RESUMO
OBJECTIVE: To review the presentation, clinical characteristics, and outcome of children with prolonged fevers of unknown origin who are referred for pediatric rheumatologic evaluation. METHODS: We used a retrospective review of the charts of the 40 children (23 boys and 17 girls, aged 9 months to 14.6 years) with fevers persisting longer than 1 month who were referred to the Pediatric Rheumatology Clinic between 1984 and 1994, in whom evaluation did not result in diagnosis. Follow-up with children's families, pediatricians, or both was done by telephone. RESULTS: Of the 40 children, 29 had periodic fevers, and 11 had daily fevers without pattern. Patients with periodic fever were younger at onset, had longer duration of symptoms before referral, and higher maximum temperatures. The two groups did not differ in frequency of associated symptoms or signs. At follow-up (mean 60.5 +/- 5 months, n = 37), 10 children with daily fevers (within 24 months) and 23 children with periodic fevers (within 48 months) had completely recovered; three patients continue to have periodic fevers. In patients with daily fevers one had Crohn disease (7 months after initial evaluation) and another had uveitis (4 years after evaluation). One patient with periodic fevers had inflammatory bowel disease 3.5 years after the onset of fevers. Petit mal seizures developed in one patient with periodic fever, and another had mitochondrial encephalopathy. Four children with periodic fevers have attention-deficit hyperactivity disorder, and two have developmental delays. CONCLUSIONS: Fevers without an obvious source usually have a benign outcome, although patients should be monitored for changes in symptoms. Of the children with periodic fevers, 29% were later found to have neurologic problems; the relation to the previous fevers is uncertain.
Assuntos
Febre de Causa Desconhecida , Adolescente , Criança , Pré-Escolar , Feminino , Febre de Causa Desconhecida/etiologia , Seguimentos , Humanos , Lactente , Masculino , Periodicidade , Prognóstico , Estudos RetrospectivosRESUMO
Human parvovirus B19 (HPV B19) infection has been associated with chronic joint complaints in adult patients. We now report 22 children with joint complaints associated with recent HPV B19 infection. These children had either erythema infectiosum or serologic evidence of recent infection. Twenty children had arthritis; two had arthralgias. Eleven children had associated constitutional symptoms. Laboratory findings were generally normal. The duration of joint symptoms was less than 4 months in 14 children; however, six children have had persistent arthritis for 2 to 13 months, which would fulfill criteria for the diagnosis of juvenile rheumatoid arthritis. Although HPV B19 is usually associated with acute arthritis of brief duration, in some children infection with HPV B19 may be associated with the development of chronic arthritis.
Assuntos
Artrite Infecciosa/microbiologia , Eritema Infeccioso , Parvovirus B19 Humano/isolamento & purificação , Adolescente , Adulto , Anticorpos Antivirais/análise , Artrite/microbiologia , Artrite Infecciosa/imunologia , Criança , Pré-Escolar , Feminino , Humanos , Imunoglobulina G/análise , Imunoglobulina M/análise , Masculino , Parvovirus B19 Humano/imunologia , Fatores de TempoRESUMO
In a prospective study, levels of interleukin-1 beta (IL-1 beta), interleukin-6) (IL-6), and tumor necrosis factor (TNF) were measured in a blind fashion in cord blood plasma from 92 neonates by specific immunoassays, and were correlated with the clinical courses of the infants, including type of delivery and perinatal complications. Plasma IL-1 beta concentration was undetectable in infants born by normal vaginal delivery or elective cesarean section but was significantly increased in infants born after induced vaginal deliveries (142 +/- 68 pg/ml) or urgent cesarean section (290 +/- 21 pg/ml; both p less than 0.05 compared with normal deliveries). The IL-1 beta levels were elevated in infants with severe perinatal complications (282 +/- 116 pg/ml; p less than 0.001), whereas TNF and IL-6 levels were not related to these complications. Infants with isolated perinatal infectious complications had elevated levels of plasma IL-6 compared with those of sick neonates without infection (p less than 0.001). In contrast, TNF plasma levels and IL-1 beta production by cord blood leukocytes were decreased in infants with infectious complications alone (both p less than 0.05). These studies suggest that the levels of IL-1 beta, IL-6, and TNF in the cord plasma relate differentially to clinical complications in the perinatal period.
