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Imam SK, Alnaqeb D, Bedaiwi M, Khouj EM. Multicentric Osteolysis Nodulosis Arthropathy Syndrome Simulating Juvenile Idiopathic Arthritis in an Adult Female: A Case Report and a Literature Review. Cureus 2023; 15:e45152. [PMID: 37842447 PMCID: PMC10571385 DOI: 10.7759/cureus.45152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Multicentric osteolysis, nodulosis, and arthropathy (MONA) syndrome is one of the rare genetic skeletal dysplasias, inherited as an autosomal recessive disorder, which predominantly involves carpal and tarsal bones with characteristic osteolytic lesions and can be misdiagnosed as juvenile idiopathic arthritis or rheumatoid arthritis. MONA syndrome includes diseases involving two genes: the matrix metalloproteinase 2 (MMP2) gene and matrix metalloproteinase 14 (MMP14). Both genes are assumed to cause phenotype variants of the same disease. Older patients may manifest some arthritic features, especially in the wrist, and minute pathological fractures can occur as well. These patients may be misdiagnosed as inflammatory arthritis and physicians might prescribe corticosteroid and disease-modifying immunosuppressive agents. Therefore, physicians should carefully evaluate genetic skeletal dysplasia to make a correct diagnosis and avoid unnecessary pharmacological intervention. We report a case of MONA syndrome in an adult female who came to our facility for an intensive rehabilitation program.
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Affiliation(s)
- Syed K Imam
- Internal Medicine Department, Sultan Bin Abdulaziz Humanitarian City, Riyadh, SAU
| | - Dhekra Alnaqeb
- Internal Medicine Department, Sultan Bin Abdulaziz Humanitarian City, Riyadh, SAU
| | - Mohammad Bedaiwi
- Internal Medicine Department, College of Medicine, King Saud University, Riyadh, SAU
| | - Ebtissal M Khouj
- Translational Genomics Department, Centre for Genomic Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
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Heidt C, Grueberger N, Grisch D, Righini-Grunder F, Rueger M, Ramseier L. The Assessment of Steroid Injections as a Potential Risk Factor for Osteochondral Lesions in Children with Juvenile Idiopathic Arthritis. Cartilage 2021; 13:894S-899S. [PMID: 32985233 PMCID: PMC8808797 DOI: 10.1177/1947603520961173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Intra-articular corticosteroid injections (IACIs) are frequently used to suppress local inflammation, that is, in children with juvenile idiopathic arthritis (JIA). While systemic high-dosage corticosteroids are known to trigger osteonecrosis and result in osteochondral (OC) lesions, the effect of IACIs on joint cartilage and subchondral bone remains unclear. This study was conceived to analyze the coincidence of IACI and the subsequent manifestation of osteochondral lesions in a large cohort of pediatric JIA patients. DESIGN Retrospective data assessment and comparative analysis of skeletally immature JIA patients treated with IACIs between 1993 and 2017. RESULTS A total of 280 JIA patients were included in the analysis, the majority were girls (64%). Osteochondral lesions were present in 16 patients (5.7%) at a mean age of 10.7 years (range 4-14 years) and appeared on average after 63-month duration of disease. The majority was present at atypical locations such as the lateral femoral condyle. Multivariable analysis using cox regression showed that steroid injections were a risk factor to develop an OC lesion (hazard ratio [95%CI] for number of steroid injections per year, 8.20 [3.18, 21.16]). CONCLUSIONS Pediatric patients with JIA show a relatively high incidence of osteochondritic lesions, which present at an early age and in rather atypical locations and repetitive steroid injection need to be considered an associated risk factor.
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Affiliation(s)
- Christoph Heidt
- University Children’s Hospital Basel,
Basel, Switzerland,University Children’s Hospital Zurich,
Zurich, Switzerland,Christoph Heidt, University Children’s
Hospital Basel, Spitalstrasse 33, 4056 Basel, 4056, Switzerland.
