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Herrington J, Batthish M, Takrouri H, Yarascavitch B, Gross A. Asymptomatic intraspinal epidermoid cyst in a 7-year-old male with juvenile idiopathic arthritis identified by an advanced physiotherapist practitioner: a case report. J Man Manip Ther 2024; 32:343-351. [PMID: 38566497 PMCID: PMC11216243 DOI: 10.1080/10669817.2024.2334103] [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: 12/31/2023] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Pediatric intraspinal epidermoid cysts are rare with potential to cause life-altering outcomes if not addressed. Reports to date describe symptomatic presentations including loss of bladder or bowel function and motor and sensory losses. This case report identifies the diagnostic challenge of an asymptomatic intraspinal epidermoid cyst in the cauda equina region presenting in a 7-year-old male with juvenile idiopathic arthritis (JIA). DIAGNOSIS An advanced physiotherapist practitioner assessed and diagnosed a previously healthy 7-year-old-male of South Asian descent with JIA based on persistent knee joint effusions. Complicating factors delayed the investigation of abnormal functional movement patterns, spinal and hip rigidity and severe restriction of straight leg raise, all atypical for JIA. Further delaying the diagnosis was the lack of subjective complaints including no pain, no reported functional deficits, and no neurologic symptoms. A spinal MRI investigation 10-months from initial appointment identified intraspinal epidermoid cysts occupying the cauda equina region requiring urgent referral to neurosurgery. DISCUSSION Clinical characteristics and pattern recognition are essential for diagnosing spinal conditions in pediatric populations. Diagnostic challenges present in this case included co-morbidity (JIA), a severe adverse reaction to treatment, a lack of subjective complaints and a very low prevalence of intraspinal epidermoid cysts. IMPACT STATEMENTS Early signs of pediatric asymptomatic intraspinal epidermoid cysts included abnormal functional movement patterns, rigidity of spine, severely limited straight leg raise and hip flexion without pain. Advanced physiotherapist practitioners can be integral to pediatric rheumatology teams considering their basic knowledge in musculoskeletal examination and functional mobility assessment when identifying rare spinal conditions that present within the complex context of rheumatic diseases.
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Affiliation(s)
- Julie Herrington
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- McMaster Children’s Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Michelle Batthish
- McMaster Children’s Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
- Department of Pediatrics, Division of Rheumatology, McMaster University, Hamilton, ON, Canada
| | - Heba Takrouri
- McMaster Children’s Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
- Department of Pediatrics, Division of Radiology, McMaster University, Hamilton, ON, Canada
| | - Blake Yarascavitch
- McMaster Children’s Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, ON, Canada
| | - Anita Gross
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Gennaro VL, Maclin J, Weiser P, Stoll ML, Smitherman EA. Juvenile Idiopathic Arthritis With Associated Inflammatory Bowel Disease and CARD8 Mutation. Pediatrics 2023; 152:e2022058964. [PMID: 37724393 DOI: 10.1542/peds.2022-058964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 09/20/2023] Open
Abstract
Juvenile idiopathic arthritis is a common chronic childhood disease, with a prevalence of ∼1 per 1000 children. Arthritis can also be a manifestation of other inflammatory conditions, such as inflammatory bowel disease (IBD). Studies suggest a genetic influence in IBD, including mutations in CARD8. CARD8 is a negative regulator of the NLRP3 inflammasome, and mutations in this gene are hypothesized to induce gastrointestinal inflammation. However, few studies have evaluated this association and most have included a limited number of patients. We present a case of a pediatric patient with IBD-associated arthritis and a CARD8 mutation. Our patient is a 7-year-old female who was initially evaluated by rheumatology for right leg pain and an intermittent rash. She had clinically active arthritis on exam and was started on methotrexate with only slight improvement. Additional workup revealed sacroiliitis by imaging, elevated inflammatory markers, no anemia, and a variant of unknown significance in CARD8. Adalimumab was recommended but before medication initiation, our patient's symptoms progressed to worsening joint pain, fatigue, fevers, nausea, vomiting, diarrhea, and hematochezia. Infectious testing was negative. Fecal calprotectin was >8000 µg/g. A colonoscopy revealed IBD most consistent with Crohn's disease. Adalimumab was ultimately added, and she has responded well to combination therapy. This case report highlights the association between CARD8 mutations and IBD, especially in the setting of IBD-associated arthritis.
