Background: Juvenile idiopathic arthritis (JIA) refers to a group of auto-immune conditions involving joint inflammation that first appears before the age of 16. In the United States, about 294,000 children are affected. Although JIA can be widely attributed to genetic factors, the consensus is that environmental factors also play a role. Attempts to assess the role of environmental factors, though scarce, have focused on the role of infections, smoking exposure, and breastfeeding. Hygiene hypothesis, which suggests that adaptive immunological response improves with higher frequencies of pathogen exposure in early childhood, has been used to try to explain the risk of JIA. Common markers of microbe exposure in early life include sibling number, pet number, and maternal parity. Some prior studies conducted outside the U.S. suggests that increasing sibling number is protective against the risk of JIA. This study aimed to evaluate prior findings, using data from the U.S. Methods: The study used data from the 2017 Centers for Disease Control and Prevention National Survey for Child Health. The survey used a sample size of 21599 children to estimate the number of children in the U.S. Descriptive statistics was carried out, and logistic regression was used to determine the association between family number and the odds of developing JIA, while adjusting for sociodemographic variables. Family number was used as a proxy for sibling number. SAS v 9.4 was used for analysis. Results: Complete data on all the variables of interest were available for 17618 children, of which 67 had JIA. Although there was a marginal association between sibling number and JIA in the unadjusted model (OR [95% CI] 0.983-1.602) (P=0.068), in the adjusted model, there was no significant association between JIA and sibling number ([OR 95% CI] 0.8985-1.447) (P=0.29). There was a significant association between JIA and age, low birth weight, highest education level in the family, while sex had a marginal association. Conclusion: There was no association between family size and the development of JIA in this study. While some prior results have supported the observed significant effect of low birth weight, the disparity in results between this study and the Australian study could be due to the use of family number instead of sibling number. Further studies should assess the association of sibling number and developing JIA in the U.S.

I Sverige drabbas varje år ca 200-250 barn och ungdomar av sjukdomen juvenil idiopatisk artrit (JIA). JIA är en av de vanligaste orsakerna till kortvarig och långvarig funktionsnedsättning och försämring av livskvalitet under barnaåren. Hela familjen påverkas när en familjemedlem blir sjuk. Syfte: Syftet med denna studie var att belysa hur en långvarig sjukdom som JIA upplevs av barn, ungdomar och deras familjer. Metod: Metoden som användes var en allmän litteraturöversikt. Totalt inkluderades 7 kvantitativa och 5 kvalitativa artiklar. Resultat: Vid analysen identifierades ett huvudtema upplevelser av att vara annorlunda. Resultatet visar att upplevelserna av att leva med JIA är mycket individuella men gemensamt för många av familjerna är en känsla av att vara annorlunda. Konklusion: När ett barn eller ungdom drabbas av en långvarig sjukdom påverkas hela familjen. Livssituationen förändras, även föräldrarnas och syskonens livsvärld blir förändrad. Varje barn och ungdom som drabbas av sjukdomen JIA är unik och har sin egen livsvärld. Som sjuksköterska är det betydelsefullt att se hela individen och involvera dess familj i omvårdnaden. / In Sweden 200-250 children and youths are affected with juvenile idiopathic arthritis (JIA) every year. JIA is one of the most common causes of short-term and long-term disability and impairment of quality of life during childhood. The entire family is affected when a family member becomes ill. Aim: The aim with this study was to illustrate how a prolonged disease as JIA is experienced by children, youths and their families. Method: The method used was a general literature overview. In total 7 quantitative and 5 qualitative articles. Result: During analysis one main themes were identified. This was experiences of being different. The result showed that the experiences of living with JIA is individual but common for many of the families is a sense of being different. Conclusion: When a child or youth is struck by protracted disease, this also affects family members. The life situation is affected, and also the life situation for parents, brothers and sisters is changed. Every child and youth who is affected by JIA is unique, and has its own reality. As a nurse it is meaningful to see the entire individual, and to involve its family in to the nursing.

