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Osteochondrosis is an injury on subchondral ossification with predominance of immature skeleton and whose etiology remains unknown. It may affect the femoral condyles (usually the medial condyle) and the involvement is mostly unilateral. The authors draw the attention to this usually late diagnosis due to its infrequent occurrence and report a child's rare case of bilateral osteochondrosis on lateral femoral condyles, stressing that just one similar case has been described in the orthopaedic literature up to the present time.

To identify the underlying mechanism of amenorrhea in juvenile systemic lupus erythematosus (JSLE) patients, thirty-five (11.7%) JSLE patients with current or previous amenorrhea were consecutively selected among the 298 post-menarche patients followed in 12 Brazilian pediatric rheumatology centers. Pituitary gonadotrophins [follicle-stimulating hormone (FSH) and luteinizing hormone (LH)] and estradiol were evaluated in 32/35 patients, and prolactin and total testosterone in 29/35 patients. Patient's medical records were carefully reviewed according to demographic, clinical and therapeutic findings. The mean duration of amenorrhea was 7.2 +/- A 3.6 months. Low FSH or LH was observed in 7/32 (22%) JSLE patients and normal FSH or LH in 25 (78%). Remarkably, low levels of FSH or LH were associated with higher frequency of current amenorrhea (57% vs. 0%, P = 0.001), higher median disease activity (SLEDAI) and damage (SLICC/ACR-DI) (18 vs. 4, P = 0.011; 2 vs. 0, P = 0.037, respectively) and higher median current dose of prednisone (60 vs. 10 mg/day, P = 0.0001) compared to normal FSH or LH JSLE patients. None of them had decreased ovarian reserve and premature ovarian failure. Six of 29 (21%) patients had high levels of prolactin, and none had current amenorrhea. No correlations were observed between levels of prolactin and SLEDAI, and levels of prolactin and SLICC/ACR-DI scores (Spearman's coefficient). We have identified that amenorrhea in JSLE is associated with high dose of corticosteroids indicated for active disease due to hypothalamic-pituitary-ovary axis suppression.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T19:02:59Z No. of bitstreams: 1 S0482-50042009000500007.pdf: 368380 bytes, checksum: 9876471f4eb6a07ccdfd6857c9a16c03 (MD5) Made available in DSpace on 2013-08-22T19:02:59Z (GMT). No. of bitstreams: 1 S0482-50042009000500007.pdf: 368380 bytes, checksum: 9876471f4eb6a07ccdfd6857c9a16c03 (MD5) Previous issue date: 2009-10-01 Made available in DSpace on 2013-09-30T20:04:20Z (GMT). No. of bitstreams: 2 S0482-50042009000500007.pdf: 368380 bytes, checksum: 9876471f4eb6a07ccdfd6857c9a16c03 (MD5) S0482-50042009000500007.pdf.txt: 73931 bytes, checksum: 50b651341d444747ef2d1e5db5caa2ec (MD5) Previous issue date: 2009-10-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:16:32Z No. of bitstreams: 2 S0482-50042009000500007.pdf: 368380 bytes, checksum: 9876471f4eb6a07ccdfd6857c9a16c03 (MD5) S0482-50042009000500007.pdf.txt: 73931 bytes, checksum: 50b651341d444747ef2d1e5db5caa2ec (MD5) Made available in DSpace on 2014-05-20T15:16:32Z (GMT). No. of bitstreams: 2 S0482-50042009000500007.pdf: 368380 bytes, checksum: 9876471f4eb6a07ccdfd6857c9a16c03 (MD5) S0482-50042009000500007.pdf.txt: 73931 bytes, checksum: 50b651341d444747ef2d1e5db5caa2ec (MD5) Previous issue date: 2009-10-01 Crianças e adolescentes com doenças reumatológicas apresentam maior prevalência de doenças infecciosas quando comparados com a população em geral, em decorrência de atividade da doença, possível deficiência imunológica secundária à própria doença, ou uso de terapia imunossupressora. A vacinação é uma medida eficaz para a redução da morbidade e mortalidade nesses pacientes. O objetivo deste artigo foi realizar um consenso de eficácia e segurança das vacinas em crianças e adolescentes com doenças reumatológicas infantis baseadas em níveis de evidência científica. Imunização passiva para os pacientes e orientações para as pessoas que convivem com doentes imunodeprimidos também foram incluídas. Os 32 pediatras reumatologistas membros do Departamento de Reumatologia da Sociedade de Pediatria de São Paulo (SPSP) e/ou da Comissão de Reumatologia Pediátrica da Sociedade Brasileira de Reumatologia elaboraram o consenso, sendo que alguns desses profissionais estão envolvidos em pesquisas e publicações científicas nesta área. A pesquisa dos termos eficácia e/ou segurança das diferentes vacinas em crianças e adolescentes com doenças reumatológicas foi realizada nas bases de Medline e Scielo, de 1966 até março de 2009, incluindo revisões, estudos controlados e relatos de casos. O grau de recomendação e o nível científico de evidências dos estudos foram classificados em quatro níveis para cada vacina. de um modo geral, as vacinas inativadas e de componentes são seguras nos pacientes com doenças reumatológicas, mesmo em uso de terapias imunossupressoras. Entretanto, vacinas com agentes vivos atenuados são, em geral, contraindicadas para os pacientes imunossuprimidos. Incidence of infectious diseases is higher in children and adolescents with rheumatic diseases than in the general population due to disease activity, possible immune deficiency secondary to the disease itself, or the use of immunosuppressive drugs. Vaccination is effective in reducing morbidity and mortality in those patients. The objective of this study was to establish an evidence-based consensus on the efficacy and safety of vaccination in children and adolescents with rheumatic diseases. Passive immunization of patients and guidelines for people who live with immunosuppressed patients were also included. The 32 pediatric rheumatologists of the Rheumatology Department of the Pediatrics Society of São Paulo, (SPSP, from the Portuguese), São Paulo, SP, Brazil, and/or the Commission on Pediatrics Rheumatology of the Brazilian Society of Rheumatology are responsible for this consensus; some of those professionals are involved on research and scientific publications in this field. The words efficacy and/or safety of different vaccines in children and adolescents with rheumatologic diseases were searched in Medline and Scielo data bases from 1966 to March 2009, including reviews, controlled studies, and case reports. The degree of recommendation and the scientific evidence of the studies were classified in four levels for each vaccine. As a rule, inactive and protein components vaccines are safe for patients with rheumatologic diseases, even in the presence of immunosuppressive therapy. However, live attenuated vaccines are, in general, contraindicated for immunosuppressed patients. Universidade de São Paulo Faculdade de Medicina Instituto da Criança Universidade de São Paulo USP Faculdade de Medicina de Ribeirão Preto FMUSP Universidade Estadual Paulista Faculdade de Medicina de Botucatu Santa Casa de Misericórdia de São Paulo Hospital Municipal Infantil Menino Jesus Universidade Estadual de Campinas Hospital Servidor Público Universidade Federal da Bahia (UFBA) Hospital Materno Infantil de Goiás Universidade Federal do Pará (UFPA) Universidade Federal de Mato Grosso do Sul Universidade Federal do Rio de Janeiro (UFRJ) UFRJ Instituto de Puericultura Martagão Gesteira Universidade Estadual Paulista Faculdade de Medicina de Botucatu

