1. Serological response after COVID-19 infection compared to vaccination against COVID-19 in children with autoimmune rheumatic diseasesTjaša Šinkovec Savšek, Mojca Zajc Avramovič, Tadej Avčin, Miša Korva, Tatjana Avšič-Županc, Nataša Toplak, 2024, original scientific article Abstract: Background Paediatric patients with autoimmune rheumatic diseases (pARD) have a dysregulated immune system, so infections present a major threat to them. To prevent severe COVID-19 infections we aimed to vaccinate them as soon as possible. Studies have shown that the BNT162b2 vaccine is safe, effective, and immunogenic, however, in a short observation period, only. Methods The main objective was to compare the serological response between three groups of pARD: after SARSCoV-2 infection, after vaccination against COVID-19 with two doses of the BNT162b2 vaccine, and after experiencing both events. Data on demographics, diagnosis, therapy, and serology (anti-SARS-CoV-2 IgG/IgA) were collected from March 2020 to April 2022. For statistical analysis ANOVA, Mann-Whitney U test, Chi-square test and Fisher’s exact test were applied. To compare adverse events (AE) after vaccination we included a control group of healthy adolescents. Results We collected data from 115 pARD; from 92 after infection and 47 after vaccination. Twenty-four were included in both groups. Serological data were available for 47 pARD after infection, 25 after vaccination, and 21 after both events. Serological response was better after vaccination and after both events compared to after infection only. No effect of medication on the antibody levels was noted. The safety profile of the vaccine was good. Systemic AE after the first dose of the vaccine were more common in healthy adolescents compared to pARD. In the observation period of 41.3 weeks, 60% of vaccinated pARD did not experience a symptomatic COVID-19 infection. Conclusions IgG and IgA anti-SARS-CoV-2 levels were higher after vaccination and after both events compared to after infection only. Six months after vaccination we observed an increase in antibody levels, suggesting that pARD had been exposed to SARS-CoV-2 but remained asymptomatic.
Keywords: covid-19, vaccination, efficacy, paediatric autoimmune rheumatic diseases
Published in DiRROS: 16.06.2026; Views: 153; Downloads: 118
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2. Comprehensive care and education can improve nutritional and growth outcomes in children with persistent cow’s milk, egg, or peanut allergies : a five-year follow-up study of nutritional statusTomaž Poredoš, Tina Vesel, Anja Koren Jeverica, Mojca Zajc Avramovič, Gašper Markelj, Nina Emeršič, Tadej Avčin, 2024, original scientific article Keywords: food allergy, children, adequate nutrition, nitric oxide, physical activity, beetroot, football
Published in DiRROS: 15.06.2026; Views: 136; Downloads: 126
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3. Dynamics of serum levels of TNF-α in a longitudinal follow-up study in 98 patients with juvenile idiopathic arthritis treated with anti-TNF-α biological drugsNataliia Morozova, Mojca Zajc Avramovič, Gašper Markelj, Nataša Toplak, Tadej Avčin, 2024, original scientific article Abstract: Objective: To determine the dynamics of serum levels of TNF-α in patients with juvenile idiopathic arthritis (JIA) treated with anti-TNF-α biological drugs and investigate their association with the disease activity. Methods: We conducted a single-centre, observational cohort study in 98 patients with JIA (30 boys, 68 girls, mean age 11.3 years) treated with anti-TNF-α biological drugs. Clinical examinations and laboratory assessments of serum levels of TNF-α were performed before starting therapy with biological drug and at 6-month intervals afterwards up to 2.5 years. Results: The analysis of serum levels of TNF-α in relation to the disease activity states showed the highest mean serum levels of TNF-α in patients on etanercept who had low disease activity states and in patients on adalimumab who had inactive disease. The correlation analysis in patients with JIA treated with etanercept or adalimumab showed a weak negative correlation between the serum levels of TNF-α and JADAS10 scores (p = 0.007), (r = - 0.177). Conclusion: The assessment of serum levels of TNF-α in children with JIA during treatment with etanercept or adalimumab is not a reliable biomarker of disease activity or immunological remission. Longitudinal measurement of TNF-α has no added clinical value in patients with JIA treated with anti-TNF-α biological drugs. Key Points • There is limited evidence regarding the effect of anti-TNF therapy on serum concentrations of TNF-α in patients with juvenile idiopathic arthritis • Our study showed an increase in the serum level of TNF-α after the initiation of therapy with either etanercept or adalimumab, which was more significant in patients with inactive or low disease activity • Serum TNF-α is most likely not biologically active during therapy with TNF-α inhibitors and therefore not a reliable biomarker of disease activity or immunological remission in patients with juvenile idiopathic arthritis
