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Bethencourt-Baute JJ, Montero N, Zacarias AM, Nieto JC, López-Corbeto M, Boteanu A, Medrano M, Díaz-Cordovés Rego G, Vargas-Lebron C, Machín-García S, Expósito L, Cacheda AP, Bernabeu P, Veroz-González R, Fernández O, Enriquez Merayo E, Torrente-Segarra V, Fernández-Alba MD, Gamir ML, López-Robledillo JC, Antón J, Otero L, Bustabad S. Juvenile idiopathic arthritis in the young adult. Methodology, objectives, and initial data from the JUVENSER registry. REUMATOLOGIA CLINICA 2023:S2173-5743(23)00101-6. [PMID: 37258400 DOI: 10.1016/j.reumae.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/30/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To describe the methodology, objectives, and initial data of the registry of young adult patients diagnosed with Juvenile Idiopathic Arthritis (JIA), JUVENSER. The main objective of the project is to know the sociodemographic and clinical characteristics, and disease activity of patients with JIA reaching the transition to adulthood. MATERIAL AND METHOD Longitudinal, prospective, multicentre study, including patients between 16 and 25 years old, with a diagnosis of JIA in any of its categories. The main objective is to determine the characteristics and activity of JIA in the young adult. It includes sociodemographic variables, clinical variables, disease activity and joint damage rates, data on the use of health resources, and treatments used. The total duration of the project will be 3 years. A cohort of 534 young adult patients was obtained. CONCLUSIONS The JUVENSER registry will constitute a cohort of young adults with JIA, which will allow the evaluation of the clinical characteristics and response to treatment of patients with disease onset in childhood, moving to adult clinics.
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Affiliation(s)
| | - Nuria Montero
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain
| | - Andrea M Zacarias
- Unidad de Transición, Hospital Sant Joan de Déu. Hospital Clínic de Barcelona, Barcelona, Spain
| | - Juan Carlos Nieto
- Servicio de Reumatología, Hospital General Gregorio Marañón, Madrid, Spain
| | | | - Alina Boteanu
- Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Marta Medrano
- Servicio de Reumatología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Carmen Vargas-Lebron
- Servicio de Reumatología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Sergio Machín-García
- Servicio de Reumatología, Complejo Hospitalario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Lorena Expósito
- Servicio de Reumatología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Ana Paula Cacheda
- Servicio de Reumatología, Hospital Universitario Son Llàtzer, Mallorca, Spain
| | - Pilar Bernabeu
- Servicio de Reumatología, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Olaia Fernández
- Servicio de Reumatología, Hospital Universitario de Basurto, Bilbao, Spain
| | | | - Vicenç Torrente-Segarra
- Servicio de Reumatología, Hospital Comarcal Alt Penedés Garraf, Vilafranca del Penedès, Spain
| | | | - María Luz Gamir
- Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Jordi Antón
- Servicio de Reumatología, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Lucía Otero
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain
| | - Sagrario Bustabad
- Servicio de Reumatología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
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Shin J, Kang MJ, Kim KN. Prevalence of Lower Bone Mineral Density and Its Associated Factors in Korean Children and Adolescents with Juvenile Idiopathic Arthritis. JOURNAL OF RHEUMATIC DISEASES 2018. [DOI: 10.4078/jrd.2018.25.4.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- JinShik Shin
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Min Jae Kang
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kwang Nam Kim
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Korea
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Galindo Zavala R, Núñez Cuadros E, Martín Pedraz L, Díaz-Cordovés Rego G, Sierra Salinas C, Urda Cardona A. Low bone mineral density in juvenile idiopathic arthritis: Prevalence and related factors. An Pediatr (Barc) 2017. [DOI: 10.1016/j.anpede.2016.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Huber AM, Ward LM. The impact of underlying disease on fracture risk and bone mineral density in children with rheumatic disorders: A review of current literature. Semin Arthritis Rheum 2016; 46:49-63. [PMID: 27020068 DOI: 10.1016/j.semarthrit.2016.02.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 10/16/2015] [Accepted: 02/20/2016] [Indexed: 11/17/2022]
Abstract
Childhood rheumatic diseases are associated with negative impacts on the skeleton, related to both the underlying illness and complications of therapy. The effects of medications like corticosteroids are well recognized, leading to reductions in bone mineral density and bone strength and concomitant increases in bone fragility and fracture risk. The impact of factors directly attributable to the underlying disease is not as well recognized. In this article, we review relevant literature to identify data which can contribute to an understanding of the impact of childhood rheumatic disease on the skeleton. We conclude that childhood rheumatic diseases are associated with reductions in bone mineral density and increased risk of vertebral and non-vertebral fractures. These data are strongest for juvenile arthritis, while conclusions are more limited for other rheumatic illnesses, like juvenile systemic lupus erythematosus or juvenile dermatomyositis, due to small numbers of patients studied. Finally, we make recommendations for areas in need of further research. These include the need for long-term longitudinal studies and for data to be collected in patients who have not been treated with corticosteroids.