In this study, we evaluate the distribution of nitric oxide (NO) in the serum of juvenile idiopathic arthritis (JIA) patients, correlating it with parameters of the severity of the disease. Ninety-seven patients with mean age 11.7 years and disease duration 4.8 years, showing active disease or not, grouped as oligoarticular (n = 34), polyarticular (n = 29) and systemic (n = 34) group, presenting uveitis and positive RF with erosive arthritis or active disease and erosions had significantly high levels of NO than the inactive ones. NO correlated with TNF-α in the oligoarticular subtype (P < 0.03), with pain in the polyarticular subtype with active disease (P < 0.04) and with ESR in the systemic subtype with active disease (P < 0.03). TNF-α concentration was high in all patients with active disease, accompanying NO production. The data confirm the production of NO in JIA patients, indicating a possible positive correlation between the production of NO and severity of the disease.

The macrophagic syndrome or reactive haemophagocytic syndrome (RHS) is a complication resulting from systemic inflammatory diseases and may also be related to malign neoplasias, immunodeficiencies and to a variety of infections caused by virus, bacteria, and fungus. It is characterized by an excessive activation of macrophages and histiocytes along with intense hemophagocytosis in bone marrow and reticulum-endothelial system, causing the phagocytosis of erythrocytes, leukocytes, platelets, and their precursors. The clinical manifestations are fever, hepatosplenomegaly, lymphadenomegalies, neurological involvement, variable degrees of cytopenias, hyperferritinemia, liver disorders, intravascular coagulation, and multiple organs failure. We report a rare case of recurrent RHS complication in a systemic lupus erythematosus male patient after two years. Although extremely rare it has evolved with an improvement after a pulse methilprednisolone and cyclophosphamide therapy.