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Magnetic resonance imaging (MRI) of the musculoskeletal system is an examination increasingly performed for suspected juvenile idiopathic arthritis, chronic nonbacterial osteomyelitis and juvenile idiopathic inflammatory myopathies, as well as other rheumatic diseases of developmental age. T1-, T2- and PD-weighted with or without fat suppression or short tau inversion recovery/turbo inversion recovery magnitude (STIR/TIRM) sequences and post-contrast sequences are evaluated to diagnose pathological changes in the synovial membrane, subchondral bone marrow and surrounding soft tissues. Magnetic resonance imaging allows detection of synovitis, tenosynovitis, bursitis, and enthesitis as well as bone marrow edema and soft tissue edema. Several pediatric-specific MRI scoring systems have been developed and validated to standardize and facilitate the assessment of the extent of the inflammatory process and disease activity in MRI. Early detection of inflammatory changes allows the inclusion of comprehensive pharmacotherapy giving the possibility of permanent remission and objective measurement of the effectiveness of treatment.

Magnetic resonance imaging (MRI) of the musculoskeletal system is an examination increasingly performed for suspected juvenile idiopathic arthritis, chronic nonbacterial osteomyelitis and juvenile idiopathic inflammatory myopathies, as well as other rheumatic diseases of developmental age. T1-, T2- and PD-weighted with or without fat suppression or short tau inversion recovery/turbo inversion recovery magnitude (STIR/TIRM) sequences and post-contrast sequences are evaluated to diagnose pathological changes in the synovial membrane, subchondral bone marrow and surrounding soft tissues. Magnetic resonance imaging allows detection of synovitis, tenosynovitis, bursitis, and enthesitis as well as bone marrow edema and soft tissue edema. Several pediatric-specific MRI scoring systems have been developed and validated to standardize and facilitate the assessment of the extent of the inflammatory process and disease activity in MRI. Early detection of inflammatory changes allows the inclusion of comprehensive pharmacotherapy giving the possibility of permanent remission and objective measurement of the effectiveness of treatment. [ABSTRACT FROM AUTHOR]

Purpose: The prevalence of juvenile idiopathic arthritis (JIA) is estimated to be 16–150 per 100,000 children worldwide. The hip joint may be involved in over 50% of children leading to significant morbidity which may require surgical intervention in the form of arthroplasty. The literature lacks a concise overview of the outcomes, including complication and implant survival of total hip arthroplasty (THA) in juvenile idiopathic arthritis (JIA). The aim of this study is to systematically analyze the literature and report the outcomes of THA in JIA. Methods: Search was conducted in the online databases PubMed, Embase and Cochrane database. It included all original studies which evaluated clinical and/or radiological outcomes of THA in JIA with a minimum sample size of 5 patients and published in English. The level of evidence of the included studies was graded according to the Oxford Centre for Evidence Based Medicine. The Institute of Health Economics checklist was used to assess the quality of the studies included. Results: The nine studies included were retrospective in nature with all being Level IV according to Oxford Centre for Evidence Based Medicine. 475 hips in 304 patients with majority of them being females (241/304, 79.2%) were included in this review. All the studies reported the outcome objectively using various scores. The proportion of revision surgeries (92/378), either femoral or acetabular, noted was 22% (95% CI 10–33%). The proportion of acetabular revisions (72/378) was 16% (95% CI 8–25%) as compared to 4% (95% CI 1–6%) for femoral revisions (20/378). There was no difference in survivorship when cemented and uncemented implants were compared. Conclusion: JIA patients with advanced hip disease represent a unique population with need for extra-long implant longevity. THA in patients of JIA leads to improved pain relief as well as mobility but the conversion of the same outcomes to functional activity is not proportionally improved. The current trend is the use of uncemented and ceramic-on-ceramic implants. Acetabular implants require earlier revision as compared to femoral implants. Age at surgery can be delayed by early institution of methotrexate which indirectly improves implant survival. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Abstract Background A third follow-up study, mean 40.7 years after uveitis onset, of a cohort originally consisting of 55 Swedish patients with uveitis associated with juvenile arthritis. Method A retrospective study of the patients’ ophthalmic medical records. The results were compared to those of the same cohort previously studied at mean 7.2 and 24.0 years after uveitis onset. In the present follow-up study, 30 of the original 55 patients consented to participate. Of these, 26 had ophthalmic medical records that were reviewed. Results In the 30 participants, active uveitis was seen in 43.4%, cataracts in 66.6% and glaucoma in 40.0%. When comparing data from previous follow-ups of the same cohort, a total of 61.8% were reported to have had cataracts at any of the three follow-ups, 29.0% had glaucoma or ocular hypertension and 12.7% had severe visual impairment in both eyes. At mean 40.7 years after uveitis onset 20% of patients in the original uveitis cohort were deceased. In 4 of the 11 deceased individuals, rheumatic disease was stated as the main cause of death, and in 3 it was considered a contributory factor in the patients deaths. Conclusions Uveitis associated with juvenile arthritis can be active into midlife and possibly longer. Ocular complications and visual loss increased up to 40 years after uveitis diagnosis. The mortality rate of this cohort was higher than that of a corresponding Swedish population. Lifelong ophthalmic check-ups are probably necessary for patients diagnosed with this type of uveitis.