Juvenile idiopathic arthritis (JIA) is a chronic rheumatic disease associated with pain, stiffness and increased psychosocial burden. The purpose of this study was to investigate through an ABAB single-case design the impact of a yoga intervention on pain and morning stiffness in adolescent females with JIA. A secondary aim was to assess the impact of this intervention on self-efficacy, mindfulness, and health-related quality of life (HRQOL). Two adolescents with JIA participated in three yoga groups and daily home yoga practice with a DVD. Participants engaged in daily self-monitoring of pain and stiffness and completed questionnaires assessing psychosocial functioning at pre- and post-intervention. A three-month follow-up on primary and secondary measures was conducted. Primary outcomes were evaluated using visual inspection and the conservative dual criterion (CDC) method. Results suggested that for one participant, there were no overall systematic changes in pain or stiffness as a result of the intervention; however, trends toward changes in pain were present during the final phases of the study. For the second participant, systematic changes were observed across most but not all phases for morning stiffness, whereas results for pain were less consistent. Modest changes were revealed on secondary outcome measures; however, not consistently in the direction of hypotheses. Lack of stable baseline data for both participants was a significant limitation of the study and is discussed. More research is needed to determine if the yoga intervention utilized in this study is an effective method for reducing pain and stiffness and enhancing psychosocial functioning in adolescent girls with JIA.

Varje år diagnostiseras cirka 200 barn med juvenil idiopatisk artrit (JIA) i Sverige. Det är inte bara inom specialistvården sjuksköterskor möter barn med JIA, utan även inom allmän sjukvård. Syftet med studien var att belysa omvårdnad för barn med juvenil idiopatisk artrit. Studien är en litteraturstudie. Resultatet belyser vad som är viktigt vid omvårdnaden för barn med JIA. Detta presenteras i tre teman: Bemötande, Information och undervisning och Emotionellt stöd. Ett bra bemötande är viktigt för att barnen skall känna tillit till sjukvården. Det är viktigt att göra barnen delaktiga. Barnen är experter på upplevelsen av sin egen sjukdom. Barnen behöver få emotionellt stöd för att kunna hantera sin vardag. Stödet kan komma från sjuksköterskorna eller Internetsidor. För att barnen skall kunna hantera sin sjukdom och sin situation krävs undervisning och information. Information kan ges i form av broschyrer och böcker samt från sjuksköterskorna och Internet. Önskvärt hade varit om grundutbildningen för sjuksköterskor innefattade omvårdnad för barn. De kunskaper grundutbildade sjuksköterskor har med sig efter examen kan tas tillvara genom att de kan uppmärksamma symtomen som ett barn med JIA har, och utefter det forma omvårdnadsåtgärder. Forskning på JIA är begränsad ur ett omvårdnadsperspektiv, och kunskapsluckorna behöver uppmärksammas. / Every year about 200 children are diagnosed with juvenile idiopathic arthritis (JIA) in Sweden. It is not only in specialized care nurses meet children who suffer from JIA, but also in universal health care. The aim of the study was to express the nursing care for children with juvenile idiopathic arthritis. This study is a literature study. The result highlights what is important in the nursing care of nursing children with JIA. This is presented in three themes: Attitudes, Information and teaching and Emotional support. A good attitude towards the children is very important so they feel a trust to the health care. It is important to make the children involved. Children are experts on the experience of their own illness. The children need emotional support to handle their everyday life. The support can come from the nurse or from Internet pages. If children shall be able to manage their condition and their situation, it requires education and information. The information can be provided from brochures, books, the nurse or the Internet. It would be desirable if nursing school would include nursing children. The knowledge a regular nurse has after the graduation can be taken advantage because they can pay attention to the symptoms a child with JIA has and shape nursing interventions. The research within JIA is limited from a nursing perspective, and knowledge gaps need attention.