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Affiliation(s)
- Adam M Huber
- Division of Pediatric Rheumatology, IWK Health Centre and Dalhousie University, 5850 University Ave, Halifax, Nova Scotia, Canada B3K 6R8.
| | - Leanne M Ward
- Division of Pediatric Endocrinology, Children׳s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
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[Advances in the treatment of secondary osteoporosis]. An Pediatr (Barc) 2014; 81:399.e1-7. [PMID: 25441207 DOI: 10.1016/j.anpedi.2014.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/21/2014] [Accepted: 05/05/2014] [Indexed: 01/19/2023] Open
Abstract
Osteoporosis is being increasingly recognised in paediatric practice as a consequence of the increasing life expectancy of children who suffer from chronic diseases and other factors. There are many non-pharmacological measures that can improve children' bone health, for example, avoiding inflammatory activity and osteotoxic treatments; increasing sun exposure and weight-bearing exercise, and maintaining an adequate nutritional status. Vitamin D and calcium supplements have been proposed as a measure to increase bone mass, but their effect and therapeutic indications are not completely clear. On the other hand, bisphosphonates are currently the only pharmacological alternative for the patients with infantile secondary osteoporosis. However, more studies are required on the therapeutic indications, posology, and long term secondary effects of biphosphonates. The aim of this article is to analyze the scientific evidence of the effectiveness of the therapeutic alternatives for childhood secondary osteoporosis and their safety in children.
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Measurement of bone mineral density by dual energy X-ray absorptiometry in juvenile idiopathic arthritis. Indian J Pediatr 2014; 81:126-32. [PMID: 23645223 DOI: 10.1007/s12098-013-1037-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 04/03/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate bone mineral density using dual X-ray absorptiometry in Juvenile Idiopathic Arthritis (JIA) patients and factors affecting it, if any. METHODS A cross sectional study was conducted by enrolling thirty five patients of JIA and age and sex matched controls. Bone Mineral Density (BMD) and Z score of whole body, total body less head, lumbar spine and distal radius were obtained and adjusted for age, sex, weight and BMI in both cases and controls. Dietary intake of calcium, vitamin D intake, sunlight exposure, weight bearing physical activity, age of onset, duration of disease, disease activity score and treatment received (prednisolone and methotrexate) were recorded. RESULTS BMD was significantly lower among patients as compared to controls. Decreased dietary intake of vitamin D and calcium, decreased weight bearing physical activity and sunlight exposure were the major factors for low BMD. Use of steroid also decreased BMD to some extent, whereas use of methotrexate, disease duration and severity did not have a significant correlation with BMD. CONCLUSIONS Apart from disease control, it is important to improve the dietary intake of calcium, vitamin D and encourage more physical activities and exposure to sunlight in JIA patients.
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Markula-Patjas KP, Valta HL, Kerttula LI, Soini IH, Honkanen VEA, Toiviainen-Salo SM, Mäkitie OM. Prevalence of vertebral compression fractures and associated factors in children and adolescents with severe juvenile idiopathic arthritis. J Rheumatol 2011; 39:365-73. [PMID: 22133619 DOI: 10.3899/jrheum.110305] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Vertebral fractures occur in patients with juvenile idiopathic arthritis (JIA), but data on their frequency and causes are scarce. Our cross-sectional study evaluated prevalence of compression fractures and associated factors in a high-risk pediatric population with severe JIA. METHODS Children and adolescents with a history of treatment-resistant polyarticular-course JIA for ≥ 5 years or systemic arthritis for ≥ 3 years were recruited. Clinical examination, dietary recall, laboratory measurements, bone mineral density (BMD) measurement by dual-energy X-ray absorptiometry, and spinal radiography were performed. RESULTS Our study included 50 patients (41 girls), of whom 6 (12%) had systemic arthritis, with a median age of 14.8 years (range 7.0-18.7 yrs) and median disease duration of 10.2 years (range 3.9-16.8 years). Ninety-four percent had used systemic glucocorticoids (GC); the median total duration of GC treatment was 7.1 years (range 0-15.5 yrs). The median weight-adjusted cumulative GC dose for the preceding 3 years was 72 mg/kg (range 0-911 mg/kg). The median bone age-corrected lumbar spine and whole-body areal BMD Z-scores were -0.8 and -1.0, respectively. Twenty-two percent had vertebral fractures, mostly thoracic. Compression fractures were associated with high disease activity, high body mass index (BMI), and high recent cumulative GC dose, but not with disease duration or BMD. Thirty percent had sustained at least 1 peripheral low energy fracture. Twenty-six percent were deemed to have significantly compromised bone health. CONCLUSION Severe JIA is associated with a significant risk of vertebral compression fractures. Associated factors include high disease activity, high BMI, and high recent GC exposure. Further studies are needed to establish optimal prevention and treatment guidelines.
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Rintamäki H, Tamm K, Vaarala O, Sidoroff M, Honkanen V, Raivio T, Jänne OA, Kolho KL. Intra-articular corticoid injection induces circulating glucocorticoid bioactivity and systemic immune activation in juvenile idiopathic arthritis. Scand J Rheumatol 2011; 40:347-53. [DOI: 10.3109/03009742.2011.560893] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
A number of studies published over the past 10 years have examined the long-term health, functional and quality of life outcomes of adults with childhood-onset rheumatic diseases such as juvenile idiopathic arthritis, systemic lupus erythematosus, juvenile dermatomyositis and localized scleroderma. As increasing numbers of patients with these conditions survive into adulthood, understanding the adult outcomes of these pediatric conditions has become ever-more important. Identifying modifiable risk factors for poor outcomes is vital to improving care for these patients. In addition, as these conditions and their treatments can affect cardiovascular health, bone health and fertility, particular attention needs to be paid to these outcomes. Preparing patients and their families for a successful transition from pediatric to adult rheumatology care is an important first-step in the long-term management strategy for this expanding patient population.
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