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Affiliation(s)
| | - Jeanine Maclin
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Peter Weiser
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Matthew L Stoll
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Emily A Smitherman
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
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Bullock CH, McAlpine SM, Roberts SE, Derfalvi B. MicroRNA-27a-3p enhances the inflammatory phenotype of Juvenile Idiopathic Arthritis fibroblast-like synoviocytes. Pediatr Rheumatol Online J 2023; 21:53. [PMID: 37277817 DOI: 10.1186/s12969-023-00833-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/25/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Juvenile Idiopathic Arthritis (JIA) is the most prevalent chronic pediatric rheumatic disorder. In joints of JIA patients, aggressive phenotypic changes in fibroblast-like synoviocytes (FLS) of the synovial lining play a key role in inflammation. MicroRNAs are dysregulated in rheumatoid arthritis and JIA, including miR-27a-3p. However, it is not understood if miR-27a-3p, enriched in JIA synovial fluid (SF) and leukocytes, alters FLS function. METHODS Primary JIA FLS cells were transfected with a miR-27a-3p mimic or a negative control microRNA (miR-NC) and stimulated with pooled JIA SF or inflammatory cytokines. Viability and apoptosis were analyzed by flow cytometry. Proliferation was evaluated using a 3H-thymidine incorporation assay. Cytokine production was assessed by qPCR and ELISA. Expression of TGF-β pathway genes was determined using a qPCR array. RESULTS MiR-27a-3p was constitutively expressed in FLS. Overexpression of miR-27a-3p caused increased interleukin-8 secretion in resting FLS, and interleukin-6 was elevated in SF-activated FLS compared to miR-NC. Furthermore, stimulation with pro-inflammatory cytokines augmented FLS proliferation in miR-27a-3p-transfected FLS relative to miR-NC. Expression of multiple TGF-β pathway genes was modulated by overexpression of miR-27a-3p. CONCLUSIONS MiR-27a-3p significantly contributes to FLS proliferation and cytokine production, making it a potential candidate for epigenetic therapy that targets FLS in arthritis.
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Affiliation(s)
- Claire H Bullock
- Dalhousie Medical School, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Sarah M McAlpine
- Division of Immunology, Dept. of Pediatrics, Dalhousie University, IWK Health, 8 East Research 5850/5980 University Ave Halifax, NS, B3K 6R8, Halifax, Canada.
| | - Sarah E Roberts
- Division of Immunology, Dept. of Pediatrics, Dalhousie University, IWK Health, 8 East Research 5850/5980 University Ave Halifax, NS, B3K 6R8, Halifax, Canada
| | - Beata Derfalvi
- Division of Immunology, Dept. of Pediatrics, Dalhousie University, IWK Health, 8 East Research 5850/5980 University Ave Halifax, NS, B3K 6R8, Halifax, Canada.
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Fazza A, Chemil S, Miladi S, Boussaa H, Makhlouf Y, Ben Abdelghani K, Laatar A. Les outils d’évaluation au cours de l’arthrite juvénile idiopathique :
Revuenarrative. LA TUNISIE MEDICALE 2023; 101:537-543. [PMID: 38372552 PMCID: PMC11217963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/29/2023] [Indexed: 07/05/2024]
Abstract
Juvenile idiopathic arthritis (JIA), as a chronic condition, is associated with significant disease- and treatment-related morbidity, thus impacting children's quality of life. In order to optimize JIA management and to ensure the best possible care and outcome for children with rheumatic diseases, dedicated disease activity and damage assessment tools are essential. In recent years, there has been a concerted and important international effort to develop and validate disease activity and outcome instruments specific to JIA. This update aims to describe the main outcome measures currently used in JIA patients. These outcome measures include composite disease activity score, measures of physical function, measures of health related quality of life, clinical measures of damage and the assessment of Parent and child reported outcomes (PCROs).
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Affiliation(s)
- Alia Fazza
- Rheumatology department, Mongi Slim hospital, La Marsa, Tunisia, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Sakina Chemil
- Rheumatology department, independent consultant, Bordj Bou Arreridj, Algeria
| | - Sawssen Miladi
- Rheumatology department, Mongi Slim hospital, La Marsa, Tunisia, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Hiba Boussaa
- Rheumatology department, Mongi Slim hospital, La Marsa, Tunisia, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Yasmine Makhlouf
- Rheumatology department, Mongi Slim hospital, La Marsa, Tunisia, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Kaouther Ben Abdelghani
- Rheumatology department, Mongi Slim hospital, La Marsa, Tunisia, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Ahmed Laatar
- Rheumatology department, Mongi Slim hospital, La Marsa, Tunisia, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Tajika T, Saito K, Tomomatsu Y, Kuboi T, Hatori Y, Hirato J, Yanagawa T, Chikuda H. Proliferative flexor tenosynovitis in the index finger of a 10-year-old baseball player gloved hand: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221095703. [PMID: 35495294 PMCID: PMC9052806 DOI: 10.1177/2050313x221095703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/04/2022] [Indexed: 11/17/2022] Open
Abstract
Flexor tenosynovitis is rare in young children. This case report describes that of a 10-year-old boy with diffuse swelling of the left index finger, pain when catching a ball, and progressive inability for full flexing of the finger 2 months after starting baseball play. Magnetic resonance imaging showed a defined lesion with iso-signal intensity to muscle on T1-weighted imaging, and with high signal intensity to muscle on T2-weighted imaging. It was enhanced in T1-weighted fat suppression imaging with gadolinium enhancement. Surgical excision relieved the symptom. Histopathological findings mainly indicated proliferation of synoviocytes and plasma cell and lymphocyte infiltration. We speculated that the physical impact of the ball on the left index finger of his gloved hand during catching activated some immunological mechanism and thereby caused nonspecific tenosynovitis in this young baseball player. Awareness of this pathophysiology might raise confidence in proper diagnosis for assessing the swelling of fingers in young baseball players.
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Affiliation(s)
- Tsuyoshi Tajika
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
| | - Kenichi Saito
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yusuke Tomomatsu
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takuro Kuboi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yuhei Hatori
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Junko Hirato
- Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takashi Yanagawa
- Department of Orthopaedic Surgery, Gunma Prefectural Cancer Center, Ota, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
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