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Abstract: Juvenile Idiopathic Arthritis (JIA) is a major contributor to chronic diseases, affecting around 1–2 in 1000 children under the age of 16. With modern treatments, the morbidity has been reduced; however, there is increasing evidence that many, if not most, children with JIA will have a chronic disease with ongoing activity into adulthood. Many studies discuss the possibility of an early window of opportunity in which patients have the best chance of responding to therapy, thereby underscoring the importance of timely and appropriate imaging. Children typically present at 4–5 years of age with one or more stiff and painful joints. If JIA is suspected, the child should undergo an ultrasound of the involved joint(s), performed by a radiologist with experience in paediatric imaging. If this is normal, with no abnormal laboratory tests and low clinical suspicion of JIA, no further imaging is required. If there is inconsistency between ultrasound and clinical findings, then they should proceed to MRI, including intravenous contrast, of the involved joint. Additional radiographs, or low-dose CT for the axial joints to examine for potential destructive change, deformation, or growth abnormalities, should be considered. In children presenting with monoarthritis, bacterial infection must be ruled out.
Keywords: child, arthritis, juvenile, diagnostic imaging, ultrasonography, magnetic resonance imaging
Published in DiRROS: 19.12.2025; Views: 406; Downloads: 105
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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: 421; Downloads: 113
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Abstract: Background: Children with rheumatic diseases are at risk for contracting severe influenza and COVID-19 and are thus targeted for these vaccination. Objectives: To assess the influenza (flu) vaccination rate in children with Juvenile Idiopathic Arthritis (JIA), investigate families’ attitudes towards the influenza vaccine, and the effect of the COVID-19 pandemic on flu vaccine uptake. Methods: This multi-centre, cross-sectional study was conducted across 9 countries. JIA caregivers completed an anonymous questionnaire about their children’s influenza vaccination, including the 2019–2020 and 2020–2021 seasons, including knowledge, and perceptions regarding influenza vaccination. Results: Based on responses from 655 JIA caregivers, 152 children (23.2%) received influenza vaccinations in the 2020–2021 season, representing a significant rise from 18.6% in the previous season (p < 0.01). The likelihood of vaccination was higher among employed/self-employed caregivers compared to unemployed (28.2% and 29.9% vs. 13.9%), and those with tertiary education versus elementary (28% vs. 9.7%), both p < 0.01. Concerns of children’s vulnerability to SARS-CoV-2 and severe COVID-19 disease due to JIA were prevalent (51.3% and 85.3% respectively), with 51.3% supporting COVID-19 vaccination. Caregivers who previously vaccinated their children for influenza showed a greater inclination towards SARS-CoV-2 vaccination (73.4% and 79.5%, p < 0.01). Conclusions: Families of children with JIA reported an increasing flu vaccine uptake and a high intention for COVID- 19 vaccine administration. Previous vaccination behavior was shown as a significant predictor of future behaviour. Strengthening health education may address fears and lead to better vaccine coverage against both influenza and SARS-CoV-2 in children with JIA and other inflammatory rheumatic diseases.
Keywords: influenza vaccine, juvenile idiopathic arthritis, JIA, COVID-19, vaccination, children
Published in DiRROS: 09.12.2025; Views: 375; Downloads: 166
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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: 289; Downloads: 142
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