| | | | - Domenic Grisch
- University Children’s Hospital Zurich,
Zurich, Switzerland
| | | | | | - Leonhard Ramseier
- University Children’s Hospital Zurich,
Zurich, Switzerland,Ortho Clinic Zurich, Zurich,
Switzerland
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3
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Cavazzana L, Fornili M, Filocamo G, Agostoni C, Auxilia F, Castaldi S. Hospital clinical pathways for children affected by juvenile idiopathic arthritis. Ital J Pediatr 2018; 44:139. [PMID: 30458837 PMCID: PMC6245695 DOI: 10.1186/s13052-018-0576-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/29/2018] [Indexed: 11/17/2022] Open
Abstract
Background Juvenile idiopathic arthritis (JIA) is the most common pediatric chronic rheumatic disease, which requires constant follow-up over the years, due to relapses during its progression. To maintain a good quality of life, it is important to limit admissions as far as possible. With the development of a Diagnostic Therapeutic Assistance Pathway (DTAP), we aim to select patients with suitable clinical conditions to be moved from routine hospital management to day care or outpatient treatment, evaluating the number of patients to whom this would apply. Methods Monocentric study regarding admissions for JIA between 2014 and 2016 in a Pediatric Unit of a university hospital in Milan. Through an analysis of the medical records, relevant information was extracted and collected in a Microsoft™ Excel database; starting from the data collected during the first year, a DTAP was prepared for patients with active arthritis and appropriate clinical conditions. Results The study includes data from 223 JIA hospitalization cases involving 127 patients. Applying DTAP criteria, 32% patients would have avoided admissions and 23% would have been admitted less frequently. The data concerning the activities of the Unit for JIA patients showed a relevant drop in the number of hospitalizations since 2015, from 89 in 2014 to 66 and 68 in 2015 and 2016 respectively. Conclusion The opportunity offered by DTAP, has suggested feasible changes in hospitalization management and it’s use would promote the possibility of treating the children without hospitalization, or minimizing it. In conclusion DTAP application is a priority for the continuous improvement of clinical practice and quality of life for patients and their families.
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Affiliation(s)
- L Cavazzana
- Post Graduate School of Public Health, University of Milan, Milan, Italy.
| | - M Fornili
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - G Filocamo
- Intermediate Pediatric Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C Agostoni
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Intermediate Pediatric Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - F Auxilia
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S Castaldi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,Quality Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Juvenile Idiopathic Arthritis: A Focus on Pharmacologic Management. J Pediatr Health Care 2018; 32:515-528. [PMID: 30177013 DOI: 10.1016/j.pedhc.2018.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 02/27/2018] [Indexed: 12/29/2022]
Abstract
Juvenile idiopathic arthritis is a chronic condition that affects many pediatric patients. It is a prevalent disease and has become the most common rheumatologic disease of childhood. The condition encompasses multiple different forms of chronic arthritides classified based on the location and number of joints affected as well as the presence or lack of a number of different inflammatory markers. The exact etiology is unknown but is thought to be multifactorial with genetic, humoral, and environmental factors playing a key role. Many pharmacologic agents are available for use in the treatment of juvenile idiopathic arthritis, with management involving the use of symptom-reducing agents and disease-modifying antirheumatic drugs. Treatment is not without adverse events, with many of the agents require monitoring regimens and patient education. Without treatment, the progression and chronicity of the disease can result in significant morbidity, with the potential for devastating consequences on the child's quality of life.
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Leal I, Rodrigues FB, Sousa DC, Romão VC, Duarte GS, Carreño E, Dick AD, Marques-Neves C, Costa J, Fonseca JE. Efficacy and safety of intravitreal anti-tumour necrosis factor drugs in adults with non-infectious uveitis - a systematic review. Acta Ophthalmol 2018; 96:e665-e675. [PMID: 29577629 DOI: 10.1111/aos.13699] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 12/09/2017] [Indexed: 12/29/2022]
Abstract
Anti-tumour necrosis factor (TNF) drugs have been extensively used in non-infectious uveitis (NIU), when corticosteroids or conventional immunosuppressive drugs cannot adequately control inflammation or intolerable side-effects occur. However, systemic anti-TNF therapies are also associated with a myriad of side-effects. Therefore, intravitreal administration of anti-TNF biologics has been employed to minimize patient morbidity and systemic adverse effects, while maintaining therapeutic effectivity. We undertook a systematic review to determine evidence of efficacy and safety of intravitreal administration of anti-TNF drugs in adults with NIU. We conducted this systematic review according to the PRISMA guidelines. The protocol was registered with PROSPERO (CRD42016041946). We searched CENTRAL, MEDLINE and EMBASE, from inception to April 2017, as well as clinical trial registries and grey literature. The qualitative analysis included all studies of adult patients with a diagnosis of NIU and who received intravitreal anti-TNF drugs with a 4-week minimum follow-up. A total of 4840 references were considered for title and abstract screening. Seven full texts were screened, and five studies were considered for analysis. All studies were open-label, single-centre, prospective, non-randomized, interventional case series with a follow-up between 4 and 26 weeks, employing either adalimumab in two studies and infliximab in three. Three studies showed a treatment effect of anti-TNF intravitreal injections, while one study revealed short-term improvement and one study revealed no efficacy of anti-TNF intravitreal therapy. None of the studies reported ocular adverse effects but only two studies included electrophysiological assessment in the safety analysis and no study assessed systemic human anti-drug antibodies. The available evidence is not sufficiently robust to conclude about the clinical effectivity of intravitreal anti-TNF in NIU and so no recommendation can be made. In conclusion, intravitreal injection of anti-TNF antibodies remains a possible treatment option to be explored through robust clinical investigation.
