Incidence of temporomandibular involvement in juvenile idiopathic arthritis

OBJECTIVE: Temporomandibular joint (TMJ) involvement is a frequent feature in cross-sectional prevalence studies among juvenile idiopathic arthritis (JIA) patients. The cross-sectional design makes it almost impossible to study the incidence. Follow-up data on TMJ involvement are sparse. In this study patients were reviewed with an interval of a minimum of 1 year and a maximum of 2 years to study the yearly incidence of TMJ involvement and to obtain follow-up data on TMJ involvement and orthopantomogram (OPT) alterations. METHODS: Children with JIA from a previous study on TMJ involvement were included. OPTs were scored according to Rohlin's grading system (grade 0-5). A paediatric rheumatologist measured the level of disease activity during the interval. RESULTS: Eighty-nine of the 97 patients were included in this study with a mean follow-up of 14 months. The yearly incidence of TMJ involvement was 7.1% in patients with JIA. Improvement on the OPT was seen in 27 patients (66%), and 19 of these patients no longer showed any signs of TMJ involvement. Worsening on the OPT was seen in four patients (10%). Disease activity was significantly lower in the improved patients than in the patients with worsening. CONCLUSION: Condylar lesions due to arthritis can improve over time, indicating a regenerative capacity of the mandibular condyle. As condylar improvement seems to be associated with low disease activity, it is important to consider the TMJ when deciding on a therapeutic regimen.     

The spectrum of CNS vasculitis in children and adults

Children and adults who present with severe, newly acquired neurological or psychiatric deficits should be evaluated for an underlying inflammatory brain disease-the inflammation could be reversible, if diagnosed and treated rapidly. In our experience, primary angiitis of the central nervous system (PACNS) is the most common inflammatory brain disease and is increasingly recognized across patients of all ages. Distinct disease subtypes have been reported with characteristic disease courses, neuroimaging features and histopathological findings. In this Review, we provide a comprehensive comparison of childhood and adult PACNS, revealing distinct gender distributions, characteristic presenting clinical phenotypes and tailored differential diagnosis evaluations in the different subtypes of PACNS. Novel and traditional laboratory markers can help to define disease subtype and activity, whilst MRI and angiography can aid diagnosis in both children and adults. Characteristic patterns of parenchymal lesions and vessel involvement have been identified in PACNS and differ markedly between subtypes. Brain histopathology has also revealed distinct inflammatory pathways at different ages. Immunosuppressive treatment protocols have been shown to be effective and safe across the age spectrum; overall, in the past few years, the mortality of PACNS has decreased dramatically.     

“Ne diyor?” (What does she say?): Informal interpreting in general practice

Objective

The aim of this study was to offer a comparative analysis of informal interpreters during medical consultations with both good and poor mutual understanding between general practitioners (GPs) and patients.

Methods

Sixteen video-registered medical interviews of Turkish immigrant patients were analysed. Stretches of discourse of eight interviews with good mutual understanding between patient and doctor were compared to eight interviews with poor mutual understanding. The discourse analysis focused on: (1) miscommunication and its causes; (2) changes in the translation; (3) side-talk activities.

Results

In the cases of ‘poor mutual understanding’, the instances of miscommunication far exceeded those in the ‘good mutual understanding’ group. Style of self-presentation, content omissions and side-talk activities seemed to hinder good mutual understanding.

Conclusion

Alongside the evidence about problems with informal interpreting, sometimes the use of family interpreters can facilitate medical communication.

Practice implications

Recommendations are given in order to increase physicians’ awareness of the complex process of interpreting, as well as to empower informal interpreters and patients to effectively deal with this communicative triad.     

Health-related quality of life in children with inflammatory brain disease

Objective

To quantify the impact of inflammatory brain diseases in the pediatric population on health-related quality of life, including the subdomains of physical, emotional, school and social functioning.

Methods

This was a multicenter, observational cohort study of children (<?18?years of age) diagnosed with inflammatory brain disease (IBrainD). Patients were included if they had completed at least one Health Related Quality of Life Questionnaire (HRQoL). HRQoL was measured using the Pediatric Quality of Life Inventory Version 4.0 (PedsQL) Generic Core Scales, which provided a total score out of 100. Analyses of trends were performed using linear regression models adjusted for repeated measures over time.

Results

In this study, 145 patients were included of which 80 (55%) were females. Cognitive dysfunction was the most common presenting symptoms (63%), and small vessel childhood primary angiitis of the CNS was the most common diagnosis (33%). The mean child’s self-reported PedsQL total score at diagnosis was 68.4, and the mean parent’s proxy-reported PedsQL score was 63.4 at diagnosis. Child’s self-reported PedsQL scores reflected poor HRQoL in 52.9% of patients at diagnosis. Seizures or cognitive dysfunction at presentation was associated with statistically significant deficits in HRQoL.

Conclusion

Pediatric IBrainD is associated with significantly diminished health-related quality of life. Future research should elucidate why these deficits occur and interventions should focus on improving HRQoL in the most affected subdomains, in particular for children presenting with seizures and cognitive dysfunction.

     

Persisting uveitis antedating psoriasis in two boys

Two young boys had a severe uveitis which was difficult to treat. They both developed psoriasis located in the pubic area almost 1 year and several years later respectively. One boy also developed arthritis of an intermittent character. Both boys were ANA and HLA-B27 negative. Conclusion: in children, the possible association between uveitis and psoriasis with or without arthritis has to be kept in mind.Abbreviations ANA antinuclear antibodies - CAU chronic anterior uveitis - JIA juvenile idiopathic arthritis - JPsA juvenile psoriatic arthritis - MTX methotrexate