International Journal of Rheumatic Diseases 2014; 17: 701–702
TOP PAPERS IN RHEUMATOLOGY
Recent advances in Pediatric Rheumatology: April–June 2014 Surjit SINGH and Dhrubajyoti SHARMA Pediatric Allergy Immunology Unit & Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Etanercept inhibits the Tumor Necrosis Factor a-Driven Shift of Th17 Lymphocytes toward a nonclassic Th1 phenotype in Juvenile Idiopathic Arthritis. Maggi L, Cimaz R, Capone M et al. (2014) Arthritis Rheum 66: 1372–1377. Maggi et al. have shown decline in the nonclassic Th1 lymphocytes (i.e., CD4+ CD161+) population in juvenile idiopathic arthritis (JIA) with etanercept treatment, thus reversing the shift of CD4+CD161+ Th17 cells to the nonclassic Th1 (i.e., CD4+ CD161+) in JIA as reported by them earlier. The investigators noted that tumor necrosis factor a (TNF-a) facilitated the shift of Th17 lymphocytes toward the nonclassic Th1 phenotype in vitro. This is possibly a reflection of the enhanced expression of the type II TNF receptor in Th17 cells. Therefore, this study demonstrates that the disease-modifying effect of etanercept may be mediated by its interference with the pathological shift of CD4+CD161+ Th17 cells to the nonclassic Th1 phenotype in children with JIA. Further, etanercept was also found to significantly inhibit the mitogen proliferative responses of peripheral blood mononuclear cells. It also increased the proportion of the subset CD4+CD161+Th17/Th1 and Th17 cells in vitro. However, the proportions of the classic Th1 lymphocytes (i.e., CD4+ CD161 ) remained relatively unchanged. Whether these beneficial effects on lymphocytes would persist for long, as well as the clinical implications of these immunological changes, remain to be seen. Prevalence of antinuclear antibodies in school children during puberty and possible relationship with musculoskeletal pain: a longitudinal study. Sperotto F, Cuffaro G, Brachi S, Seguso M, Zulian F (2014) Journal of Rheumatology 41, 1405–1408. The aim of this study was to evaluate the prevalence and persistence of antinuclear antibodies (ANA) in
school children and to assess its possible relationship with chronic noninflammatory musculoskeletal pain (MSP). Two hundred and sixty-one children, aged 8–13 years, were enrolled in the study and subjected to a clinical examination for pubertal status and the presence of chronic noninflammatory MSP, if any, was recorded. Individuals with ANA positivity and/or chronic noninflammatory MSP were re-evaluated 3 years later. Although there was ANA positivity in 28 (12.3%) of the children, no apparent correlation was found with sex or pubertal status. Chronic noninflammatory MSP was noted in 67 (25.6%). When analyzed 3 years later, ANA positivity in the latter group (i.e., the ones with chronic noninflammatory MSP) had increased from 13.4% to 44.8%. In the group with ANA positivity at baseline, 92.9% were found to be positive yet again, and with a significantly increased titer. However, there was no apparent association between ANA positivity and chronic noninflammatory MSP. This study reiterates that the prevalence and titres of ANA gradually increase with age during early adolescence. However, this increase does not appear to have any association with chronic noninflammatory MSP. It provides useful clinical insights into the correct interpretation of an ANA report in the context of musculoskeletal pain in an adolescent. Clinical features of childhood granulomatosis with polyangiitis (Wegeners granulomatosis). Bohm M, Isabel M, Fernandez G, et al. for the Paediatric Rheumatology International Trials Organisation (PRINTO) (2014) Pediatric Rheumatology 12, 18. doi: 10.1186/1546-0096-12-18. Granulomatosis with polyangiitis (GPA) is an uncommon condition in the pediatric age group. The authors describe a cohort comprising 56 children (68% girls) with GPA, the majority of who were Caucasians (82%). Data were collected both retrospectively
© 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd
S. Singh and D. Sharma
and prospectively. Mean age at onset of disease was 11.7 years with a median period of delay in diagnosis of 4.2 months. Constitutional symptoms were seen in as many as 89%. Major organ systems involved were the ears, nose and throat (91%), respiratory (79%), skin (64%), musculoskeletal (59%), eye (35%) and the kidneys (50%). Almost 2/3 of the children had antineutrophil cytoplasmic antibodies (ANCA) – PR3 positivity. The authors describe significant differences between adult and pediatric presentations of GPA. While adults had a lower female preponderance and lower occurrence rates of constitutional symptoms and systemic involvement (principally ear, nose, throat and respiratory involvement), they had higher occurrence rates of conductive deafness. The authors conclude that while children with GPA have similar patterns of clinical inviolvement, the relative frequencies of systemic involvement may vary.
