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Narazaki H, Akioka S, Akutsu Y, Araki M, Fujieda M, Fukuhara D, Hara R, Hashimoto K, Hattori S, Hayashibe R, Imagawa T, Inoue Y, Ishida H, Ito S, Itoh Y, Kawabe T, Kitoh T, Kobayashi I, Matsubayashi T, Miyamae T, Mizuta M, Mori M, Murase A, Nakagishi Y, Nagatani K, Nakano N, Nishimura T, Nozawa T, Okamoto N, Okura Y, Sawada H, Sawanobori E, Sugita Y, Tanabe Y, Tomiita M, Yamaguchi KI, Yasuoka R, Yokoyama K. Epidemiology conduction of paediatric rheumatic diseases based on the registry database of the Pediatric Rheumatology Association of Japan. Mod Rheumatol 2023; 33:1021-1029. [PMID: 36112493 DOI: 10.1093/mr/roac112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 08/27/2023]
Abstract
OBJECTIVES Although epidemiological surveys of paediatric rheumatic diseases in Japan have been conducted, they were single surveys with no continuity. This is the first report of the Pediatric Rheumatology Association of Japan registry database, which was established to continuously collect data for paediatric rheumatic diseases. METHODS Pediatric Rheumatology International Collaborate Unit Registry version 2 (PRICUREv2) is a registry database established by the Pediatric Rheumatology Association of Japan. The registry data were analysed for the age of onset, time to diagnosis, sex differences, seasonality, and other factors. RESULTS Our data showed the same trend regarding rates of paediatric rheumatic diseases reported in Japan and other countries. The age of onset was lower in juvenile idiopathic arthritis (JIA) and juvenile dermatomyositis and higher in systemic lupus erythematosus and Sjögren's syndrome. The time to diagnosis was relatively short in JIA and systemic lupus erythematosus but longer in juvenile dermatomyositis and Sjögren's syndrome. Rheumatoid factor-positive polyarticular JIA showed a seasonality cluster with regard to onset. CONCLUSION PRICUREv2 aided the retrieval and evaluation of current epidemiological information on patients with paediatric rheumatic diseases. It is expected that the data collection will be continued and will be useful for expanding research in Japan.
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Affiliation(s)
- Hidehiko Narazaki
- Committee on Patient Registries System, Pediatric Rheumatology Association of Japan, Kyoto, Japan
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Shinji Akioka
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuko Akutsu
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mariko Araki
- Department of Pediatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Mikiya Fujieda
- Department of Pediatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Daisuke Fukuhara
- Department of Pediatrics, Kyorin University School of Medicine, Tokyo, Japan
| | - Ryoki Hara
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kunio Hashimoto
- Department of Pediatrics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Seira Hattori
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ren Hayashibe
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tomoyuki Imagawa
- Committee on Patient Registries System, Pediatric Rheumatology Association of Japan, Kyoto, Japan
- Department of Infection and Immunology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yuzaburo Inoue
- Committee on Patient Registries System, Pediatric Rheumatology Association of Japan, Kyoto, Japan
- Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Allergy and Rheumatology, Chiba Children's Hospital, Chiba, Japan
| | | | - Shuici Ito
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yasuhiko Itoh
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Tomohiro Kawabe
- Department of Pediatric Rheumatology, Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Toshiyuki Kitoh
- Laboratory of Pediatrics, Aichi Gakuin University, School of Pharmacy, Nagoya, Japan
| | - Ichiro Kobayashi
- Center for Pediatric Allergy and Rheumatology, KKR Sapporo Medical Center, Sapporo, Japan
| | | | - Takako Miyamae
- Department of Pediatric Rheumatology, Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Mao Mizuta
- Department of Pediatric Rheumatology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Masaaki Mori
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Division of Rheumatology and Allergology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ayako Murase
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yasuo Nakagishi
- Department of Pediatric Rheumatology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Koji Nagatani
- Department of Pediatrics, Uwajima City Hospital, Ehime, Japan
| | - Naoko Nakano
- Department of Pediatrics, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Toyoki Nishimura
- Division of Pediatrics, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Tomo Nozawa
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nami Okamoto
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Osaka, Japan
- Department of Pediatrics, Osaka Rosai Hospital, Osaka, Japan
| | - Yuka Okura
- Center for Pediatric Allergy and Rheumatology, KKR Sapporo Medical Center, Sapporo, Japan
| | | | - Emi Sawanobori
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Yuko Sugita
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Yujiro Tanabe
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Minako Tomiita