Background: A third follow-up study, mean 40.7 years after uveitis onset, of a cohort originally consisting of 55 Swedish patients with uveitis associated with juvenile arthritis. Method: A retrospective study of the patients' ophthalmic medical records. The results were compared to those of the same cohort previously studied at mean 7.2 and 24.0 years after uveitis onset. In the present follow-up study, 30 of the original 55 patients consented to participate. Of these, 26 had ophthalmic medical records that were reviewed. Results: In the 30 participants, active uveitis was seen in 43.4%, cataracts in 66.6% and glaucoma in 40.0%. When comparing data from previous follow-ups of the same cohort, a total of 61.8% were reported to have had cataracts at any of the three follow-ups, 29.0% had glaucoma or ocular hypertension and 12.7% had severe visual impairment in both eyes. At mean 40.7 years after uveitis onset 20% of patients in the original uveitis cohort were deceased. In 4 of the 11 deceased individuals, rheumatic disease was stated as the main cause of death, and in 3 it was considered a contributory factor in the patients deaths. Conclusions: Uveitis associated with juvenile arthritis can be active into midlife and possibly longer. Ocular complications and visual loss increased up to 40 years after uveitis diagnosis. The mortality rate of this cohort was higher than that of a corresponding Swedish population. Lifelong ophthalmic check-ups are probably necessary for patients diagnosed with this type of uveitis. [ABSTRACT FROM AUTHOR]

Patients with juvenile idiopathic arthritis (JIA) always experience persistent pain and stiffness which induces muscle weakness, fatigue, and functional limitations. This study evaluated whether applying low-energy laser therapy (LLT) on the knee joint could be an effective adjuvant intervention for patients with JIA. Sixty children with polyarticular JIA participated and were randomly allocated to receive either LLT (wavelength λ = 903 nm; power output of 50 mW; and energy of 1.5 J) plus exercises (LLT group) or exercises alone (control group). Pain, peak concentric torque of quadriceps muscles, fatigue, and functional status were measured by the visual analogue scale, isokinetic testing system, Pediatric Quality of Life Inventory Multidimensional Fatigue Scale, and Childhood Health Assessment Questionnaire, respectively pre- and post-intervention, and at 6-month follow-up. Per the mixed-model analysis of variance, the LLT group showed a statistically more favorable improvement in pain (P =.003, ηp2 =.014), fatigue perception (P =.004, ηp2 =.015), and functional status (P =.022, ηp2 =.09) across the three assessment occasions, as compared to the control group. However, no significant difference was demonstrated between both groups concerning peak concentric torque (all P >.05). Incorporation of LLT into the standard physical rehabilitation program for patients with JIA has the potential to induce more conducive improvements in pain, fatigue, and functional performance, but is not effective for improving muscle performance. [ABSTRACT FROM AUTHOR]

Arthritis is one of the most common chronic rheumatic diseases in children. Juvenile idiopathic arthritis (JIA) is the current nomenclature that is used to refer to a group of diseases that include chronic arthritis, childhood-onset arthritis of unknown cause. The etiology of JIA is unknown and the pathogenesis is likely to be multifactorial. One of the risk factors for the development of this disease is an insufficient level of vitamin D in the blood serum. The purpose of the analysis of the literature data was to compile and interpret data on the current point of view on the status of vitamin D in children with JIA. This article summarizes reports about the role of vitamin D in the development and clinical manifestation of juvenile arthritis (JA). Plenty of studies show a low level of vitamin D in blood serum in children with juvenile arthritis. At the same time, the role of low vitamin D status in the initiation of juvenile idiopathic arthritis development, activation of the inflammatory process, and further prognosis is controversial. The questions about vitamin D supplementation, its duration and dosage are still relevant. Five biomedical literature search bases were accessed, in the following order: Medline (using Ovid), Embase (using Ovid), Cumulative Index to Nursing and Allied Health Literature (CINHAL), Web of Science, and Scopus.