Keywords: adalimumab, cytokines, etanercept, juvenile idiopathic arthritis, tumour necrosis factor-alpha
Published in DiRROS: 05.06.2026; Views: 201; Downloads: 87
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4. Long-term follow-up of 109 children with juvenile idiopathic oligoarthritis after first intra-articular corticosteroid injectionMojca Zajc Avramovič, Nataša Toplak, Gašper Markelj, Nina Emeršič, Tadej Avčin, 2024, original scientific article Abstract: Background: To evaluate long-term outcomes and prognostic factors in patients with juvenile idiopathic arthritis (JIA), presenting as oligoarthritis, who received IAC as the first treatment for their disease. Methods: We conducted retrospective study at the University Children's Hospital Ljubljana, Slovenia, from January 2015 to May 2023 in children with JIA, clinically presenting as oligoarthritis receiving intra-articular corticosteroid injection (IAC) as the initial treatment. Patient and treatment data were collected, and the outcomes were categorized into three groups based on the later need for therapy: no therapy needed, only additional IAC needed and systemic therapy needed. The last group was further divided based on the requirement of bDMARD. Log-rank (Mantel-Cox) survival analyses compared different outcome groups. Results: We included 109 patients with JIA, presenting as oligoarthritis (63% female), who were first treated with IAC. The mean age at IAC was 8.0 years, with a 4.3-year follow-up. Notably, 38.5% of patients did not require additional therapy post-IAC, whereas 15.5% required only additional IAC. Systemic therapy, mainly methotrexate (MTX), was necessary for 45.9% of patients, initiated in average 7.8 months post-IAC. Biologic therapy was initiated in 22% in average 2.2 years post-IAC. Number of injected joints correlated with the need for biologics. At the last follow-up, 88.9% had inactive disease. ANA positivity (P = 0.049, chi square 3.89) and HLA B27 antigen presence (P = 0.050, chi square 3.85) were associated with the need for systemic therapy. A subgroup of children older than 8 years, ANA and HLA B27 negative required significantly less systemic (25.8%) and biologic therapy (9.6%) compared to other patients (p = 0.050, chi square 3.77). Conclusion: Almost 40% of children with oligoarticular JIA requiring IAC did not progress to chronic disease. Younger age, ANA positivity, and HLA B27 presence were predictive factors for systemic therapy, while the number of injected joints predicted the future need for biologic therapy
Keywords: ANA, biologic therapy, HLA B27, juvenile idiopathic arthitis, long-term follow-up, methotrexate, oligoarthritis, outcome, pediatric arthritis
Published in DiRROS: 04.06.2026; Views: 179; Downloads: 133
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5. Otrok z bolečinami v sklepih-pristop revmatologaMojca Zajc Avramovič, 2025, review article Keywords: bolečine v sklepih, artralgije, artritis, pGALS, juvenilni idiopatski artritis, revmatska vročica, poststreptokokni artritis, kronični nebakterijski osteomielitis, sistemske vezivno-tkivne bolezni, vaskulitisi, Raynaudov sindrom
Published in DiRROS: 06.05.2026; Views: 282; Downloads: 91
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6. Systemic auto-inflammatory manifestations in patients with spondyloarthritisCarla Gaggiano, Mojca Zajc Avramovič, Antonio Vitale, Nina Emeršič, Jurgen Sota, Nataša Toplak, Stefano Gentileschi, Valeria Caggiano, Maria Tarsia, Gašper Markelj, Tina Vesel, Anja Koren Jeverica, Tadej Avčin, 2024, original scientific article Abstract: Objectives. – (1) characterizing a group of spondyloarthritis (SpA) patients with systemic autoinflammatory symptoms (S-SpA); (2) comparing SpA features with and without auto-inflammatory symptoms; (3) comparing the auto-inflammatory features of S-SpA and Still’s disease (SD). Methods. – Retrospective observational study. Clinical data of adult and pediatric patients