- Department of Allergy and Rheumatology, Chiba Children's Hospital, Chiba, Japan
- Center of Pediatric Allergy and Rheumatology, National Hospital Organization Shimoshizu National Hospital, Chiba, Japan
| | - Ken-Ichi Yamaguchi
- Committee on Patient Registries System, Pediatric Rheumatology Association of Japan, Kyoto, Japan
- Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan
| | - Ryuhei Yasuoka
- Department of Pediatrics, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Koji Yokoyama
- Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
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Horikoshi H, Nakanishi T, Tamura K, Kimura F, Itoh K. 18F-fluorodeoxyglucose-positron emission tomography/computed tomography for the diagnosis of polymyalgia-like illnesses: a retrospective study. BMC Rheumatol 2020; 4:21. [PMID: 32346670 PMCID: PMC7181584 DOI: 10.1186/s41927-020-00121-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 02/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background Various inflammatory conditions may present with musculoskeletal symptoms similar to those of polymyalgia rheumatica (PMR). We investigated findings on 18F-fluorodexoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) images that may differentiate PMR from polymyalgia-like illnesses. Methods We analyzed data from 25 patients with new-onset polymyalgia-like illnesses who fulfilled Bird's diagnostic criteria for PMR and had undergone FDG-PET/CT scan. To assess the uptake by major joints and synovial bursae, particularly at PMR-specific sites (shoulder, sternoclavicular, and hip joints, interspinous bursae, ischial tuberosities, and greater trochanters), we used visual scoring system to score FDG uptake: 0, no uptake (same as bone); 1, slight uptake; 2, moderate uptake (same as the liver); 3, greater uptake than the liver; and 4, uptake as strong as in the cerebellum. Results The final diagnoses were PMR in 17 patients and non-PMR in eight patients (three malignancies, two infections, one cholesterol crystal embolism, one ANCA-associated vasculitis, and one undefined diagnosis). Although the serum MMP-3 levels were significantly higher in patients with PMR, C-reactive protein and erythrocyte sedimentation rate mean values did not differ between the two groups. In PMR-specific sites, FDG accumulations were observed in all cases of PMR, with a high PET-positive score of 2.00 (range, 0-3), but it was low in non-PMR cases, with a PET-positive score of 1.00 (range, 0-3). Conclusions The FDG accumulation patterns in polymyalgia-like illness differ from those in PMR, despite the similar clinical presentations of both conditions. An FDG-PET/CT scan is useful for differentiating PMR from other polymyalgia-like illnesses.
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Affiliation(s)
- Hideyuki Horikoshi
- 1Division of Hematology and Rheumatology, Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513 Japan
| | - Takashi Nakanishi
- 1Division of Hematology and Rheumatology, Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513 Japan
| | - Katsumi Tamura
- Tokorozawa PET Diagnostic Imaging Clinic, 7-5 Higashi Sumiyoshi, Tokorozawa, Saitama, 359-1124 Japan
| | - Fumihiko Kimura
- 1Division of Hematology and Rheumatology, Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513 Japan
| | - Kenji Itoh
- 1Division of Hematology and Rheumatology, Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513 Japan
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Zhao J, Zhao X, Dou ZY, Rong ZH. [Association between autophagy and systemic juvenile idiopathic arthritis and related mechanism: a preliminary study]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:966-971. [PMID: 31642428 PMCID: PMC7389724 DOI: 10.7499/j.issn.1008-8830.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/13/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To study the role of autophagy in the development of systemic juvenile idiopathic arthritis (sJIA) by analyzing the expression of microtubule-associated protein 1 light chain 3-II (LC3-II), myeloid differentiation factor 88 (MyD88), and suppressor of T-cell receptor signaling 1 (STS-1) in peripheral blood lymphocytes of children with sJIA. METHODS A total of 26 children with sJIA were enrolled as the sJIA group, and 26 healthy children were enrolled as the control group. Western blot was used to measure the protein expression of LC3-II, STS-1, and MyD88 in peripheral blood lymphocytes. Immunofluorescence assay was used to measure the expression of LC3-II in the cytoplasm of lymphocytes. Pearson correlation analysis was used to assess the correlation between indices. RESULTS Compared with the control group, the sJIA group had significant increases in the expression of LC3-II, STS-1, and MyD88 (P<0.05). In the sJIA group, the expression of LC3-II was positively correlated with that of MyD88 (r=0.478, P<0.05), and the expression of STS-1 was also positively correlated with that of MyD88 (r=0.817, P<0.05). CONCLUSIONS There is high expression of LC3-II in peripheral blood lymphocytes of children with sJIA, suggesting that the development of sJIA may be associated with excessive expression of autophagy. STS-1 may induce autophagy by activating some signaling pathways, and MyD88 may participate in autophagy through the Toll-like receptor signaling pathway.
