RESUMEN
OBJECTIVES: To translate into Argentine Spanish and cross-culturally adapt the Childhood Health Assessment Questionnaire (CHAQ) and validate the adapted instrument in Argentine patients with juvenile rheumatoid arthritis (JRA). METHODS: Five bilingual Argentine pediatric rheumatologists translated into Argentine Spanish and cross-culturally adapted the United States English CHAQ. Pretesting was done in a sample of 23 parents using a probe question technique. Parents of 70 patients with JRA and 21 healthy children (controls) participated in the validation phase. All were from Argentina. RESULTS: The mean disability index (DI) scores for patients with systemic, polyarticular, or pauciarticular onset JRA were 0.64, 0.32, and 0.1, respectively. Healthy controls averaged 0.2. Intercomponent correlations were between 0.4 and 0.9, suggesting internal consistency, but also some redundancy. Test-retest reliability, studied at a 1-week interval, was moderate (mean DI 0.44 [in clinic] and 0.29 [one week later], Pearson's correlation = 0.82). We compared CHAQ scores from 15 parents with those of their children > 10 years of age. Significantly higher DI scores were given by patients than their respective parents (P > 0.019), but the pairwise scores (parent-patient) were highly correlated (r = 0.986). CONCLUSIONS: Cross-cultural adaptation of the US CHAQ to Argentina required few changes. Although DI scores for all patient subgroups were higher than for controls subjects, the scores were low, particularly for those with pauciarticular disease. Prospective studies designed to examine the sensitivity to change and predictive validity will help to assess further the usefulness of the adapted CHAQ in the Argentine population.
Asunto(s)
Actividades Cotidianas , Artritis Juvenil/etnología , Artritis Juvenil/fisiopatología , Personas con Discapacidad/clasificación , Estado de Salud , Encuestas y Cuestionarios/normas , Traducción , Adolescente , Argentina , Estudios de Casos y Controles , Niño , Preescolar , Comparación Transcultural , Humanos , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Estados UnidosRESUMEN
To determine whether genetic markers for chronic iridocyclitis could be identified, we used both serologic and oligonucleotide dot blot techniques to characterize immunogenetically 164 children with early-onset pauciarticular juvenile rheumatoid arthritis. Seventy-eight children (47.6%) had chronic iridocyclitis and 86 (52.4%) had not had evidence of eye disease during a mean follow-up period after the onset of arthritis of 15.8 years (minimum of 5.5 years). Control subjects were 218 healthy, unrelated individuals. The analysis was limited to alleles known to be associated with an increased or decreased risk of early-onset pauciarticular juvenile rheumatoid arthritis or of chronic iridocyclitis in this form of juvenile rheumatoid arthritis. Only one split of human leukocyte antigen (HLA)-DR5, HLA-DRB1* 1104, showed a statistically significant association with a risk of chronic iridocyclitis (chi-square value = 7.52; p = 0.036 adjusted; odds ratio 3.45); HLA-DQA1* 0501 and HLA-DQB1* 0301, both in linkage disequilibrium with HLA-DRB1* 1104, also were significantly associated with eye disease. Patients with both the DRB1* 1104 and DPB1* 0201 genes had a 7.7-fold increased risk for chronic iridocyclitis compared with that for other patients. The presence of HLA-DRB1* 1104 was about four times as specific, but only about one third as sensitive, as antinuclear antibodies in identifying patients at risk for eye disease. Although all children with early-onset pauciarticular juvenile rheumatoid arthritis should undergo periodic slit-lamp examinations, those with the HLA class II gene DRB1* 1104 are at particularly high risk for eye disease, and we recommend that they be monitored carefully for its evolution.
Asunto(s)
Artritis Juvenil/inmunología , Genes MHC Clase II/genética , Antígenos HLA-DR/genética , Antígenos de Histocompatibilidad Clase II/genética , Iridociclitis/inmunología , Adulto , Alelos , Anticuerpos Antinucleares/análisis , Artritis Juvenil/genética , Niño , Enfermedad Crónica , Sondas de ADN , Susceptibilidad a Enfermedades , Amplificación de Genes , Marcadores Genéticos/genética , Genotipo , Cadenas HLA-DRB1 , Haplotipos , Humanos , Iridociclitis/genética , Reacción en Cadena de la Polimerasa , Factores de Riesgo , Sensibilidad y EspecificidadRESUMEN
Ninety-two children with juvenile rheumatoid arthritis were randomly assigned to treatment in a multicenter, double-blind, 12-week trial designed to compare the efficacy and safety of a liquid formulation of ibuprofen at a dosage of 30 to 40 mg/kg/day versus those of aspirin at a dosage of 60 to 80 mg/kg/day. No significant intergroup differences in response rates or in the amount of improvement in articular indexes of disease activity were observed. More children treated with aspirin discontinued treatment early because of adverse reactions. After this trial, 84 additional patients with juvenile rheumatoid arthritis entered a 24-week, multidose (30, 40, and 50 mg/kg/day), open trial of ibuprofen suspension. Favorable response rates for the three groups were similar, and continued improvement was observed throughout the 24-week period. A dose-response relationship was observed with respect to adverse reactions of the upper gastrointestinal tract. We conclude that ibuprofen suspension is an effective nonsteroidal antiinflammatory drug and that its tolerability in children is acceptable.