Objetivos: Avaliar associações da velocidade de crescimento com marcadores inflamatórios e dose cumulativa de glicorticóide em uma coorte de pacientes com Artrite Idiopática Juvenil acompanhados por 1 ano. Material e Métodos: Foram avaliados 79 pacientes com AIJ segundo critérios da ILAR. A atividade clínica da doença foi classificada por médicos reumatologistas pediátricos. Os dados antropométricos foram mensurados e classificados de acordo com as normas da Organização Mundial da Saúde. Foram utilizadas curvas de velocidade de crescimento segundo Tanner; considerou-se baixa velocidade de crescimento valores de escore Z ≤ -2. Concentrações séricas de IL-6 foram mensuradas por ELISA no período basal, e valores acima de 1 pg/ml foram considerados elevados. Resultados: Baixa velocidade de crescimento teve uma prevalência de 25,3% e esteve associada com atividade da doença no período do seguimento (p=0,085), valores elevados de IL-6 (interleucina-6) (p=0,003), velocidade de sedimentação globular (VSG) (p=0,022) e proteína C reativa (PCR) (p=0,001) e maior dosagem cumulativa de glicocorticóide (0=0,044). Na regressão linear múltipla tendo como variável dependente a velocidade de crescimento, observou-se que somente os níveis elevados de IL-6 foram independente e negativamente associados com a velocidade de crescimento (p=0,025). Conclusão: Baixa velocidade de crescimento é altamente prevalente em crianças com AIJ. Níveis elevados de IL-6 têm um importante impacto negativo no crescimento desses pacientes, enquanto a exposição ao glicocorticóide total parece ser um fator secundário. / Objective: To evaluate associations of growth velocity with inflammatory markers and cumulative dose of glucocorticoid in a cohort of patients with Juvenile Idiopathic Arthritis (JIA) followed during 1 year. Methods: Seventy-nine patients were evaluated by criteria according to the ILAR. The disease activity was evaluated by a pediatric rheumatologist. The anthropometic data were measured and classified according to the World Health Organization standards. Growth velocity curves were used according to Tanner, values below the Z-score ≤ -2 were considered low growth velocity. Serum concentrations of IL-6 were measured by ELISA in the baseline period, and values over 1pg/ml were considered as elevated. Results: The prevalence of low growth velocity was 25.3%, and it was associated with: active disease on follow-up visit (p=0,085), elevated interleukin-6 (IL-6) (p=0,003), erythrocyte sedimentation rate (ESR) (p=0,022) and C-reactive protein (CRP) (p=0,001) and higher cumulative glucocorticoid doses (0=0,044). In the multiple linear regression with growth velocity as the dependent variable, only elevated IL-6 levels were independently and negatively associated with growth velocity (p=0,025). Conclusion: Low growth velocity is highly prevalent in children with JIA. Elevated IL-6 levels seem to have an important negative impact on growth in these children, while total glucocorticoid exposure appears to be a secondary factor.

A Artrite idiopática juvenil (AIJ) é a artropatia crônica mais prevalente na infância e adolescência. A prevalência da síndrome metabólica, assim como da obesidade, vem apresentando um rápido aumento, atingindo todas as faixas etárias, incluindo a infância. A síndrome metabólica é caracterizada por um conjunto de riscos para doença cardiovascular e diabetes melito tipo 2, incluindo adiposidade abdominal, resistência à insulina, dislipidemias e hipertensão arterial sistêmica. Além destes componentes, a inflamação tem sido reconhecida cada vez mais como um fator importante na síndrome metabólica e obesidade, e pacientes com doenças caracterizadas por processos inflamatórios crônicos, como a AIJ, poderiam representar grupos de risco especiais. Os glicocorticoides são utilizados rotineiramente no controle da inflamação da artrite idiopática juvenil, em doses elevadas e com uso prolongado. O uso crônico do glicocorticoide pode induzir resistência à insulina, hipertensão arterial sistêmica e obesidade, aumentando o risco de desenvolver síndrome metabólica. O presente trabalho tem como objetivo avaliar a prevalência de obesidade e síndrome metabólica em pacientes com AIJ. Em pacientes acompanhados no Serviço de Reumatologia do Hospital de Clínicas de Porto Alegre (HCPA) e Hospital da Criança Santo Antônio (complexo Santa Casa) foram observados uma prevalência de 19,7% de síndrome metabólica e 22,7% de obesidade, sem diferença entre os subtipos da doença. A obesidade foi associada com tempo de duração da doença, obesidade abdominal, pressão arterial elevada, resistência à insulina e presença de síndrome metabólica. O IMC, circunferência