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81.
A followup study of antiphospholipid antibodies and associated neuropsychiatric manifestations in 137 children with systemic lupus erythematosus 总被引:2,自引:0,他引:2
OBJECTIVE: To determine the prevalence of anticardiolipin antibodies (aCL), anti-beta(2)-glycoprotein I (anti-beta(2)GPI) antibodies, and lupus anticoagulant (LAC) in a large cohort of children with systemic lupus erythematosus (SLE), and to evaluate the associations with neuropsychiatric manifestations. METHODS: A single-center retrospective cohort study with longitudinal followup of antiphospholipid antibodies (aPL) in 137 children with SLE (25 boys and 112 girls, mean age at diagnosis 13.0 years) was performed. Patients were followed up for a mean of 31 months. RESULTS: At the time of diagnosis, 65% of the children were aCL positive, 41% had anti-beta(2)GPI antibodies, and 26% were LAC positive. Analysis of the association between presence of aPL and individual neuropsychiatric manifestations at diagnosis showed a statistically significant association of positive LAC with cerebrovascular disease (5 patients; P = 0.015). A persistently positive aCL was observed in 50%, anti-beta(2)GPI antibodies in 29%, and LAC in 16% of children over time. The prevalence of anti-beta(2)GPI antibodies, but not aCL and LAC, was found to be statistically significantly higher in children with neuropsychiatric disease compared with those without (P = 0.02). Comparison for specific neuropsychiatric manifestations showed a statistically significant association between a persistently positive LAC and chorea (2 patients; P = 0.02). CONCLUSION: The prevalence of anti-beta(2)GPI antibodies was found to be higher in the group of SLE patients with neuropsychiatric disease compared with those without. Our data suggest an association between LAC and cerebrovascular disease at the time of SLE diagnosis and chorea over the disease course, but not between aPL and other neuropsychiatric manifestations. 相似文献
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Susanne M. Benseler Gabrielle deVeber Cynthia Hawkins Rayfel Schneider Pascal N. Tyrrell Richard I. Aviv Derek Armstrong Ronald M. Laxer Earl D. Silverman 《Arthritis \u0026amp; Rheumatology》2005,52(7):2159-2167
Inflammatory central nervous system (CNS) diseases in childhood comprise a wide spectrum of heterogeneous conditions. We studied 4 children with primary CNS vasculitis in whom results of magnetic resonance imaging studies were abnormal but results of conventional angiography were normal. We determined that angiography‐negative, biopsy‐confirmed primary small‐vessel CNS vasculitis is a previously unrecognized distinct disease entity in children. The diagnosis must be considered in a child with a progressive, acquired diffuse or focal neurologic deficit, even if the results of conventional angiography are normal. A lesional brain biopsy is required to confirm the diagnosis. Use of immunosuppressive therapy plus aspirin leads to an excellent neurologic outcome. 相似文献
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Health‐Related Quality of Life in an Inception Cohort of Children With Juvenile Idiopathic Arthritis: A Longitudinal Analysis 下载免费PDF全文
Kiem Oen Jaime Guzman Brenden Dufault Lori B. Tucker Natalie J. Shiff Karen Watanabe Duffy Jennifer J. Y. Lee Brian M. Feldman Roberta A. Berard Paul Dancey Adam M. Huber Rosie Scuccimarri David A. Cabral Kimberly A. Morishita Suzanne E. Ramsey Alan M. Rosenberg Gilles Boire Susanne M. Benseler Bianca Lang Kristin Houghton Paivi M. Miettunen Ga?lle Chédeville Deborah M. Levy Alessandra Bruns Heinrike Schmeling Elie Haddad Rae S. M. Yeung Ciarán M. Duffy the Research in Arthritis in Canadian Children emphasizing Outcomes investigators 《Arthritis care & research》2018,70(1):134-144
Objective
To describe changes in health‐related quality of life (HRQoL) over time in children with juvenile idiopathic arthritis (JIA), relative to other outcomes, and to identify predictors of unfavorable HRQoL trajectories.Methods
Children with JIA in the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh‐Out) cohort were included. The Juvenile Arthritis Quality of Life Questionnaire (JAQQ, a standardized instrument), health‐related Quality of My Life (HRQoML, an instrument based on personal valuations), and JIA core variables were completed serially. Analyses included median values, Kaplan‐Meier survival curves, and latent trajectory analysis.Results
A total of 1,249 patients enrolled at a median of 0.5 months after diagnosis were followed for a median of 34.2 months. The degree of initial HRQoL impairment and probabilities of reaching the best possible HRQoL scores varied across JIA categories (best for oligoarthritis, worst for rheumatoid factor–positive polyarthritis). Median times to attain best possible HRQoL scores (JAQQ 59.3 months, HRQoML 34.5 months), lagged behind those for disease activity, pain, and disability measures. Most patients followed trajectories with minimal or mild impairment; however, 7.6% and 13.8% of patients, respectively, followed JAQQ and HRQoML trajectories with persistent major impairment in HRQoL. JIA category, aboriginal ethnicity, and baseline disease activity measures distinguished between membership in trajectories with major and minimal impairments.Conclusion
Improvement in HRQoL is slower than for disease activity, pain, and disability. Improvement of a measure based on respondents’ preferences (HRQoML) is more rapid than that of a standardized measure (JAQQ). Higher disease activity at diagnosis heralds an unfavorable HRQoL trajectory. 相似文献85.