Objective: We conducted a systematic review and network meta-analysis to compare the efficacy and safety of nine non-steroidal antiinflammatory drugs (NSAIDs) in treating patients with juvenile idiopathic arthritis (JIA). Methods: Randomized controlled trials (RCTs) of NSAIDs for the treatment in children with JIA were searched systematically by using MEDLINE, EMBASE, and the Cochrane Library for available literature up to January 1, 2019. Bayesian network meta-analysis was used to combine direct and indirect evidence on treatment effectiveness and safety. Results: Eight eligible RCTs involving 1112 patients with JIA were identified, addressing 9 interventions. The ranking probability plot based on the surface under the cumulative ranking curve (SUCRA) indicated that celecoxib (6 mg/kg twice-a-day) had the highest probability of being most effective (SUCRA = 76.4%) among four NSAIDs (celecoxib, rofecoxib, meloxicam, and naproxen). Also, rofecoxib (0.3 mg/kg once-a-day) and piroxicam demonstrated a higher probability of safety in treating children with JIA (SUCRA = 33.0% and 35.5%, respectively), compared with other interventions. Conclusions: The quality of available evidence limits the formation of powerful conclusions regarding the comparative efficacy or safety of NSAIDs used to treat JIA. [ABSTRACT FROM AUTHOR]

Abstract Background The goal of this study was to apply the varicella zoster virus (VZV) vaccine to patients with pediatric rheumatic diseases (PRD) at risk for severe chickenpox, without interrupting their current immunosuppression, including biological agents, using an immunological-based pre-vaccination checklist to assure safety. A pre-vaccination checklist was implemented to ensure adequate immune competence prior to immunization. Methods This prospective study included seronegative patients (VZV-IgG ≤200 mIU/ml) and patients who had previously received only a single dose of VZV vaccine. All vaccinees demonstrated clinically inactive PRD. Patients were categorized according to their actual treatment in low-intensity IS (LIIS) and high-intensity IS (HIIS) including biological therapy. The pre-vaccination checklist defined thresholds for the following basic laboratory tests: white blood cell count ≥3000/mm3, lymphocytes ≥1200/mm3, serum IgG ≥500 mg/dl, IgM ≥20 mg/dl, tetanus toxoid antibody ≥0.1 IU/ml. In case of HIIS additional specifications included a CD4+ lymphocyte count ≥200/mm3 and a positive T-cell function (via analyzable positive control of a standard tuberculosis interferon-gamma-release-assay (TB-IGRA) indicating mitogen-induced T cell proliferation). Patients who met the criteria of the pre-vaccination checklist received the first and/or second VZV vaccination. Immunologic response and side effects were monitored. Results Twenty-three patients were recruited of whom nine had already received one VZV immunization before initiating IS. All patients met the pre-vaccination checklist criteria despite ongoing IS. There was no overall difference in VZV-IgG levels when comparing the LIIS (n=9) and HIIS (n=14) groups. In total, 21 patients (91%) showed a positive vaccination response, after the first immunization the median VZV-IgG across all patients was 224 (59-1219) mIU/ml (median (range)), after booster immunization it increased to 882 (30-4685) mIU/ml. Two patients in the HIIS group failed to raise positive VZV-IgG, despite booster immunization. All nine patients receiving only the second immunization on IS reached high titers of VZV-IgG >500 mIU/ml (1117 (513-4685) mIU/ml). There were no cases of rash or other vaccine-induced varicella disease symptoms and no evidence of PRD flare. Conclusions VZV vaccination is safe and largely immunogenic in children with ongoing IS fulfilling an immunological based pre-vaccination checklist. This new approach is based on immunologic function rather than on type of medications. Trial registration number ISRCRTN trial registration number 21654693, date of registration February 12, 2018, retrospectively registered.