da cintura, triglicerídeos, baixos níveis de HDL-c, pressão arterial sistólica e diastólica, níveis séricos de insulina e resistência a insulina (HOMA-ir) mostraram associação com a SM (p<0,05). Não houve associação entre a presença de SM e dose cumulativa de glicocorticoide, atividade da doença e tempo de duração da doença. Os resultados mostram uma alta frequência de obesidade e síndrome metabólica em pacientes com AIJ, sugerindo um aumento do risco de futuras complicações cardiovasculares. e parecem ser independentes do uso de glicocorticoide. Ações de intervenção são necessárias entre os pacientes com AIJ para reduzir o excesso de peso, evitar as complicações metabólicas e fatores de risco cardiovasculares na vida adulta. / Juvenile idiopathic arthritis is the most prevalent chronic arthropathy in childhood and adolescence. The prevalence of metabolic syndrome, as well as obesity, is increasing fast, in all age groups, including the childhood. Metabolic syndrome is defined as a cluster of risk factors for cardiovascular and type 2 diabetes, including abdominal obesity, insulin resistance, dyslipidaemia and hypertension. Besides these components, inflammation has been increasingly considered as a significant component in metabolic syndrome and obesity, and patients with diseases characterized by the presence of chronic inflammation, such as JIA, could represent special groups of risk. Glucocorticoids are used routinely in the management of the inflammation of JIA, in high doses and long-term. Long-term use of the glucocorticoids can cause insulin resistance, hypertension and obesity, increasing the risk for the metabolic syndrome. The aim of the present study was to evaluate prevalence of the obesity and metabolic syndrome in patients with juvenile idiopathic arthritis (JIA). In patients followed in the Hospital de Clínicas de Porto Alegre (HCPA) and Hospital da Criança Santo Antônio (Santa Casa Complex) service of reumatology were observed a prevalence of 19.7% of metabolic syndrome and 22.7% of obese, without difference between the subtypes of the disease. Obesity was associated with disease duration, abdominal obesity, arterial hypertension, insulin resistance and presence of metabolic syndrome. BMI, waist circunference, triglycerides, low HDL-c level, systolic and diastolic BP, fasting insulin serum levels and insulin resistance (HOMA-ir) showed significant association with MetS (p<0,05). There was no correlation between the presence of metabolic syndrome and cumulative glucocorticoid dose, disease activity and duration of disease. The results showed that there were high frequencies of obesity and metabolic syndrome in JIA patients and use appears to be indeoendent of the use glucocorticoid. Intervation actions are needed among JIA patients, to decrease excess weight, metabolic complications and cardiovascular risk factors in adulthood.

Made available in DSpace on 2015-07-22T20:49:38Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-04-27 / Objetivo: Determinar as concentrações séricas de 25-hidroxicolecalciferol (25(OH)D), cálcio sérico total, fósforo sérico, fosfatase alcalina e paratormônio (PTH) em pacientes com artrite idiopática juvenil (AIJ) poliarticular e associá-las com a atividade e duração da doença, com a densidade mineral óssea e com o uso de medicamentos. Método: Por meio de um estudo transversal e controlado, foram avaliados 30 pacientes com AIJ poliarticular, pareados por sexo e idade com 30 controles saudáveis. Realizou-se avaliação clínica, antropométrica e laboratorial nos pacientes e controles e densitometria óssea nos pacientes. Resultados: Dos 30 pacientes incluídos no estudo, 23 (76,7%) eram meninas, 16 (53,3%) não caucasóides e com média de idade de 14 anos (4 a 20 anos). O tempo médio de doença foi 5 anos. Concentrações médias de cálcio sérico total e fosfatase alcalina foram significantemente mais baixas nos pacientes com AIJ comparativamente aos controles (p< 0,0001 e p= 0,001, respectivamente). Em relação a 25(OH)D, PTH e fósforo sérico não se observaram diferenças entre os grupos AIJ e controle. Quanto às concentrações séricas de 25(OH)D, 8 pacientes (26,7%) e 5 controles (16,7%) apresentaram valores compatíveis com deficiência (inferiores a 20 ng/ml) e 14 pacientes (46,7%) e 18 controles (60%) apresentaram valores compatíveis com insuficiência (entre 20–32 ng/ml). Estes valores não se associaram com a atividade de doença, com o uso de medicamentos ou densidade mineral óssea. Conclusão: Observamos elevada frequência de insuficiência e deficiência de 25(OH)D nas amostras estudadas. O comprometimento do metabolismo ósseo enfatiza a importância do acompanhamento evolutivo