Joel David

Psychological functioning of children and adolescents with juvenile idiopathic arthritis is related to physical disability but not to disease status

OBJECTIVES This study investigates the psychological functioning of children with polyarticular joint disease and its association with disease activity and disability. METHODS Sixty children aged 7-18 yrs with juvenile idiopathic arthritis and >4 joints involved were recruited. Children underwent a physical examination. The Childhood HAQ was completed by both the children and their parents. Children also completed questionnaires for depression (Birleson Depression Inventory; BDI), anxiety (Revised Childrens Manifest Anxiety Scale; RCMAS) and peer, emotional and behavioural problems (Strengths and Difficulties Questionnaire; SDQ). Clinical information was extracted from the hospital records. RESULTS Self-reported psychological functioning (depression, anxiety, and behaviour) was not different from the normal population. Parent-reported emotional difficulties on the SDQ were somewhat elevated. There were no significant correlations between psychological functioning and physician-rated disease activity score or the number of active joints at the time of assessment. Furthermore, no differences in psychological functioning were found between children with or without significantly raised inflammatory markers. All aspects of psychological function (depression, anxiety and behaviour) correlated moderately with physical function (r(s) = 0.49, 0.41, 0.46, respectively; all P < 0.01). CONCLUSIONS Children and adolescents with polyarthritis are not at significantly elevated risk of psychological difficulties. Poor psychological outcome was associated with more severe physical disability but not with the level of disease activity.

Chronic Recurrent Multifocal Osteomyelitis: Two Cases of Sacral Disease Responsive to Corticosteroids

Chronic recurrent multifocal osteomyelitis is a rare inflammatory form of osteomyelitis of unknown etiology. It affects children and adolescents, and signs and symptoms include recurrent episodes of bone pain, tenderness, possible constitutional upset, and increased inflammatory markers. We present 2 patients with cases of chronic recurrent multifocal osteomyelitis affecting the sacrum who responded dramatically to treatment with corticosteroids.

Early use of steroid-sparing agents in the inactivation of moderate-to-severe active thyroid eye disease: a step-down approach

The current first‐line treatment for management of active thyroid eye disease (TED) is high‐dose intravenous corticosteroids, which have the potential for serious adverse effects. Our aim was to evaluate the effect of steroid‐sparing agents (SSAs) in patients with moderate‐to‐severe active TED, using methotrexate as first‐line.

A diagnosis of sarcoid arthritis: ‘check the tattoos’

A 36-year-old construction worker described a 3-month history of bilateral pain, stiffness and swelling of the ankles and lower limb joints. Symptoms were worse in the mornings and were associated with generalised fatigue. He had no significant medical history and was taking regular naproxen only with no recorded drug allergies. On examination, cardiovascular and respiratory systems were normal. There was bilateral synovitis of the ankles. Of note, the patient had multiple small papules within the large tattoos on his upper limbs. The lesions were non-tender and were of the same colour as the underlying tattoo ink (figure 1). Figure 1 Multiple cutaneous lesions within tattoo ink. …

Rheumatoid Arthritis and the Lung

Publisher Summary This chapter discusses rheumatoid arthritis and the lung. Rheumatoid arthritis (RA) is the most common inflammatory disease, the hallmark of which is a small and large joint inflammatory erosive arthritis. The cause of the disease remains unknown; however, a large number of observed immunological phenomena are recognized, many of which are utilized in targeted therapy. Pulmonary complications of rheumatoid are common. Autopsy studies suggest pulmonary involvement in up to 50% of patients. RA is a multi-factorial disease and, given its increased prevalence in women, it seems likely that hormones have an important, if not completely elucidated, influence. In most women, the disease remits during pregnancy, only to return, often more severely than before, in the post partum period. One of the major genetic factors in the aetiology of RA is the class II major histocompatability complex (MHC) gene product HLA-DR4.