with S-SpA, SD or SpA were collected retrospectively and analyzed. Results. – Forty-one subjects with S-SpA, 39 with SD and 42 with SpA were enrolled. The median latency between systemic and articular manifestations in S-SpA was 4.4 (IQR: 7.2) years. S-SpA and SpA had similar frequency of peripheral arthritis and enthesitis (N.S.), while tenosynovitis was more frequent(P = 0.01) and uveitis less frequent (P < 0.01) in S-SpA. MRI showed signs of sacroiliac inflammation and damage in both S-SpA and SpA equally (N.S.). S-SpA patients had less corner inflammatory lesions (P < 0.05) and inflammation at the facet joints (P < 0.01), more interspinous enthesitis (P = 0.01) and inter-apophyseal capsulitis (P < 0.01). Compared to SD, S-SpA patients had lower-grade fever (P < 0.01), less rash (P < 0.01) and weight loss (P < 0.05), but more pharyngitis (P < 0.01), gastrointestinal symptoms (P < 0.01) and chest pain (P < 0.05). ESR, CRP, WBC, ANC, LDH tested higher in SD (P < 0.01). Resolution of systemic symptoms was less frequent in S-SpA than SD on corticosteroid (P < 0.01) and methotrexate (P < 0.05) treatment. When considering all SD patients, a complete response to corticosteroids in the systemic phase significantly reduced the likelihood of developing SpA (OR = 0.06, coefficient −2.87 [CI: −5.0 to −0.8]). Conclusions. – SpA should be actively investigated in patients with auto-inflammatory manifestations, including undifferentiated auto-inflammatory disease and SD
Keywords: spondyloarthritis, febrile spondyloarthritis, Still’s disease, systemic juvenile idiopathic arthritis, adult-onset Still’s disease, auto-inflammatory diseases
Published in DiRROS: 10.12.2025; Views: 691; Downloads: 344
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7. Safety, long-term effectiveness, and immunogenicity of varicella vaccination in children with juvenile idiopathic arthritis treated with biologic therapyMaša Bizjak, Jakob Peterlin, Tadej Avčin, Miroslav Petrovec, Alojz Ihan, Mojca Zajc Avramovič, Gašper Markelj, Tina Vesel, Veronika Osterman, Jerneja Ahčan, Helena Mole, Katja Dejak Gornik, Alenka Biteznik, Sara Jevnikar, Larisa Janžič, Miha Bajc, Andreja Nataša Kopitar, Nataša Toplak, 2025, original scientific article Abstract: Objective: To evaluate safety, long-term effectiveness and immunogenicity of varicella vaccination in children with JIA, treated with biologic disease-modifying antirheumatic drugs (bDMARDs). Methods: This is a prospective case-control study. VZV-naive patients with JIA on selected bDMARDs (TNFi, IL-6 and IL-1 inhibitors), who were at risk for contracting varicella, had stable disease and normal values of immunoglobulins and lymphocyte populations, were vaccinated against varicella. Adverse events (AEs) and disease activity were followed after vaccination. VZV-specific humoral (VZV-IgG) and cell-mediated immunity (VZV-CMI) were measured at predetermined time points after vaccination by Liaison and intracellular cytokine staining, respectively. Two healthy control (HC) groups comprised 52 healthy children after varicella vaccination and 69 healthy children after varicella infection. Results: 17 patients were vaccinated against varicella (12 on TNFi, 4 on IL-6 inhibitors and 1 on IL-1 inhibitor), of whom 14 patients received both the first and second dose on bDMARDs. No vaccine-strain infections or other serious AEs occurred after vaccination. Disease activity increased in 3/17 (18 %) patients following vaccination. Four out of 17 (24 %) patients developed mild breakthrough varicella (BV) 4 months-4.5 years after vaccination, and none of the HC. Fourteen out of 17 (82 %) patients and 50/52 (96 %) vaccinated HC were seropositive after second vaccination and 8/11 (72 %) patients and 42/43 (98 %) vaccinated HC developed VZV-CMI, which persisted longer compared to VZV-IgG. Patients presented lower antibody levels compared to HC. The rate of VZV-IgG decline was comparable between patients and HC after vaccination or infection. Five patients received the third vaccine dose due to primary or secondary vaccine failure, and none of them developed BV. Conclusions: Varicella vaccination was safe and largely immunogenic in our cohort of JIA patients treated with bDMARDs. Although the vaccination was not always fully effective, it prevented severe disease in all vaccinated patients.
Keywords: varicella vaccination, juvenile idiopathic arthritis, biologic therapy, anti-cytokine therapy
Published in DiRROS: 13.11.2025; Views: 584; Downloads: 354
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