Systemic lupus erythematosus in children and adolescents is a multisystem autoimmune disease with a great variability in disease presentation and course. This article summarizes available epidemiologic data, clinical patterns, approaches to investigation and treatment, and recent outcome data. 相似文献
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Uribe AG Huber AM Kim S O'Neil KM Wahezi DM Abramson L Baszis K Benseler SM Bowyer SL Campillo S Chira P Hersh AO Higgins GC Eberhard A Ede K Imundo LF Jung L Kingsbury DJ Klein-Gitelman M Lawson EF Li SC Lovell DJ Mason T McCurdy D Muscal E Nassi L Rabinovich E Reiff A Rosenkranz M Schikler KN Singer NG Spalding S Stevens AM Cabral DA;ARegistry for Children with Vasculitis e-entry 《The Journal of rheumatology》2012,39(8):1687-1697
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Granulomatosis with polyangiitis (GPA) is a rare yet frequently organ- or life-threatening systemic vasculitis affecting small-
to medium-sized arteries in multiple organs. It characteristically leads to alveolar hemorrhage and destructive, pauci-immune
glomerulonephritis. GPA is also characterized by granulomas in the upper and lower respiratory tract causing erosive sinusitis
and nodular or even cavitating lesions in the respiratory tract. Antineutrophil cytoplasmic antibodies, a hallmark of GPA,
are likely integral to the pathogenesis and recently have become a therapeutic target. International collaborations in childhood
vasculitis have led to the development and validation of childhood vasculitis classification criteria, advanced our understanding
of the clinical phenotype at presentation of GPA, and improved our ability to capture disease activity and determine treatment
choices. Treatment efficacy and safety data continue to be largely derived from adult GPA studies. This review focuses on
the recent publications on epidemiology, pathogenesis, and treatment in childhood GPA and relevant publications from the adult
GPA literature. 相似文献
90.
Feasibility and effectiveness of an aerobic exercise program in children with fibromyalgia: results of a randomized controlled pilot trial 总被引:1,自引:0,他引:1
Stephens S Feldman BM Bradley N Schneiderman J Wright V Singh-Grewal D Lefebvre A Benseler SM Cameron B Laxer R O'Brien C Schneider R Silverman E Spiegel L Stinson J Tyrrell PN Whitney K Tse SM 《Arthritis and rheumatism》2008,59(10):1399-1406
OBJECTIVE: To determine the feasibility of conducting a randomized controlled trial of a 12-week exercise intervention in children with fibromyalgia (FM) and to explore the effectiveness of aerobic exercise on physical fitness, function, pain, FM symptoms, and quality of life (QOL). METHODS: FM patients ages 8-18 years were randomized to a 12-week exercise intervention of either aerobics or qigong. Both groups participated in 3 weekly training sessions. Program adherence and safety were monitored at each session. Data were collected at 3 testing sessions, 2 prior to and 1 after the intervention, and included FM symptoms, function, pain, QOL, and fitness measures. RESULTS: Thirty patients participated in the trial. Twenty-four patients completed the program; 4 patients dropped out prior to training and 2 dropped out of the aerobics program. Better adherence was reported in the aerobics group than in the qigong group (67% versus 61%). Significant improvements in physical function, functional capacity, QOL, and fatigue were observed in the aerobics group. Anaerobic function, tender point count, pain, and symptom severity improved similarly in both groups. CONCLUSION: It is feasible to conduct an exercise intervention trial in children with FM. Children with FM tolerate moderate-intensity exercise without exacerbation of their disease. Significant improvements in physical function, FM symptoms, QOL, and pain were demonstrated in both exercise groups; the aerobics group performed better in several measures compared with the qigong group. Future studies may need larger sample sizes to confirm clinical improvement and to detect differences in fitness in childhood FM. 相似文献