Juvenile arthritis is the most common group of childhood rheumatic diseases, the dominant manifestation of which is chronic progressive joint inflammation showing the considerable variability of clinical presentations and the possibility of different nosological outcomes. Diagnosis and monitoring of disease activity in juvenile arthritis, unlike inflammatory joint diseases in adults, are attended with great difficulties in the interpretation of clinical symptoms and radiological findings. One of the most popular current technologies of musculoskeletal visualization is ultrasonography that has become an integral part of a pediatric rheumatology practice. Based on the data available in the literature and their own experience of long-term daily use of ultrasound diagnosis, the authors present current approaches to using the ultrasound diagnostic technique in patients with juvenile arthritis, by taking into account the features of child development.

The aim of this study was to assess current evidence for the surgical correction of dentofacial deformities in patients with temporomandibular joint (TMJ) involvement from juvenile idiopathic arthritis (JIA). A systematic literature review, according to the PRISMA guidelines, was conducted. Meta-analyses, randomized controlled trials, cohort studies, observational studies, and case reports were eligible for inclusion. Exclusion criteria were no JIA diagnosis, no clearly defined outcomes, dual publications (except meta-analyses), non peer-reviewed studies, non English language publications, and animal studies. The outcome measures assessed were TMJ function, skeletal alignment, and morbidity. The database search identified 255 citations, of which 28 met the eligibility criteria. Of these, 24 were case reports or case series with a low level of evidence that did not allow for meta-analysis. Extrapolated evidence supports orthognathic surgery in skeletally mature patients with controlled or quiescent JIA and a stable dentofacial deformity. Distraction osteogenesis was recommended for severe deformities. Some authors demonstrated unpredictable postoperative mandibular growth with costochondral grafts. Alloplastic TMJ reconstruction was efficacious, but should be used cautiously in skeletally immature patients. TMJ function and skeletal alignment was improved with reconstruction by any technique and morbidity was low. The surgical correction of arthritis-induced dentofacial deformities is indicated but the level of evidence is low. Prospective multicenter studies are needed. [ABSTRACT FROM AUTHOR]

The paper reviews the literature dealing with juvenile idiopathic arthritis (JIA) prognosis, patient physical activity, its role in the development of functional problems that cause limited vital activity and reduced quality of life, as well as the efficiency of physical exercises (exercise therapy (ET)) in the treatment of this disease. It stresses the relationship between physical developmental delay in patients with JIA and the occurrence of psychological and social problems. There are data of publications about the need for physical loads for patients with various rheumatic diseases, as well as for adults. Special attention is paid to the good endurance of ET that is identified by a number of authors as an additional treatment for JIA patients, which improves their functional status, but fails to affect the course and outcome of the disease. The author analyzes survey papers on the multidisciplinary rehabilitation of children, adolescents in particular, and the importance of science-based propaganda of active lifestyle. By having analyzed the literature, the author concludes that it is expedient to include ET into standard treatment for patients with JIA.

Objective: to estimate a need for conservative rehabilitation treatment in patients with juvenile chronic arthritis (JCA).Material and methods. Data on the principles and procedures of rehabilitation treatment were analyzed in patients with JCA on the basis of 25- year experience. The need for these packages of measures in 1999, 2008, and 2014 was compared. Standard procedures for joints at different sites were described. According to the degree of joint functions, there were rehabilitation treatment packages: corrective, mobilization, and general health-improving.Results and discussion. All patients with juvenile arthritis need rehabilitation (physical, psychological, and social). Comparison of the total number of patients who had received rehabilitation treatment in 1999, 2008, and 2014 showed a small trend towards its reduction. This is due to the smaller number of patients with dysfunctions and to the larger number of those without movement disorders who had received adequate treatment in early periods of the disease. The high percentage of patients having limited joint functions needs a mobilization package. Analysis of the data available in the literature and the authors' experience may lead to the conclusion that all patients with JCA need exercise therapy. The latter is a major procedure for physical rehabilitation and should be included in the standards for adjuvant treatment during basic medical therapy. Emphasis is laid on the importance of the early initiation of treatment to prevent incapacitating deformity at early stages of the disease.

Based on the data available in the literature, the author analyzes the association of chronic pain, psychological status, and behavioral reactions, which appear as an unjustified reduction in social activity, in patients with juvenile chronic arthritis. The possible causes of pain behavior in these patients are indicated.