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Affiliation(s)
- Jie Zhao
- Department of Pediatrics, Second Hospital of Hebei Medical University, Shijiazhuang 050000, China.
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Huang Z, Lee PY, Yao X, Zheng S, Li T. Tofacitinib Treatment of Refractory Systemic Juvenile Idiopathic Arthritis. Pediatrics 2019; 143:peds.2018-2845. [PMID: 30948682 DOI: 10.1542/peds.2018-2845] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2018] [Indexed: 11/24/2022] Open
Abstract
Systemic juvenile idiopathic arthritis (sJIA) is an aggressive form of childhood arthritis accompanied by persistent systemic inflammation. Patients with sJIA often exhibit poor response to conventional disease-modifying antirheumatic drugs, and chronic glucocorticoid use is associated with significant adverse effects. Although biologics used to target interleukin 1 and interleukin 6 are efficacious, the long-term commitment to frequent injections or infusions remains a challenge in young children. Janus-activated kinase (JAK) inhibitors block the signaling of numerous proinflammatory cytokines and are now used clinically for the treatment of rheumatoid arthritis in adults. Whether this new class of medication is effective for sJIA has not been reported. Here, we describe the case of a 13-year-old girl with recalcitrant sJIA characterized by polyarticular arthritis, fever, lymphadenopathy, and serological features of inflammation. She showed minimal response to nonsteroidal antiinflammatory drugs, glucocorticoids, conventional disease-modifying antirheumatic drugs, and etanercept. She also developed osteoporosis and vertebral compression fracture as the result of chronic glucocorticoid therapy. Oral therapy with the JAK inhibitor tofacitinib was initiated, and the patient experienced steady improvement of both arthritis and systemic features. Complete remission was achieved after 3 months, and no evidence of disease activity or adverse effects was seen through 6 months of follow-up. Our experience reveals the effectiveness of JAK inhibition in a case of refractory sJIA. Tofacitinib is an intriguing oral alternative to the available biologics for children with sJIA, and its efficacy and safety should be further assessed by clinical trial.
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Affiliation(s)
- Zhixiang Huang
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou, China; and
| | - Pui Y Lee
- Division of Allergy, Immunology and Rheumatology, Boston Children's Hospital, Boston, Massachusetts
| | - Xiaoyan Yao
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou, China; and
| | - Shaoling Zheng
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou, China; and
| | - Tianwang Li
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou, China; and
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Allogeneic hematopoietic stem cell transplantation for severe, refractory juvenile idiopathic arthritis. Blood Adv 2019; 2:777-786. [PMID: 29618462 DOI: 10.1182/bloodadvances.2017014449] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/21/2018] [Indexed: 12/13/2022] Open
Abstract
Patients with juvenile idiopathic arthritis (JIA) can experience a severe disease course, with progressive destructive polyarthritis refractory to conventional therapy with disease-modifying antirheumatic drugs including biologics, as well as life-threatening complications including macrophage activation syndrome (MAS). Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative immunomodulatory strategy for patients with such refractory disease. We treated 16 patients in 5 transplant centers between 2007 and 2016: 11 children with systemic JIA and 5 with rheumatoid factor-negative polyarticular JIA; all were either refractory to standard therapy, had developed secondary hemophagocytic lymphohistiocytosis/MAS poorly responsive to treatment, or had failed autologous HSCT. All children received reduced toxicity fludarabine-based conditioning regimens and serotherapy with alemtuzumab. Fourteen of 16 patients are alive with a median follow-up of 29 months (range, 2.8-96 months). All patients had hematological recovery. Three patients had grade II-IV acute graft-versus-host disease. The incidence of viral infections after HSCT was high, likely due to the use of alemtuzumab in already heavily immunosuppressed patients. All patients had significant improvement of arthritis, resolution of MAS, and improved quality of life early following allo-HSCT; most importantly, 11 children achieved complete drug-free remission at the last follow-up. Allo-HSCT using alemtuzumab and reduced toxicity conditioning is a promising therapeutic option for patients with JIA refractory to conventional therapy and/or complicated by MAS. Long-term follow-up is required to ascertain whether disease control following HSCT continues indefinitely.
