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Objective: To evaluate idiopathic musculoskeletal pain, musculoskeletal pain syndromes, and use of electronic devices in adolescents with asthma and healthy controls. Methods: Cross-sectional study was conducted on 150 asthmatic adolescents and 300 controls. Adolescents completed a self-administered questionnaire regarding painful symptoms, use of electronic devices, and physical activity. Seven musculoskeletal pain syndromes were evaluated, and Asthma Control Test (ACT) was assessed. Results: Musculoskeletal pain (42% vs. 61%, p = 0.0002) and musculoskeletal pain syndromes (2.7% vs. 15.7%, p = 0.0006) were significantly lower in asthmatic adolescents than in controls. The frequency of pain in the hands and wrists was reduced in asthmatic than in controls (12.6% vs. 31.1%, p = 0.004), in addition to cell phone use (80% vs. 93%, p < 0.0001), simultaneous use of at least two electronic media (47% vs. 91%, p < 0.0001), myofascial syndrome (0% vs. 7.1%, p = 0.043), and tendinitis (0% vs. 9.2%, p = 0.008). Logistic regression analysis, including asthma with musculoskeletal pain as the dependent variable, and female sex, ACT > 20, simultaneous use of at least two electronic devices, cell phone use, and weekends and weekdays of cell phone use, as independent variables, showed that female sex (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.929–6.316; p = 0.0009) and ACT ≥ 20 (OR, 0.194; 95% CI, 0.039–0.967; p = 0.045) were associated with asthma and musculoskeletal pain (Nagelkerke R2 = 0.206). Conclusion: Musculoskeletal pain and musculoskeletal pain syndromes were lower in adolescents with asthma. Female sex was associated with musculoskeletal pain in asthmatic, whereas patients with asthma symptoms and well-controlled disease reported a lower prevalence of musculoskeletal pain.

Objetivo: Avaliar o uso de mídias digitais em adolescentes com asma, comparando-os com uma população de adolescentes sem doenças crônicas; avaliar a associação entre dor musculoesquelética e uso da mídia digital em adolescentes com asma comparando-a com adolescentes sem doenças crônicas; avaliar a associação entre os asmáticos com queixa saúde (QVRS) e controle da asma. Métodos: Estudo transversal com 150 adolescentes asmáticos (10 a 18 anos) de um hospital público da cidade de São Paulo comparados com 300 adolescentes sem doenças crônicas (11 a 17 anos) provenientes de uma escola pública da cidade de São Paulo, que responderam um questionário individual e autoaplicável, com perguntas sobre o uso de dispositivos eletrônicos; dados demográficos; prática de atividade física e sintomas dolorosos do sistema musculoesquelético. Aplicado o questionário ACT/ c- ACT (Asthma control test/ Children Asthma control test) para classificação do controle da asma e o PedsQLTM 4.0 (Pediatric Quality of Life) para avaliação dos aspectos da QVRS no grupo asmático. Após a aplicação dos questionários, foi realizado exame físico específico do aparelho musculoesquelético nos adolescentes asmáticos e do grupo controle que apresentavam queixas álgicas nos últimos três meses, visando à avaliação das seguintes síndromes musculoesqueléticas: fibromialgia juvenil, síndrome de hipermobilidade articular benigna, síndrome miofascial, tendinite, bursite, epicondilite e síndrome de dor regional complexa. Resultados: Dor musculoesquelética foi significativamente menor em adolescentes com asma comparados aos controles (42% vs. 61%, p = 0,0002), bem como síndromes de dor musculoesquelética (2,7% vs. 15,7%, p = 0,0006). A frequência de dor nas mãos e punhos foi significativamente reduzida no grupo asma (12,6% vs. 31,1%, p = 0,004), da mesma forma que o uso de telefone celular (80% vs. 93%, p < 0,0001), uso simultâneo de pelo menos dois dispositivos eletrônicos (47% vs. 91%, p < 0,0001), síndrome miofascial (0% vs. 7,1%, p = 0,043) e tendinite (0% vs. 9,2%, p = 0,008). Análise de regressão logística incluindo pacientes asmáticos com dor musculoesquelética como variável dependente e sexo feminino, ACT > 20, uso simultâneo de pelo menos dois dispositivos eletrônicos, uso de telefone celular nos fins de semana e nos dias de semana como variáveis independentes, mostrou que o sexo feminino (OR 2,06; IC 95%, 1,929- 6,316, p = 0,0009) e ACT > 20 (OR 0,194; IC 95%, 0,039-0,967, p = 0,045) foram associados com asma e dor musculoesquelética (Nagelkerke R2 = 0,206). As análises das médias dos itens do questionário PedsQLTM 4.0 foram significativamente menores nos domínios saúde e sentimentos em asmáticos com dor versus asmáticos que não relataram dor (p < 0,0001 e p < 0,0006, respectivamente). Conclusões: Dor e síndromes musculoesqueléticas foram menos prevalentes em adolescentes com asma em comparação com controles saudáveis. O sexo feminino foi associado à dor musculoesquelética em adolescentes asmáticos, enquanto pacientes com asma e doença bem controladas relataram menor dor musculoesquelética. Adolescentes com asma e que referiram dor apresentaram pior índice na avaliação da qualidade de vida nas questões de saúde e sentimentos Background: Evaluate the use of electronic devices in adolescents with asthma, comparing them with a population of adolescents without chronic diseases; to evaluate the association between musculoskeletal pain and the use of digital media in adolescents with asthma, comparing it with adolescents without chronic diseases; to evaluate the association between asthmatics complaining of musculoskeletal pain and aspects of health-related quality of life (HRQoL) and asthma control .Methods: A cross-sectional study was carried-out with 150 adolescent with asthma and 300 healthy controls. All adolescents completed an individually and self-administered questionnaire about painful symptoms, electronic devices, and physical activity. After the questionnaires were applied, a specific physical examination of the musculoskeletal system was performed in asthmatic and control adolescents who had pain complaints in the last three months, aiming at the evaluation of the following musculoskeletal syndromes, such as: juvenile fibromyalgia, benign joint hypermobility syndrome, myofascial syndrome, tendonitis, bursitis, epicondylitis and complex regional pain syndrome. The ACT / c- ACT questionnaire (Asthma control test / Children Asthma control test) was applied to classify asthma control and PedsQLTM 4.0 (Pediatric Quality of Life) to assess aspects of HRQoL in the asthmatic group. Results: Musculoskeletal pain was significantly lower in adolescents with asthma compared to controls (42% vs. 61%, p=0.0002), as well as musculoskeletal pain syndromes (2.7% vs. 15.7%, p=0.0006). The frequencies of pain in the hands and wrists were significantly reduced in the asthmatic group (12.6% vs. 31.1%, p=0.004), likewise cell phone use (80% vs. 93%, p < 0.0001), simultaneous use of at least two electronic media (47% vs. 91%, p < 0.0001) myofascial syndrome (0% vs. 7.1%, p=0.043) and tendinitis (0% vs. 9.2%, p=0.008). Further analysis of logistic regression including asthmatic patients with musculoskeletal pain as dependent variable and female sex, ACT > 20, simultaneous use of at least two electronic devices, cell phone use, weekends and weekdays of cell phone use as independent variables, showed that female sex (OR, 2.06; 95%CI, 1.929- 6.316, p=0.0009) and ACT > 20 (OR, 0.194; 95%CI, 0.039-0.967, p=0.045) were associated with asthma and musculoskeletal pain (Nagelkerke R2= 0.206). The analysis of the means of the items in the PedsQLTM 4.0 questionnaire were significantly lower in the domains health and feelings in asthmatics with pain versus asthmatics who did not report pain (p < 0.0001 and p < 0.0006, respectively). Conclusions: Musculoskeletal pain and musculoskeletal pain syndromes were lower in adolescents with asthma compared to healthy controls. Female sex was associated with musculoskeletal pain in asthmatic adolescents, whereas patients with asthma and well controlled disease reported lower musculoskeletal pain. Adolescents with asthma and who reported pain had a worse rate in assessing quality of life in questions about health and feelings