Keywords: Juvenile idiopathic arthritis; juvenile chronic arthritis; juvenile rheumatoid arthritis; arthritis; temporomandibular joint; facial morphology; orofacial examination; clinical examination; treatment Temporomandibular joint (TMJ) arthritis is a frequent feature of Juvenile Idiopathic Arthritis (JIA) and affects up to 8 out of 10 children with JIA, irrespective of their JIA subtype [[1]-[3]]. Currently, the diagnosis of active JIA associated TMJ arthritis mandates gadolinium-enhanced magnetic resonance imaging (MRI) [[11], [13]]. Juvenile idiopathic arthritis, juvenile chronic arthritis, juvenile rheumatoid arthritis, arthritis, temporomandibular joint, facial morphology, orofacial examination, clinical examination, treatment. [Extracted from the article]

La radiosinovectomía es una forma local de radioterapia utilizada como tratamiento de segunda línea en el manejo de artropatías inflamatorias y no inflamatorias con respuesta insatisfactoria a la terapia sistémica o local con corticoesteroides. Tiene una eficacia similar a la sinovectomía quirúrgica, con las ventajas de ser un tratamiento de menor costo, menos cruento y con menor tiempo de convalecencia. Su eficacia es mayor en artropatías inflamatorias caracterizadas por sinovitis, como la artritis reumatoide y artritis crónica juvenil, con compromiso mono u oligoarticular y en articulaciones de extremidades superiores. Existen múltiples isótopos que se pueden utilizar en suspensiones coloidales, siendo el sulfuro coloidal de renio-186 el utilizado para la articulación radiocarpiana. Una técnica de administración adecuada es fundamental para el éxito del tratamiento, siendo la inyección con guía ultrasonográfica adecuada para articulaciones de volumen pequeño, instancia en la que la colaboración del médico radiólogo entrenado es fundamental.Radiosynovectomy is a local form of radiotherapy used as second-line treatment in the management of inflammatory and non-inflammatory arthropathies with unsatisfactory response to local or systemic corticosteroid therapy. Its efficacy is similar to that of surgical synovectomy, with the advantages of being a low-cost and minimally- invasive treatment that requires a shorter recovery time. Its efficacy is greater in the treatment of inflammatory arthritis characterized by synovitis, such as rheumatoid arthritis and juvenile chronic arthritis with mono/ oligoarticular involvement, especially in upper extremity joints. A number of isotopes can be used in colloidal suspensions. Rhenium-186-sulphide colloid is currently indicated for the treatment of medium-sized joints. The ultrasound-guided injection is suitable for small joints, such as wrist. For proper and safe use and administration of this technique the collaboration of a trained and experienced radiologist is critical to successful treatment.

Objective: to estimate the concentration of anti-cyclic citrullinated peptide antibodies (CCPA), the frequency of their increase, and their diagnostic value in children with early juvenile arthritis (JA). Subjects and methods. Sera from 80 patients (36 girls and 44 boys) aged 1,5 to 16 years (mean age 8,5+5,03 years) who had early JA were tested for CCPA. The diagnosis of juvenile rheumatoid arthritis (JRA) and juvenile chronic arthritis (JCA) was made in 19 and 57 patients, respectively; the duration of JA being < 3 months in 4. The systemic type of JA was present in 8 (10%) children; the polyarticular and oligoar-ticular types in 37 (46,2%) and 35 (43,8%) children, respectively. The duration of the disease in all children did not exceed 6 months. A comparison group comprised 54 adult patients with early rheumatoid arthritis (RA), 27 with undifferentiated arthritis (UDA), and 37 apparently healthy children. The concentration of CCPA was measured by immunoassay using the commercial оAxis Shield Diagnosticsп kits (United Kingdom), the upper normal range being 5 U/ml. Results. The higher levels of CCPA were revealed in 7 (8,8%) children with early JA. Their frequency was higher than that in healthy children; however, it was lower than that in adult patients with RA and comparable with UDA. CCPAs were detected more frequently in JCA and rheumatoid factor (RF)-positive patients. Higher concentrations were observed in patients with RF-positive polyarticular JA. There were correlations of CCPA with the number of swollen and tender joints, RF. Conclusion. In patients with early JA, the detection rate of CCPA is significantly higher than that in healthy children and comparable with that of RF. CCPAs have a high specificity for the diagnosis of JRA (an independent nosological entity within JA) are a risk factor of polyarthritis. The early detection of CCPA alone or in combination with RF in JA patients may serve the basis for the early use of active, frequently aggressive therapy.