Asunto(s)
Artritis Juvenil/tratamiento farmacológico , Ibuprofeno/administración & dosificación , Adolescente , Aspirina/uso terapéutico , Niño , Preescolar , Método Doble Ciego , Femenino , Humanos , Ibuprofeno/efectos adversos , Masculino , Cooperación del Paciente , SuspensionesRESUMEN
It has been suggested that hypermobility of the joints may predispose children to the development of arthritis or arthralgia. To determine the normal frequency of hypermobility, 260 normal schoolchildren (5 to 17 years of age) were examined. In addition, 34 patients with juvenile rheumatoid arthritis (JRA) and 32 children with juvenile episodic arthritis/arthralgia (JEA) were tested. Any child who met at least three of the following criteria was considered to have joint hypermobility: (1) passive apposition of the thumbs to the flexor aspect of the forearms; (2) passive hyperextension of the fingers so that they lie parallel with the extensor aspect of the forearms; (3) hyperextension of the elbows greater than 10 degrees; (4) hyperextension of the knees greater than 10 degrees; (5) flexion of the trunk with knees extended so the palms rest on the floor. Thirty-two (12%) of 260 normal schoolchildren and 21 (66%) of 32 with JEA had hypermobility. Further, a significantly higher proportion (23 of 126) of normal girls than normal boys (nine of 134) had hypermobility (chi 2 = 8.0, P less than 0.005). Hypermobility was not common in children with JRA. These findings support the hypothesis that hypermobility may be an important factor in the cause of JEA.
Asunto(s)
Artritis Juvenil/complicaciones , Artritis/complicaciones , Inestabilidad de la Articulación/complicaciones , Adolescente , Niño , Preescolar , Femenino , Humanos , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/epidemiología , MasculinoRESUMEN
Auranofin (triethylphosphine gold) was administered to 21 patients with juvenile rheumatoid arthritis during an open-ended, open-label, noncontrolled trial designed to establish safety and preliminary efficacy. Initial dosage was 0.1 mg/kg/day; incremental increases to 0.2 mg/kg/day were allowed. Aspirin (80 mg/kg/day), tolmetin (20 to 40 mg/kg/day), and naproxen (400 to 600 mg/m2/day) were allowed as rapidly acting anti-inflammatory agents. All patients attained measurable plasma concentrations of gold during the study. Clinically significant improvement (greater than 25%) occurred in more than half the patients with regard to the number and severity of joints with swelling, pain on motion, and tenderness. The number of joints with active arthritis decreased by at least 25% in nine of the 19 patients. Group mean changes between the initial and final visit indicated improvement in all articular disease indices measured. Eleven of 16 patients with an elevated erythrocyte sedimentation rate showed decreases of at least 25%. The group given the higher dosage had a greater proportion of responders with decreases in erythrocyte sedimentation rate. Four of six patients whose sera contained rheumatoid factor showed decreases in its titer. Discontinuation of auranofin was necessary in two patients because of headaches and because of hematuria and anemia associated with a severe flare of polyarticular disease, respectively. The results from this trial are sufficiently encouraging to merit a double-blind trial of auranofin in children with juvenile rheumatoid arthritis.
Asunto(s)
Antiinflamatorios/uso terapéutico , Artritis Juvenil/tratamiento farmacológico , Aurotioglucosa/análogos & derivados , Oro/análogos & derivados , Adolescente , Antiinflamatorios/efectos adversos , Auranofina , Aurotioglucosa/efectos adversos , Aurotioglucosa/uso terapéutico , Sedimentación Sanguínea , Niño , Preescolar , Ensayos Clínicos como Asunto , Femenino , Cefalea/inducido químicamente , Hematuria/inducido químicamente , Humanos , Lactante , Masculino , Factor Reumatoide/análisis , Factores de TiempoRESUMEN
Plasma exchange with either fresh-frozen plasma or 5% albumin solution as replacement fluid was performed in four selected patients with juvenile rheumatoid arthritis unresponsive to standard therapy. One 13-year-old boy with life-threatening systemic disease experienced a partial remission of disease and tolerated a decrease in prednisone dose from 15 to 4 mg daily following 14 exchanges with FFP. A 14-year-old girl, dwarfed by systemic disease and long-term corticosteroid therapy, was able to discontinue prednisone and grew 6.3 cm in 11 months following 18 plasma exchanges with FFP. An 8-year-old girl with pauciarticular disease, antinuclear antibody, and uncontrollable iridocyclitis underwent 16 plasma exchanges with 5% albumin solution as replacement; despite removal of antinuclear antibody, her eye disease and arthritis were not helped. A 16-year-old girl with erosive, polyarticular JRA showed no detectable change in her articular disease following nine exchanges. Transient decreases in hematocrit, complement components, and immunoglobulin concentrations occurred. In three patients Westergren sedimentation rate decreased for up to five months after exchanges. One patient died suddenly during an exchange with FFP; the cause of death appeared related to microemboli of unknown nature found in the lungs at autopsy. Plasma exchange should be done only in an intensive care setting and as a research procedure for children with JRA.