Introduction: Immunoglobulin G4-related disease (IgG4-RD) is an condition rarely reported in children. Additionally, IgG4-RD may rarely mimic vasculitis in adults and may infrequently present with uveitis. In our service, 6,198 patients were followed-up and only one (0.0001%) of them had IgG4-RD. To our knowledge, the present IgG4-RD case was the first mimicking childhood polyarteritis nodosa (c-PAN) with recurrent uveitis and kidney tumor. Case Report: We describe herein a 7-year-old boy that presented intermittent fever. He developed arthralgia, weight loss, myalgia, skin lesions and recurrent uveitis. Skin biopsy revealed necrotizing vasculitis in medium/small sized vessels associated with septal panniculitis suggesting cPAN. Prednisone and azathioprine were administered with improvement. At 11 years, he had persistent fever and abdominal angiotomography revealed a large tumor in left kidney and he was then submitted to nephrectomy. The renal histopathology showed lymphoplasmacytic and histiocytic proliferation with extensive areas of fibrosis, and lymphomonocitic phlebitis with presence of IgG4 in 43 plasmocyte cells, suggesting IgG4-RD. Discussion: we present herein a unique case of a male pediatric patient with IgG4-RD with rare ocular, cutaneous and renal manifestations.

Objective To evaluate symptomatic polyautoimmunity (PA) at childhood-onset systemic lupus erythematosus(cSLE) diagnosis, and its association with demographic data, disease activity, clinical manifestations and laboratorial abnormalities in a large Brazilian cSLE population. Methods A multicenter retrospective study was performed in 1463 cSLE(ACR criteria) patients from 27 Pediatric Rheumatology services. Symptomatic PA was defined according to the presence of more than one concomitant autoimmune disease(AD) and symptomatic multiple autoimmune syndrome(MAS) was defined as three or more AD. An investigator meeting was held to define the protocol. Demographic data, SLICC classification criteria and SLEDAI-2K were evaluated. Results At cSLE diagnosis symptomatic PA was observed in 144/1463(9.8%) and symptomatic MAS occurred in solely 10/1463(0.7%). In the former group the more frequently observed associated AD were Hashimoto thyroiditis n = 42/144(29%), antiphospholipid syndrome n = 42/144(29%), autoimmune hepatitis n = 26/144(18%) and type 1 diabetes mellitus n = 23/144(15.9%). Further comparisons between cSLE patients with and without PA showed a higher median age(p = 0.016) and lower mean SLICC criteria (p = 0.039) in those with PA. Additionally, these cSLE patients had less renal involvement(35% vs. 44%, p = 0.038) and red blood cell cast(6% vs. 12%, p = 0.042) and more antiphospholipid antibodies(29% vs. 15%, p Conclusions Approximately 10% of cSLE had symptomatic PA at diagnosis, particularly endocrine autoimmune disorders and antiphospholipid syndrome. Lupus was characterized by a mild disease onset and MAS was infrequently evidenced. Further studies are necessary to determine if this subgroup of cSLE patients have a distinct genetic background with a less severe disease and a better long-term outcome.