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Han JH, Je YJ, Yoon HJ, Ahn JG, Lee JS, Park JW, Park HJ. The First Case Series of Cryopyrin-Associated Periodic Syndrome in Korea. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2019; 11:583-588. [PMID: 31172726 PMCID: PMC6557769 DOI: 10.4168/aair.2019.11.4.583] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/21/2018] [Accepted: 12/26/2018] [Indexed: 12/13/2022]
Abstract
Cryopyrin-associated periodic syndrome (CAPS) is a hereditary autoinflammatory syndrome caused by mutations in NLRP3 (encoding cryopyrin), which presents with fever, fatigue and arthralgia. Thus far, however there have been no reports of CAPS in Korea. Herein, we report 3 cases of CAPS for the first time in Korea. The first case, a 28-year-old man with recurrent urticaria, arthralgia and fever induced by cold, all of which were observed in his father, showed elevated erythrocyte sedimentation rate and C-reactive protein. He exhibited a p.Gly303Asp variant of the NLPR3 gene. The second case, a 2-year-old girl who had recurrent urticaria, arthritis and oral and genital ulcers, was positive for HLA B51 and a p.Glu569Lys mutation in exon 3 of the NLRP3 gene. Administration of anakinra greatly improved her symptoms. The third case, a 4-year-old boy who presented with recurrent urticaria, arthralgia, and fever, exhibited a p.Val72Met mutation in exon 1 of the NLRP3 gene. Administration of tocilizumab improved all of his symptoms. This small case series suggests that clinicians consider CAPS and conduct genetic studies when arthralgia and fever are accompanied by urticaria in Korea.
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Affiliation(s)
- Jong Hee Han
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yeon Jin Je
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Je Yoon
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Gyun Ahn
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Sung Lee
- Division of Clinical Genetics, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Won Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Jung Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Marchesi A, Tarissi de Jacobis I, Rigante D, Rimini A, Malorni W, Corsello G, Bossi G, Buonuomo S, Cardinale F, Cortis E, De Benedetti F, De Zorzi A, Duse M, Del Principe D, Dellepiane RM, D’Isanto L, El Hachem M, Esposito S, Falcini F, Giordano U, Maggio MC, Mannarino S, Marseglia G, Martino S, Marucci G, Massaro R, Pescosolido C, Pietraforte D, Pietrogrande MC, Salice P, Secinaro A, Straface E, Villani A. Kawasaki disease: guidelines of Italian Society of Pediatrics, part II - treatment of resistant forms and cardiovascular complications, follow-up, lifestyle and prevention of cardiovascular risks. Ital J Pediatr 2018; 44:103. [PMID: 30157893 PMCID: PMC6116479 DOI: 10.1186/s13052-018-0529-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 07/29/2018] [Indexed: 02/08/2023] Open
Abstract
This second part of practical Guidelines related to Kawasaki disease (KD) has the goal of contributing to prompt diagnosis and most appropriate treatment of KD resistant forms and cardiovascular complications, including non-pharmacologic treatments, follow-up, lifestyle and prevention of cardiovascular risks in the long-term through a set of 17 recommendations.Guidelines, however, should not be considered a norm that limits the treatment options of pediatricians and practitioners, as treatment modalities other than those recommended may be required as a result of peculiar medical circumstances, patient's condition, and disease severity or individual complications.
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Affiliation(s)
| | | | - Donato Rigante
- Università Cattolica Sacro Cuore, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | | | | | | | | | - Sabrina Buonuomo
- Bambino Gesù Children’s Hospital, Piazza S. Onofrio n. 4, 00165 Rome, Italy
| | | | | | | | - Andrea De Zorzi
- Bambino Gesù Children’s Hospital, Piazza S. Onofrio n. 4, 00165 Rome, Italy
| | - Marzia Duse
- Università degli Studi Sapienza, Rome, Italy
| | | | | | | | - Maya El Hachem
- Bambino Gesù Children’s Hospital, Piazza S. Onofrio n. 4, 00165 Rome, Italy
| | | | | | - Ugo Giordano
- Bambino Gesù Children’s Hospital, Piazza S. Onofrio n. 4, 00165 Rome, Italy
| | | | | | | | | | - Giulia Marucci
- Bambino Gesù Children’s Hospital, Piazza S. Onofrio n. 4, 00165 Rome, Italy
| | | | | | | | | | | | - Aurelio Secinaro
- Bambino Gesù Children’s Hospital, Piazza S. Onofrio n. 4, 00165 Rome, Italy
| | | | - Alberto Villani
- Bambino Gesù Children’s Hospital, Piazza S. Onofrio n. 4, 00165 Rome, Italy
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Nozawa T, Nishimura K, Ohara A, Hara R, Ito S. Primary varicella infection in children with systemic juvenile idiopathic arthritis under tocilizumab therapy. Mod Rheumatol 2016; 29:558-562. [DOI: 10.1080/14397595.2016.1254314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Tomo Nozawa
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama City, Japan
| | - Kenichi Nishimura
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama City, Japan
| | - Asami Ohara
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama City, Japan
| | - Ryoki Hara
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama City, Japan
| | - Shuichi Ito
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama City, Japan
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