Assuntos
Parto Obstétrico/métodos , Sangue Fetal/química , Infecções/sangue , Interleucina-1/análise , Interleucina-6/análise , Complicações do Trabalho de Parto/sangue , Fator de Necrose Tumoral alfa/análise , Feminino , Humanos , Infecções/epidemiologia , Interleucina-1/biossíntese , Interleucina-6/biossíntese , Masculino , Complicações do Trabalho de Parto/epidemiologia , Gravidez , Estudos Prospectivos , Radioimunoensaio , Fatores de Risco , Fator de Necrose Tumoral alfa/biossínteseRESUMO
The nailfold capillary patterns of 84 patients with a variety of childhood rheumatic diseases and 34 normal control subjects were observed. Distinctive morphologic abnormalities with capillary dilation and dropout of surrounding structures were noted in two groups: patients with childhood dermatomyositis and with scleroderma (P less than 0.001). Among those with scleroderma, capillary abnormalities were found in all nine patients with systemic disease and in none of 10 patients with cutaneous disease only (Fisher's exact P less than 0.001). Of 25 patients with dermatomyositis for whom muscle biopsies were available for analysis, abnormal nailfold capillary pattern was found with highest prevalence in patients with two or more specific vascular lesions noted on biopsy (Fisher's exact P = 0.041). Nailfold capillary abnormalities are present in distinct populations of childhood rheumatic diseases, reflect the underlying vasculopathy of childhood dermatomyositis, and may be of diagnostic value in distinguishing localized from systemic scleroderma.
Assuntos
Doenças do Colágeno/patologia , Pele/irrigação sanguínea , Adolescente , Adulto , Artrite Juvenil/patologia , Capilares/patologia , Criança , Pré-Escolar , Dermatomiosite/patologia , Feminino , Humanos , Masculino , Unhas , Esclerodermia Localizada/patologia , Escleroderma Sistêmico/patologiaRESUMO
One hundred and twelve well-studied patients with a prior diagnosis of juvenile rheumatoid arthritis were differentiated into seven clinically distinct subgroups, including a group in whom recognizable ankylosing spondylitis had developed by time of follow-up. An apparent increased prevalence of HLA-B27 in the entire series (26%) was clearly related to its increased prevalence in only two subgroups: patients whose disease had progressed to overt ankylosing spondylitis (five of five patients) and boys with pauciarticular arthritis whose disease would be consistent with early ankylosing spondylitis (11 of 18 patients). There were no significant associations of B27 with systemic onset JRA, polyarticular JRA, pauciarticular JRA in girls, or JRA with chronic iridocyclitis. The only other significant alterations found were increased prevalences of HLA-A2 and HLA-BW15 in patients with polyarticular disease without identifiable rheumatoid factor. This study emphasizes that the clinical disorders included under the category of juvenile rheumatoid arthritis represent more than a single disease and that this heterogeneity must be considered in interpreting studies such as those of histocompatibility typing.
Assuntos
Artrite Juvenil/imunologia , Antígenos de Histocompatibilidade , Artrite Juvenil/classificação , Criança , Pré-Escolar , Feminino , Antígenos HLA , Humanos , Masculino , Fator Reumatoide , Espondilite Anquilosante/imunologiaRESUMO
The histocompatibility system and its associations with human diseases have been described. Although these associations remain unexplained, they represent an important step forward in the search for basic causes and mechanisms of diseases. Further studies may lead to better classifications of diseases and to an increased understanding of basic biologic processes, of etiologies of many important diseases, and of relationships between genetic and environmental susceptibility to disease. However, at the present time histocompatibility studied have little value as diagnostic or prognostic tests in clinical medicine, aside from their obvious usefulness in matching tissue donors to recipients.
Assuntos
Alergia e Imunologia , Histocompatibilidade , Doença de Addison/imunologia , Alelos , Formação de Anticorpos , Artrite/imunologia , Artrite Juvenil/imunologia , Dor nas Costas/imunologia , Doença Celíaca/imunologia , Mapeamento Cromossômico , Dermatite Herpetiforme/imunologia , Diabetes Mellitus/imunologia , Genes , Ligação Genética , Doença de Graves/imunologia , Hepatite/imunologia , Antígenos de Histocompatibilidade , Humanos , Teste de Cultura Mista de Linfócitos , Miastenia Gravis/imunologia , Psoríase/imunologia , Espondilite Anquilosante/imunologia , Tireoidite/imunologia , Uveíte Anterior/imunologiaRESUMO
Arthritis occurred in 23 of 136 (17 per cent) children and teenagers with inflammatory bowel disease, in 18 of 86 (21 per cent) patients with ulcerative colitis, and 5 of 50 (10 per cent) with granulomatous bowel disease. Eighteen children had peripheral arthritis which characteristically affected only a few large joints and was of brief duration and benign outcome. Five boys had spondylitis which was progressive and inseparable clinically from ankylosing spondylitis. Occurrence of joint manifestations was not associated with severity of bowel disease. Anemia and growth retardation occurred frequently. Mucocutaneous lesions were associated with peripheral arthritis but not with spondylitis. No patient had iridocyclitis. The possibility of bowel disease should be considered in children presenting with arthritis, particularly if gastrointestinal complaints, mucocutaneous lesions, anemia, or growth retardation are associated with pauciarticular arthritis. Peripheral arthritis is benign and regresses with improvement of underlying bowel disease but spondylitis is progressive and requires recognition and management for prevention of deformity.