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Affiliation(s)
- Inês Leal
- Department of Ophthalmology; Hospital de Santa Maria-CHLN; Lisbon Academic Medical Centre; Lisboa Portugal
- Department of Ophthalmology; Faculdade de Medicina; Universidade de Lisboa; Lisboa Portugal
- Centro de Estudos das Ciências da Visão; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
| | - Filipe B Rodrigues
- Laboratory of Clinical Pharmacology and Therapeutics; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
- Clinical Pharmacology Unit; Instituto de Medicina Molecular; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
- Huntington's Disease Centre; University College London; London UK
| | - David Cordeiro Sousa
- Department of Ophthalmology; Hospital de Santa Maria-CHLN; Lisbon Academic Medical Centre; Lisboa Portugal
- Department of Ophthalmology; Faculdade de Medicina; Universidade de Lisboa; Lisboa Portugal
- Centro de Estudos das Ciências da Visão; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
| | - Vasco C Romão
- Department of Rheumatology; Hospital de Santa Maria-CHLN; Lisbon Academic Medical Centre; Lisbon Portugal
- Rheumatology Research Unit; Instituto de Medicina Molecular; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
| | - Gonçalo S Duarte
- Laboratory of Clinical Pharmacology and Therapeutics; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
- Clinical Pharmacology Unit; Instituto de Medicina Molecular; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
| | - Ester Carreño
- Clinical Research Unit; Bristol Eye Hospital NHS Foundation Trust; Bristol UK
| | - Andrew D Dick
- Clinical Research Unit; Bristol Eye Hospital NHS Foundation Trust; Bristol UK
- School of Clinical Sciences; Faculty of Medicine and Dentistry; University of Bristol; Bristol UK
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology; London UK
| | - Carlos Marques-Neves
- Department of Ophthalmology; Hospital de Santa Maria-CHLN; Lisbon Academic Medical Centre; Lisboa Portugal
- Department of Ophthalmology; Faculdade de Medicina; Universidade de Lisboa; Lisboa Portugal
- Centro de Estudos das Ciências da Visão; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
| | - João Costa
- Laboratory of Clinical Pharmacology and Therapeutics; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
- Clinical Pharmacology Unit; Instituto de Medicina Molecular; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
- Evidence Based Medicine Centre; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
- Portuguese Collaborating Centre of the Cochrane Iberoamerican Network; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
| | - João Eurico Fonseca
- Department of Rheumatology; Hospital de Santa Maria-CHLN; Lisbon Academic Medical Centre; Lisbon Portugal
- Rheumatology Research Unit; Instituto de Medicina Molecular; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
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Confidence amongst Multidisciplinary Professionals in Managing Paediatric Rheumatic Disease in Australia. ARTHRITIS 2018; 2018:7807490. [PMID: 29593902 PMCID: PMC5822930 DOI: 10.1155/2018/7807490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/24/2017] [Accepted: 12/19/2017] [Indexed: 11/17/2022]
Abstract
Objective Interprofessional collaboration is a crucial component of care for children with rheumatic disease. Interprofessional care, when delivered appropriately, prevents disability and improves long-term prognosis in this vulnerable group. Methods The aim of this survey was to explore allied health professionals' and nurses' confidence in treating paediatric rheumatology patients. Results Overall, 117 participants were recruited, 77.9% of participants reported being “not confident at all,” “not confident,” or “neutral” in treating children with rheumatic diseases (RD) despite 65.1% of participants reporting having treated >1 paediatric rheumatology case in the past month. Furthermore, 67.2% of participants felt their undergraduate education in paediatric rheumatology was inadequate. “Journals” or “texts books” were used by 49.3% of participants as their primary source of continuing professional development (CPD) and 39.3% of participants indicated that they did not undertake any CPD related to paediatric rheumatology. Small group and online education were perceived to be potentially of “great benefit” for CPD. Conclusion This paper highlights allied health professionals' and nurses' perceived inadequacy of their undergraduate education in paediatric RD and their low confidence in recognising and treating RD. Undergraduate and postgraduate education opportunities focusing on interprofessional collaboration should be developed to address this workforce deficiency.