dos pacientes com AIJ. / Objective: To determine serum concentrations of 25-hydroxycholecalciferol (25(OH)D) and biochemical markers of bone turnover in patients with polyarticular juvenile idiopathic arthritis (JIA) and to associate them with disease activity and duration, with bone mineral density and with use of medications. Methods: In a cross-sectional and controlled study, 30 patients with polyarticular JIA were assessed, compared with 30 age and sex-matched healthy subjects. We evaluated clinical, anthropometric, laboratory parameters and dual-energy x-ray absorptiometry (DEXA). Results: Out of 30 patients included in the study, 23 (76.7%) were girls, 16 (53.3%) no caucasian and the mean age was 14 years old (4 to 20 years). The mean time of disease was 5 years. The mean serum calcium and phosphatase alkaline were significantly lower in patients with JIA compared to controls (p<0.0001 and p=0.001, respectively). There was no difference between the serum concentrations of 25(OH)D, PTH and phosphorus between patients and controls. Based on serum 25(OH)D concentrations, 8 patients (26.7%) and 5 controls (16.7%) were vitamin D deficient (< 20 ng/ml) and 14 patients (46.7%) and 18 controls (60%) were vitamin D insufficient (between 20 and 32 ng/ml). These values were not associated with disease activity, use of medications or bone mineral density. Conclusions: A high frequency of 25(OH)D insufficiency and defficiency was observed in the study population. The involvement of biochemical bone markers emphasizes the importance of the bone metabolism follow-up in patients with JIA. / TEDE / BV UNIFESP: Teses e dissertações

Objetivos: Avaliar associações da velocidade de crescimento com marcadores inflamatórios e dose cumulativa de glicorticóide em uma coorte de pacientes com Artrite Idiopática Juvenil acompanhados por 1 ano. Material e Métodos: Foram avaliados 79 pacientes com AIJ segundo critérios da ILAR. A atividade clínica da doença foi classificada por médicos reumatologistas pediátricos. Os dados antropométricos foram mensurados e classificados de acordo com as normas da Organização Mundial da Saúde. Foram utilizadas curvas de velocidade de crescimento segundo Tanner; considerou-se baixa velocidade de crescimento valores de escore Z ≤ -2. Concentrações séricas de IL-6 foram mensuradas por ELISA no período basal, e valores acima de 1 pg/ml foram considerados elevados. Resultados: Baixa velocidade de crescimento teve uma prevalência de 25,3% e esteve associada com atividade da doença no período do seguimento (p=0,085), valores elevados de IL-6 (interleucina-6) (p=0,003), velocidade de sedimentação globular (VSG) (p=0,022) e proteína C reativa (PCR) (p=0,001) e maior dosagem cumulativa de glicocorticóide (0=0,044). Na regressão linear múltipla tendo como variável dependente a velocidade de crescimento, observou-se que somente os níveis elevados de IL-6 foram independente e negativamente associados com a velocidade de crescimento (p=0,025). Conclusão: Baixa velocidade de crescimento é altamente prevalente em crianças com AIJ. Níveis elevados de IL-6 têm um importante impacto negativo no crescimento desses pacientes, enquanto a exposição ao glicocorticóide total parece ser um fator secundário. / Objective: To evaluate associations of growth velocity with inflammatory markers and cumulative dose of glucocorticoid in a cohort of patients with Juvenile Idiopathic Arthritis (JIA) followed during 1 year. Methods: Seventy-nine patients were evaluated by criteria according to the ILAR. The disease activity was evaluated by a pediatric rheumatologist. The anthropometic data were measured and classified according to the World Health Organization standards. Growth velocity curves were used according to Tanner, values below the Z-score ≤ -2 were considered low growth velocity. Serum concentrations of IL-6 were measured by ELISA in the baseline period, and values over 1pg/ml were considered as elevated. Results: The prevalence of low growth velocity was 25.3%, and it was associated with: active disease on follow-up visit (p=0,085), elevated interleukin-6 (IL-6) (p=0,003), erythrocyte sedimentation rate (ESR) (p=0,022) and C-reactive protein (CRP) (p=0,001) and higher cumulative glucocorticoid doses (0=0,044). In the multiple linear regression with growth velocity as the dependent variable, only elevated IL-6 levels were independently and negatively associated with growth velocity (p=0,025). Conclusion: Low growth velocity is highly prevalent in children with JIA. Elevated IL-6 levels seem to have an important negative impact on growth in these children, while total glucocorticoid exposure appears to be a secondary factor.

