onset oligo-juvenile idiopathic arthritis (JIA) and bilateral anterior uveitis (AU), was treated at first with prednisone (0.5–1 mg/kg/day) and methotrexate (10 mg/m2/week), then, due to severe arthritis, with etanercept (0.4 mg/kg twice/week). Despite the improvement in arthritis, in 2 years’ time, the child underwent six relapses of bilateral AU with development of posterior synechiae and cystoid macular oedema (CMO). Etanercept was then discontinued and, after a 2-month washout period, infliximab (5 mg/kg at 0, 2, 6 weeks and then every 4 weeks) was administered. Visual acuity soon improved, and CMO disappeared. After 12 months of treatment, the child complained of a sudden visual loss on the right side. Since ocular examination was impaired by the presence of synechiae and cataract, several instrumental tests have been performed. Visual evoked potentials (VEPs) howed a reduced amplitude and prolonged latency of P100 component of the right eye. Automated perimetry (AP) evidenced no responses to the stimuli in the right eye, while the electroretinogram (ERG) was normal. MRI of the orbits revealed enhancement in the intraconic portion of the right optic nerve, with hypointensity in the short-tau inversion recovery (STIR) coronal images after gadolinium injection (fig 1). MRI of the brain was otherwise normal. Infliximab treatment was interrupted, and the patient was treated with three consecutive intravenous methylprednisolone pulses (15 mg/kg) followed by oral prednisone (0.3 mg/kg/day). Three weeks later, orbital MRI (fig 2) and VEPs revealed normalisation in the right optic nerve. The decimal BCVA in both eyes was 0.63 a month before ON, and decreased to 0.1 in the RE when ON was detected. At the end of the follow-up, 10 months after ON onset, the BCVA went up to 0.5 in the RE.mixedZannin ME; Martini G; Buscain I; Cermakova I; Suppiej A; Manara R; Zulian FZannin, Me; Martini, G; Buscain, I; Cermakova, I; Suppiej, A; Manara, R; Zulian,

Sudden visual loss in a child with juvenile idiopathic arthritis-related uveitis

An 8-year-old Italian girl with early-onset oligo-juvenile idiopathic arthritis (JIA) and bilateral anterior uveitis (AU), was treated at first with prednisone (0.5–1 mg/kg/day) and methotrexate (10 mg/m2/week), then, due to severe arthritis, with etanercept (0.4 mg/kg twice/week). Despite the improvement in arthritis, in 2 years’ time, the child underwent six relapses of bilateral AU with development of posterior synechiae and cystoid macular oedema (CMO). Etanercept was then discontinued and, after a 2-month washout period, infliximab (5 mg/kg at 0, 2, 6 weeks and then every 4 weeks) was administered. Visual acuity soon improved, and CMO disappeared. After 12 months of treatment, the child complained of a sudden visual loss on the right side. Since ocular examination was impaired by the presence of synechiae and cataract, several instrumental tests have been performed. Visual evoked potentials (VEPs) howed a reduced amplitude and prolonged latency of P100 component of the right eye. Automated perimetry (AP) evidenced no responses to the stimuli in the right eye, while the electroretinogram (ERG) was normal. MRI of the orbits revealed enhancement in the intraconic portion of the right optic nerve, with hypointensity in the short-tau inversion recovery (STIR) coronal images after gadolinium injection (fig 1). MRI of the brain was otherwise normal. Infliximab treatment was interrupted, and the patient was treated with three consecutive intravenous methylprednisolone pulses (15 mg/kg) followed by oral prednisone (0.3 mg/kg/day). Three weeks later, orbital MRI (fig 2) and VEPs revealed normalisation in the right optic nerve. The decimal BCVA in both eyes was 0.63 a month before ON, and decreased to 0.1 in the RE when ON was detected. At the end of the follow-up, 10 months after ON onset, the BCVA went up to 0.5 in the RE

Abatacept for Severe Anti-Tumor Necrosis Factor alpha Refractory Juvenile Idiopathic Arthritis-Related Uveitis

Objective. To evaluate the safety and efficacy of abatacept in patients with severe juvenile idiopathic arthritis (JIA)-related uveitis refractory or intolerant to immunosuppressive and anti-tumor necrosis factor alpha (anti-TNF alpha) agents. Methods. Patients with JIA-related uveitis refractory to immunosuppressive and anti-TNF alpha agents were treated with intravenous abatacept (10 mg/kg monthly). Side effects, frequency of uveitis flares, and ocular complications before and after treatment were reported. Results. Seven patients (6 females and 1 male) with a mean uveitis duration of 11.6 years entered the study. All patients had failed previous immunosuppressive therapy and >= 2 anti-TNF alpha treatments. All patients responded to abatacept and 6 maintained a clinical remission after a mean of 9.2 months of treatment. One patient withdrew from the study with oral mycosis and arthritis flare; no other patients had side effects. The mean frequency of uveitis flares during the 6 months before and after treatment decreased from 3.7 to 0.7 episodes. No new ocular complications or worsening of preexisting ones were reported. Conclusion. Abatacept treatment led to sustained improvement in severe anti-TNF alpha-resistant JIA-related uveitis and was well tolerated in all but 1 patient. These results provide new insights into a possible indication of abatacept for the treatment of uveitis