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Hart RI, McDonagh JE, Thompson B, Foster HE, Kay L, Myers A, Rapley T. Being as Normal as Possible: How Young People Ages 16-25 Years Evaluate the Risks and Benefits of Treatment for Inflammatory Arthritis. Arthritis Care Res (Hoboken) 2016; 68:1288-94. [PMID: 27040737 PMCID: PMC5042182 DOI: 10.1002/acr.22832] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 12/08/2015] [Accepted: 01/05/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To explore how young people (ages 16-25 years) with inflammatory arthritis evaluate the risks and benefits of treatment, particularly treatment with biologic therapies. METHODS This qualitative study involved in-depth interviews (n = 44) with young people, trusted others (e.g., parents), and health professionals; audio-recordings (n = 4) of biologic therapy-related consultations; and focus groups (n = 4). Analysis used techniques from grounded theory (open and focused coding, constant comparison, memoing, and mapping). RESULTS Young people aspired to live what they perceived as a "normal" life. They saw treatment as presenting both an opportunity for and a threat to achieving this. Treatment changes were therefore subject to complex and ongoing evaluation, covering administration, associated restrictions, anticipated effects, and side effects. Information sources included expert opinion (of professionals and other patients) and personal experience. Previous treatments provided important reference points. Faced with uncertain outcomes, young people made provisional decisions. Both trusted others and health professionals expressed concern that young people were too focused on short-term outcomes. CONCLUSION Young people value treatment that helps them to live a "normal" life. There is more to this than controlling disease. The emotional, social, and vocational consequences of treatment can be profound and lasting: opportunities to discuss the effects of treatment should be provided early and regularly. While making every effort to ensure understanding of the long-term clinical consequences of taking or not taking medication, the wider impact of treatment should not be dismissed. Only through understanding young people's values, preferences, and concerns can a sustainable balance between disease control and treatment burden be achieved.
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Affiliation(s)
| | | | - Ben Thompson
- Newcastle Hospitals NHS Foundation TrustNewcastle‐upon‐TyneUK
| | - Helen E. Foster
- Newcastle Hospitals NHS Foundation Trust and Newcastle UniversityNewcastle‐upon‐TyneUK
| | - Lesley Kay
- Newcastle Hospitals NHS Foundation TrustNewcastle‐upon‐TyneUK
| | - Andrea Myers
- Northumbria Healthcare NHS Foundation TrustNorth ShieldsUK
| | - Tim Rapley
- Newcastle UniversityNewcastle‐upon‐TyneUK
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Kearsley-Fleet L, Davies R, Baildam E, Beresford MW, Foster HE, Southwood TR, Thomson W, Hyrich KL. Factors associated with choice of biologic among children with Juvenile Idiopathic Arthritis: results from two UK paediatric biologic registers. Rheumatology (Oxford) 2016; 55:1556-65. [PMID: 26732349 PMCID: PMC4993954 DOI: 10.1093/rheumatology/kev429] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 11/25/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The objectives of this study were to describe patients starting first-line biologics for JIA, to describe characteristics over time among patients starting etanercept, and to describe patterns of second biologic prescribing. METHODS The British Society for Paediatric and Adolescent Rheumatology Etanercept Cohort Study, and the Biologics for Children with Rheumatic Diseases study are ongoing prospective observational cohorts, collecting data on patients starting biologic therapy for JIA. Patients registered from 1 January 2010 starting their first biologic were compared between therapies. Patients starting etanercept before 2010 were included to analyse changes in etanercept prescribing. The pathway of patients starting a second biologic was recorded in all patients. RESULTS To 26 August 2014, 931 patients were recruited starting a first-line biologic (142 Biologics for Children with Rheumatic Diseases; 789 British Society for Paediatric and Adolescent Rheumatology Etanercept Cohort Study). From 2010, patients with systemic JIA (sJIA) were almost exclusively prescribed anakinra or tocilizumab. Choice between anti-TNF therapies was largely driven by history of chronic anterior uveitis (CAU). When investigating trends in patients starting etanercept over time, disease duration at etanercept start, patients with sJIA, a history of CAU, and those who received concomitant oral corticosteroids decreased over time. Patients who started a second biologic from 1 January 2010 showed a similar stratification. CONCLUSION Although etanercept remains the most common biologic prescribed for JIA, there has been a clear shift towards the use of alternative biologics, largely driven by disease subtype and history of CAU. This channelling of children towards specific therapies should be considered carefully in future studies and in clinical guidelines and ongoing research.