A Artrite idiopática juvenil (AIJ) é a artropatia crônica mais prevalente na infância e adolescência. A prevalência da síndrome metabólica, assim como da obesidade, vem apresentando um rápido aumento, atingindo todas as faixas etárias, incluindo a infância. A síndrome metabólica é caracterizada por um conjunto de riscos para doença cardiovascular e diabetes melito tipo 2, incluindo adiposidade abdominal, resistência à insulina, dislipidemias e hipertensão arterial sistêmica. Além destes componentes, a inflamação tem sido reconhecida cada vez mais como um fator importante na síndrome metabólica e obesidade, e pacientes com doenças caracterizadas por processos inflamatórios crônicos, como a AIJ, poderiam representar grupos de risco especiais. Os glicocorticoides são utilizados rotineiramente no controle da inflamação da artrite idiopática juvenil, em doses elevadas e com uso prolongado. O uso crônico do glicocorticoide pode induzir resistência à insulina, hipertensão arterial sistêmica e obesidade, aumentando o risco de desenvolver síndrome metabólica. O presente trabalho tem como objetivo avaliar a prevalência de obesidade e síndrome metabólica em pacientes com AIJ. Em pacientes acompanhados no Serviço de Reumatologia do Hospital de Clínicas de Porto Alegre (HCPA) e Hospital da Criança Santo Antônio (complexo Santa Casa) foram observados uma prevalência de 19,7% de síndrome metabólica e 22,7% de obesidade, sem diferença entre os subtipos da doença. A obesidade foi associada com tempo de duração da doença, obesidade abdominal, pressão arterial elevada, resistência à insulina e presença de síndrome metabólica. O IMC, circunferência da cintura, triglicerídeos, baixos níveis de HDL-c, pressão arterial sistólica e diastólica, níveis séricos de insulina e resistência a insulina (HOMA-ir) mostraram associação com a SM (p<0,05). Não houve associação entre a presença de SM e dose cumulativa de glicocorticoide, atividade da doença e tempo de duração da doença. Os resultados mostram uma alta frequência de obesidade e síndrome metabólica em pacientes com AIJ, sugerindo um aumento do risco de futuras complicações cardiovasculares. e parecem ser independentes do uso de glicocorticoide. Ações de intervenção são necessárias entre os pacientes com AIJ para reduzir o excesso de peso, evitar as complicações metabólicas e fatores de risco cardiovasculares na vida adulta. / Juvenile idiopathic arthritis is the most prevalent chronic arthropathy in childhood and adolescence. The prevalence of metabolic syndrome, as well as obesity, is increasing fast, in all age groups, including the childhood. Metabolic syndrome is defined as a cluster of risk factors for cardiovascular and type 2 diabetes, including abdominal obesity, insulin resistance, dyslipidaemia and hypertension. Besides these components, inflammation has been increasingly considered as a significant component in metabolic syndrome and obesity, and patients with diseases characterized by the presence of chronic inflammation, such as JIA, could represent special groups of risk. Glucocorticoids are used routinely in the management of the inflammation of JIA, in high doses and long-term. Long-term use of the glucocorticoids can cause insulin resistance, hypertension and obesity, increasing the risk for the metabolic syndrome. The aim of the present study was to evaluate prevalence of the obesity and metabolic syndrome in patients with juvenile idiopathic arthritis (JIA). In patients followed in the Hospital de Clínicas de Porto Alegre (HCPA) and Hospital da Criança Santo Antônio (Santa Casa Complex) service of reumatology were observed a prevalence of 19.7% of metabolic syndrome and 22.7% of obese, without difference between the subtypes of the disease. Obesity was associated with disease duration, abdominal obesity, arterial hypertension, insulin resistance and presence of metabolic syndrome. BMI, waist circunference, triglycerides, low HDL-c level, systolic and diastolic BP, fasting insulin serum levels and insulin resistance (HOMA-ir) showed significant association with MetS (p<0,05). There was no correlation between the presence of metabolic syndrome and cumulative glucocorticoid dose, disease activity and duration of disease. The results showed that there were high frequencies of obesity and metabolic syndrome in JIA patients and use appears to be indeoendent of the use glucocorticoid. Intervation actions are needed among JIA patients, to decrease excess weight, metabolic complications and cardiovascular risk factors in adulthood.