Objective. To determine frequency of anti-cyclic citrullinated peptide antibodies (ACCP) and anti-modified citrullinated vimentin antibodies (AMCV) elevation and their diagnostic significance in children with early juvenile arthritis (JA). Material and methods. ACCP were evaluated in serum of 80 pts with early JA (36 girls, 44 boys, mean age 8,5±5,03 years), AMCV — in 85 pts with early JA (49 girls and 36 boys) aged from 1,5 to 16 years (mean age 8,7±4,9 years). Disease duration in all children was less than 6 months. Control group included 54 grown up pts with early rheumatoid arthritis (RA), 27 - with undifferentiated arthritis (UDA) and 37 conditionally healthy children. АССР was assessed by immuno-enzyme assay (IEA) with commercial kits “Axis Shield Diagnostics" (Great Britain), upper normal limit 5,0 U/ml. AMCV was examined by IEA with commercial kits “Orgentec Diagnostics” (Germany), upper normal limit — 25 U/ml. Results. ACCP was elevated in 7 children with early JA (8,8%). Frequency was higher than in healthy children but lower than in grown up pts with early RA and comparable with UDA. In juvenile rheumatoid arthritis (JRA) ACCP were more frequent than in juvenile chronic arthritis (JCA). Concentration was higher in rheumatoid factor (RF) positive pts with polyarticular JA. AMCV level was elevated in in 23 (27,1%) pts with early JA (more frequent than in healthy donors but less frequent than in grown up pts with early RA and UDA). AMCV was significantly more frequent in JRA than in JCA and in RF positive than in RF negative pts. AMCV concentration in JA was higher than in healthy children but lower than in grown up pts with RA. It was also higher in RF+ than RF- JA. ACCP and AMCV correlated with swollen joint count, tender joint count and RF. AMCV also correlated with ESR and CRP. Conclusion. In pts with early JA ACCP and AMCV are equally or more frequent than RF. In spite of low sensitivity they have high specificity for JRA in contrast to JCA. Assessment of ACCP itself or in combination with RF and AMCV is of significant importance for prognosis of polyarticular joint damage with risk of significant functional disability development and timely administration of proper quite often aggressive therapy in early stage of the disease.

Objective. To study functional status, character of functional disturbances and possibilities of their correction in children of early age with juvenile arthritis (JA). Material and methods. 42 pts with oligoarticular (at presentation) variant of JA with onset before 4 years of age admitted to pediatric department of the Institute of rheumatology of RAMS were included. Mean age of children at the disease onset was 22,4+10 months (from 9 to 46 months), mean disease duration at the first hospitalization — 9,5±5,5 months. Functional status and daily activities limitations (decrease of moving capacity and hand performance) were assessed at the beginning of the disease, at admission to the institute and at discharge after drug and rehabilitation treatment. Results. At the disease onset 40 pts (95,2%) had knee joint damage (one sided in 28 — 66,6%). 30 from these 40 pts (75%) had flexion deformity and daily activities limitations and two pts had anlde joint damage. 12 pts (28,6%) received courses of nonsteroidal anti-inflammatory drugs (NSA1D) and 5 pts (11,9%) — disease modifying anti-rheumatic drugs (DMARD) before admission. All pts had active joint syndrome at admission. Daily activities limitations were present in 41 pts (97,6%). DMARD were prescribed to 41 pts (with glucocorticoids (GC) in 12 cases). Intra-articular injections of GC were performed in 15 pts. Individual exercise therapy (passive joint movement) was applied in all pts, postural treatment — in 41 (97,6%). One pt received exercise therapy in a group. Splints were done for 6 pts. Stepped correction in plaster was performed in 4 from them. In all pts after treatment arthritis subsided and functional status improved. In 18 (42,8%) from them function of damaged joint was fully restored and in 19 (45,2%) — improved. After several stages of hospital treatment deformation was corrected and function restored in 4 (9,5%) pts Conclusion. Клее joints are frequently involved in children of early age with oligoarticular variant of JA. Pain contractures and moving disturbances appear already at the onset of the disease. Appropriate and timely drug and rehabilitation treatment allow correcting joint deformity and preventing disability of these pts.

