Biologikatherapie der juvenilen idiopathische Arthritis im jungen Erwachsenenalter

Background

The majority of patients with juvenile idiopathic arthritis (JIA) need specialized care when they enter adulthood. An increasing number of these patients take biologic disease modifying antirheumatic drugs (DMARDs) at the time of transition. The biologic register BiKeR provides information about the health status and healthcare situation of JIA patients during childhood and adolescence and with their entrance into adulthood these patients are systematically transferred to JuMBO, the follow-up register for young adults with JIA treated with biologics and nonbiologic DMARDs.

Objective

The aim of this study was to investigate the healthcare situation of patients with JIA during transition from pediatric to adult care.

Methods

The current analyses included patients who were successfully transferred from the BiKeR to JuMBO registers. The DMARD treatment and patient-reported outcome (i.e. disease activity, pain and functional ability) were assessed at the last documentation in BikeR and at the first as well as the last documentation in JuMBO.

Results

During the transition period 1 in 10 JIA patients stopped DMARD therapy and 1 in 20 patients did not visit a physician for adults. Three-quarters of the adult JIA patients included in JuMBO (N?=?811) reached adult rheumatology care. Adult rheumatologists usually continued therapy with biologics in these patients. Every second patient was still being treated with etanercept, 5 years after the start of the first treatment with biologics. Adult rheumatologists changed the biologic substance in every fourth patient, mainly because of treatment failure. In comparison to patients in regular adult rheumatology care, those who did not remain in specialized care had a higher discontinuation rate of biologics. Moreover, patients with sporadic use of medical care had a significantly poorer health status than those with a regular use of medical care at least every 6 months.

Conclusion

The data show that there is a need for improving healthcare during the period of transition from pediatric to adult rheumatology.     

Transition-Clinic—

Zusammenfassung Im Kindesalter beginnende chronische rheumatische Erkrankungen bleiben oft bis in das Erwachsenenalter aktiv und sind mit Einschränkungen auf körperlicher, funktioneller und sozialer Ebene verbunden. Die medizinische und psychosoziale Betreuung der Patienten muss also über das Jugendalter hinaus fortgeführt werden, was einen Wechsel von der kind-zentrierten in die erwachsenen-orientierte Gesundheitsbetreuung erforderlich macht. Jugendliche und junge Erwachsene geplant, individuell ausgerichtet und gut koordiniert in die erwachsenen-medizinische Betreuung zu überführen (=Transition), ist relevant für deren zukünftige Partizipation in der Gesellschaft und gehört heute zu einer guten klinischen Praxis. Im Rahmen der medizinischen Begleitung rheumakranker Jugendlicher beim Übergang in das Erwachsenenalter müssen neben krankheitsspezifischen Aspekten auch die entwicklungsbedingten Besonderheiten dieses Lebensabschnittes berücksichtigt werden. Die derzeitigen Betreuungsangebote für rheumakranke Jugendliche und junge Erwachsene in Deutschland sind unzureichend. Pädiatrische und internistische Rheumatologen sollten in enger Zusammenarbeit spezielle Betreuungskonzepte für diese Patientengruppe etablieren.     

Phospholipases of Candida albicans

Infections due to Candida albicans are frequent and of clinical importance. Especially at a time of increasing organ transplantations, HIV infections, and resistance to antimicrobial agents a profound knowledge of the interaction between C. albicans and host tissue is mandatory. In addition to secreted aspartyl proteinase, dimorphism, cell surface composition, and toxin production phospholipases are a main factor in pathogenicity. Up to the present, many different groups and subgroups of phospholipases have been detected. These different enzymes are related to various types of aggressive and defensive actions. These range from active invasion of host cell tissue to growth control and remodelling of the yeast cell membrane. It is clear that a multiplicity of factors must co-operate to overcome the host's defences. Yet it can be supposed today that phospholipases are one important factor in this complex interaction. Therefore the known phospholipases of C. albicans are described in detail under clinical aspects.     

Klinische Formen der juvenilen idiopathischen Arthritis und ihre Klassifikation

There have been major advances in the field of paediatric rheumatology over the last 15 years, which have included improvements in the classification of chronic arthritis, the most common chronic rheumatic disease in children and adolescents. A new classification was proposed by the International League of Associations for Rheumatology (ILAR) in 1995, which facilitated collaborative research and comparability of study results. According to the ILAR classification juvenile idiopathic arthritis (JIA) is a new term that encompasses the heterogeneous forms of arthritis of unknown cause, which begin before 16 years of age. The JIA classification identifies seven disease categories, which differ in their clinical presentation, outcome, and in some cases, genetic background, and which are characterized here on the basis of data from the national paediatric rheumatology database. Despite its usefulness for international research, the ILAR classification also has restrictions and further revision is therefore required. A special problem with a need for a solution is represented by the limited application in adult rheumatology.     

Prognosis of patients with juvenile chronic arthritis and juvenile spondyloarthropathy

OBJECTIVE: Evaluation of the course and the prognosis of juvenile chronic arthritis (JCA) and juvenile spondyloarthropathy (JSpA). METHODS: The entire medical histories of 171 patients with JCA or JSpA were reviewed. The study cohort comprised 102 patients with oligoarticular, 17 with systemic, and 24 with polyarticular onset of JCA; 28 patients had a SpA; 91 patients with JCA from a population based cohort were included in that study cohort. The mean period of followup was 7.4 years. The probability of remission was estimated by survival analysis methods (Kaplan-Meier method). RESULTS: After a disease duration of 10 years the highest probability of complete remission was estimated for patients with oligoarticular or systemic onset of JCA (54% and 38%, respectively). In the oligoarthritis group with late onset of JCA, a lower probability of remission was found for the HLA-B27+ patients compared with HLA-B27- patients. Patients with polyarticular onset of JCA had the poorest prognosis, with a significantly lower probability of complete remission (15%) within 10 years, more secondary injuries, and a lower functional capacity at followup. Patients with JSpA showed a 17% probability of remission after a disease duration of 5 years and ranged between the remission rates for oligoarticular and polyarticular JCA. The estimated remission rates for the patients with JCA in the population based cohort and in the whole cohort were quite similar. CONCLUSION: Our data suggest a favorable prognosis for JCA and JSpA in general, but with differences among the subtypes. It seems that more than 50% of the patients with JCA and JSpA reach adulthood with active arthritis and need further rheumatological care.     

Rheumatische Erkrankungen im Kindes- und Jugendalter: Wichtigkeit einer frühzeitigen multiprofessionellen Versorgung

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Die juvenile idiopathische Arthritis (JIA) ist die häufigste chronisch-entzündliche rheumatische Erkrankung im...     

Properties of L-streptococci in comparison with those of A-streptococci

Despite some similarities, L-streptococci could be clearly differentiated from A-streptococci. Formamide, autoclaved and nitrous acid extracts of all L-streptococcal cultures studied reacted only with their specific antisera and did not cross-react with any other group specific streptococcal antigens. All 33 L-streptococcal cultures, in contrast to A-streptococci, produced -D-glucuronidase and -D-galactosidase, hydrolyzed Na-hippurate, grew on 10% and 40% bile blood agar and were agglutinated by the lectin of Arachis hypogaea. Some differences between A- and L-streptococci were also observed in their sensitivity patterns to bacitracin and sulfamethoxazol-trimethoprim.