Made available in DSpace on 2014-06-11T19:29:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-02-26Bitstream added on 2014-06-13T19:59:21Z : No. of bitstreams: 1 sato_jo_me_botfm.pdf: 837870 bytes, checksum: 61feb55418bf3755870bbd16ff20c4c0 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Avaliar as propriedades clinimétricas do Juvenile Arthritis Damage Index (JADI), e de seus componentes articular (JADI – A) e extra-articular (JADI – E), em diferentes subtipos de Artrite Idiopática Juvenil (AIJ), caracterizando-se os danos e estabelecendo-se a probabilidade de dano articular e extra-articular durante o curso da AIJ. Uma avaliação transversal foi realizada em uma série de casos de AIJ, entre 2006 e 2008. Os dados clínicos e demográficos, exame articular, pontuação do JADI-A e JADI-E, compilação do Childhood Health Assessment Questionnaire (CHAQ) e das escalas visuais analógicas para dor e bem-estar global pelos pais e pelo médico, classificação funcional de Steinbrocker e avaliação radiológica foram realizados durante uma visita ambulatorial. A avaliação longitudinal retrospectiva foi realizada da primeira até última visita ao serviço (1997 a 2008), observando-se as medidas de desfecho e tratamento. As propriedades de medida do JADI-A e JADI-E foram correlacionadas ao desfecho e a probabilidade de dano analisada por meio de curva de sobrevida com cálculo do risco de dano anual. Foram incluídos cento e um casos de AIJ, classificados como oligoarticular persistente (68,3%), artrite relacionada à entesite (8,9%), oligoarticular estendido (7,9%), poliarticular fator reumatóide (FR) + (5,0%), sistêmica (5,0%), poliarticular FR - (4,0%) e artrite psoriásica (1%), idade de início 7,1 anos (0,9 – 14,2) e duração da doença 2,7 anos (0,3 – 18,6), 66,3% em atividade, ANA + em 46,5% e HLA-B27 + em 5%. Noventa e oito porcento receberam AINH, 21,8% corticosteróides, 50,5% corticosteróide intra-articular, 39,6% DMARD e 10,9% agentes biológicos. Oitenta e três porcento não apresentavam incapacidade funcional pela classificação de Steinbrocker, e 53% pelo CHAQ. Foram observados dano articular em 45,5% e extra-articular nem 37,6% dos casos... / To assess clinimetric properties of the Juvenile Arthritis Damage Index (JADI) and its two components, articular (JADI-A) and extraarticular (JADI-E), in different subtypes of Juvenile Idiopathic Arthritis (JIA), in order to characterize the damage and to establish the probability of articular and extraarticular damage during the course of JIA. A cross-sectional evaluation in a JIA case series was carried out, between 2006 and 2008. The clinical and demographic data, joint assessment, JADI-A and JADI-E scoring, Childhood Health Assessment Questionnaire (CHAQ) scoring as well as physician’s global assessment, pain and child’s overall well-being by visual analog scale (VAS), Steinbrocker functional and radiographic assessments were assessed during a routine clinic visit. A retrospective longitudinal case-note revision was performed collecting data from the first to the last visit (1997 to 2008) for recording outcome measures and treatment. JADI-A and JADI-E measurement properties were correlated with outcome measures and the damage probability calculated by survival analysis alongside the damage risk calculated year by year. One hundred and one cases of JIA were included, classified as persistent oligoarthritis (68.3%), enthesitis-related arthritis (8.9%), extended oligoarthritis (7.9%), positive rheumatoid factor (RF) polyarthritis (5.0%), systemic arthritis (5.0%), negative RF polyarthritis (4.0%) and psoriatic arthritis (1.0%), age at onset 7.1 years (0.9 – 14.2), and disease duration 2.7 years (0.3 – 18.6), active disease in 66.3%, positive ANA in 46.5%, positive HLA-B27 in 5%. Ninety eight percent received NSAID, 21.8% corticosteroid, 50.5% intraarticular corticosteroid, 39.6% DMARD and 10.9% biologic agent. Eighty three percent did not have functional disability by Steinbrocker classification, and 53% baseline CHAQ. Overall, joint damage was observed in 45.5% and extraarticular... (Complete abstract click electronic access below)