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Affiliation(s)
- Lianne Kearsley-Fleet
- Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, The University of Manchester, Manchester
| | - Rebecca Davies
- Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, The University of Manchester, Manchester
| | | | - Michael W Beresford
- Clinical Academic Department of Paediatric Rheumatology, Institute of Translational Medicine (Child Health), University of Liverpool, Alder Hey Children's NHS Foundation Trust, Liverpool
| | - Helen E Foster
- Musculoskeletal Research Group, Institute Cellular Medicine, Newcastle University, Newcastle upon Tyne
| | - Taunton R Southwood
- Department of Paediatric Rheumatology, Institute of Child Health, Birmingham Children's Hospital - NHS Trust and University of Birmingham, Birmingham
| | - Wendy Thomson
- Arthritis Research UK Centre for Genetics and Genomics, Manchester Academic Health Science Centre and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK
| | - Kimme L Hyrich
- Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, The University of Manchester, Manchester, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK
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Barth S, Schlichtiger J, Bisdorff B, Hügle B, Michels H, Radon K, Haas JP. Association between drug intake and incidence of malignancies in patients with Juvenile Idiopathic Arthritis: a nested case-control study. Pediatr Rheumatol Online J 2016; 14:6. [PMID: 26842529 PMCID: PMC4739096 DOI: 10.1186/s12969-016-0066-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 01/29/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Several medications for treatment of Juvenile Idiopathic Arthritis (JIA) are considered to be carcinogenic. Therefore, the aim was to assess whether there is an association between therapeutic interventions and malignancies in JIA patients. FINDINGS A nested case-control study was carried out within a retrospective cohort study of 3698 JIA patients diagnosed between 1952 and 2010. All 48 JIA patients with a diagnosis of a malignant tumour and up to four matched controls for each received a questionnaire about their use of medication. Subsequently treatment was compared between cases and controls and analyses performed for 37 cases and 125 controls (response 88.5 %). Treatment with DMARD (84 %) was most frequently used, followed by glucocorticoids (66 %) and immunosuppressives (65 %). Twenty percent reported to have ever been taking biologics. Medication use did not differ significantly between cases and controls. CONCLUSIONS Our results did not show an association between medications used and malignancies in JIA patients.
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Affiliation(s)
- Swaantje Barth
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Munich (Ludwig-Maximilans-University), Ziemssenstr.1, 80337, Munich, Germany.
| | - Jenny Schlichtiger
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Munich (Ludwig-Maximilans-University), Ziemssenstr.1, 80337, Munich, Germany.
| | - Betty Bisdorff
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Munich (Ludwig-Maximilans-University), Ziemssenstr.1, 80337, Munich, Germany.
| | - Boris Hügle
- German Center for Pediatric and Adolescent Rheumatology, Gehfeldstraße 24, 82467, Garmisch-Partenkirchen, Germany.
| | - Hartmut Michels
- German Center for Pediatric and Adolescent Rheumatology, Gehfeldstraße 24, 82467, Garmisch-Partenkirchen, Germany.
| | - Katja Radon
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Munich (Ludwig-Maximilans-University), Ziemssenstr.1, 80337, Munich, Germany.
| | - Johannes-Peter Haas
- German Center for Pediatric and Adolescent Rheumatology, Gehfeldstraße 24, 82467, Garmisch-Partenkirchen, Germany.
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