Objective. To assess utility of East European diagnostic criteria of juvenile rheumatoid arthritis (J RA) in the modern conditions. Material and methods. 260 children with juvenile arthritis aged 2 to 18 years (mean 8,5±1,1 years) were included. Disease duration varied from 6 months to 15,5 years (mean 5,4±0,9 years). JRA was diagnosed in 94, juvenile chronic arthritis (JCA) — in 107 and other arthritides — in 12 cases (44,1%, 50,2% and 5,6% respectively). Pts with J RA were included in the main group. Group of comparison consisted of 107 pts with JCA, 12 pts with other arthritides, 35 pts with mixed connective tissue disease, 6 pts with Wissler-Fanconi syndrome, 4 — with Still’s disease and 2 - with primary Sjogren’s syndrome. All pts were assessed according to East European diagnostic criteria of JRA. Sensitivity and specificity were determined for every single criterion as well as for combinations of signs. Results. 35 from 260 pts had less than 3 criteria. This group included 2 children with JCA and 33 — with other rheumatic diseases (RD). 207 pts fulfilled criteria of definite or classical JRA (presence of 4 or more criteria but in fact JRA was diagnosed in only 94 (45,4%) from them. Most of remaining pts had JCA (44,9%) or other arthritides (4,8%). 10 pts with other RD also fulfilled criteria of definite or classical JRA (4,8%). Probable JRA could be diagnosed in 17 pts but no one of them had this disease. Combination of 8 or more signs was most sensitive (74,5%) and specific (76,6-100%) and presence of 4-7 criteria was common in other diseases. 9 signs were sensitive for JRA in comparison with JCA (20,2-96,8%). Only 4 from them (small joints symmetric arthritis, rheumatoid factor, bone growth disturbance, cervical spine damage) had high specificity (86,9-99,1%). Conclusion. At the present time East European diagnostic criteria of J RA need modification. They allow to differentiate JRA from other RD but do not help to reveal intra-group differences in pts with juvenile arthritis. Quality features of every criterion are more important for the diagnosis than their quantity combination. It is necessary to develop diagnostic criteria of JRA allowing to differentiate it from JCA and to develop criteria for JCA itself.

Bone mineral density (BMD), bone biochemical markers, influence of inflammation and glucocorticoid administration on bone metabolism in 70 children with chronic arthritis were studied. Osteopenia was detected by dual energetic X-ray absorptiometry L1-L4 in 18,7% children. Disease duration enhanced osteopenia frequency. Low BMD was associated with low levels of total calcium and osteocalcine. We revealed that BMD parameters positively correlated with anthropometry and negatively correlated with total alkaline phosphatase activity and osteocalcine and p — CrossLaps levels. As inflammatory activity, as glucocorticoids decreased BMD parameters and bone biochemical markers levels. The most negative changes were been revealed in children with systemic variant of arthritis and little changes in children with monooligoarthicular variant of arthritis. Conclusion. BMD, levels of bone biochemical markers, osteopenia risk realization depend on arthritis duration, inflammatory activity, disease degree, number of joints, involved in arthritis and therapy.

Background: The purpose of the study is to determine levels of total cholesterol (TC), low-density, and high-density lipoprotein fractions of cholesterol (LDLc and HDLc), in patients with juvenile idiopathic arthritis (JIA), and relate those to disease activity, overweight, and physical activity (PA), testing the hypothesis that the levels of cholesterol fractions are associated with inflammation as well as with overweight and low PA. Methods: Two hundred ten patients with JIA were included in this descriptive cross-sectional study. TC, LDLc, HDLc were measured, and associations with clinical disease activity (JADAS27), biomarkers of inflammation (myelo-related protein complex 8/14 (MRP8/14), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR)), body mass index (BMI), waist-to-height ratio (WtH ratio), and PA were explored. Results: Mean values for TC, LDLc, and HDLc in the patients were within the normal range for Danish Children. HDLc was negatively correlated with MRP8/14 (r = -0.343, CI -0.474 to -0.201, p < 0.0005) but was not related to overweight or PA. Neither TC nor LDLc showed any association with inflammation, overweight, or PA. MRP8/14 correlated positively with CRP, JADAS27 and WtH ratio (r = 0.277, CI 0.142 to 0.413, p = 0.001). Conclusions: Levels of cholesterol fractions in patients with JIA were found within the normal range. Nonetheless, the level of HDLc was negatively associated with the level of the inflammatory marker MRP8/14, which is in accordance with the concept of inflammation as an important driver for premature development of atherosclerosis in JIA. WtH ratio (a measure of central fatness) was not associated to HDLc, but to MRP8/14, suggestive of central fatness as an additional driving factor for the chronic inflammation in JIA. [ABSTRACT FROM AUTHOR]