702
Juvenile idiopathic arthritis and malignancy (Review). Ruperto N, Martini A. Rheumatology (2014) 53, 968– 974. Since 2010 biologics have been increasingly used in the treatment of juvenile idiopathic arthritis (JIA). While anti-interleukin-6 therapies are used widely in children with systemic onset JIA, anti-tumor necrosis factor a (TNF-a) therapy is the treatment of choice in polyarthritis and in some cases of oligoarthritis. There have been serious concerns about the use of anti-TNF-a agents in growing children because of the perceived risk of development of malignancies. In this review the authors dwell on a hypothesis that the disease (i.e., JIA) itself may predispose to malignancies and this risk may not be significantly enhanced by the concomitant use of anti-TNF-a agents. This is a piece of useful information for counselling anxious parents of children with JIA.
International Journal of Rheumatic Diseases 2014; 17: 701–702
Copyright of International Journal of Rheumatic Diseases is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
TOP PAPERS IN RHEUMATOLOGY
Recent advances in Pediatric Rheumatology: April–June 2014 Surjit SINGH and Dhrubajyoti SHARMA Pediatric Allergy Immunology Unit & Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Etanercept inhibits the Tumor Necrosis Factor a-Driven Shift of Th17 Lymphocytes toward a nonclassic Th1 phenotype in Juvenile Idiopathic Arthritis. Maggi L, Cimaz R, Capone M et al. (2014) Arthritis Rheum 66: 1372–1377. Maggi et al. have shown decline in the nonclassic Th1 lymphocytes (i.e., CD4+ CD161+) population in juvenile idiopathic arthritis (JIA) with etanercept treatment, thus reversing the shift of CD4+CD161+ Th17 cells to the nonclassic Th1 (i.e., CD4+ CD161+) in JIA as reported by them earlier. The investigators noted that tumor necrosis factor a (TNF-a) facilitated the shift of Th17 lymphocytes toward the nonclassic Th1 phenotype in vitro. This is possibly a reflection of the enhanced expression of the type II TNF receptor in Th17 cells. Therefore, this study demonstrates that the disease-modifying effect of etanercept may be mediated by its interference with the pathological shift of CD4+CD161+ Th17 cells to the nonclassic Th1 phenotype in children with JIA. Further, etanercept was also found to significantly inhibit the mitogen proliferative responses of peripheral blood mononuclear cells. It also increased the proportion of the subset CD4+CD161+Th17/Th1 and Th17 cells in vitro. However, the proportions of the classic Th1 lymphocytes (i.e., CD4+ CD161 ) remained relatively unchanged. Whether these beneficial effects on lymphocytes would persist for long, as well as the clinical implications of these immunological changes, remain to be seen. Prevalence of antinuclear antibodies in school children during puberty and possible relationship with musculoskeletal pain: a longitudinal study. Sperotto F, Cuffaro G, Brachi S, Seguso M, Zulian F (2014) Journal of Rheumatology 41, 1405–1408. The aim of this study was to evaluate the prevalence and persistence of antinuclear antibodies (ANA) in
school children and to assess its possible relationship with chronic noninflammatory musculoskeletal pain (MSP). Two hundred and sixty-one children, aged 8–13 years, were enrolled in the study and subjected to a clinical examination for pubertal status and the presence of chronic noninflammatory MSP, if any, was recorded. Individuals with ANA positivity and/or chronic noninflammatory MSP were re-evaluated 3 years later. Although there was ANA positivity in 28 (12.3%) of the children, no apparent correlation was found with sex or pubertal status. Chronic noninflammatory MSP was noted in 67 (25.6%). When analyzed 3 years later, ANA positivity in the latter group (i.e., the ones with chronic noninflammatory MSP) had increased from 13.4% to 44.8%. In the group with ANA positivity at baseline, 92.9% were found to be positive yet again, and with a significantly increased titer. However, there was no apparent association between ANA positivity and chronic noninflammatory MSP. This study reiterates that the prevalence and titres of ANA gradually increase with age during early adolescence. However, this increase does not appear to have any association with chronic noninflammatory MSP. It provides useful clinical insights into the correct interpretation of an ANA report in the context of musculoskeletal pain in an adolescent. Clinical features of childhood granulomatosis with polyangiitis (Wegeners granulomatosis). Bohm M, Isabel M, Fernandez G, et al. for the Paediatric Rheumatology International Trials Organisation (PRINTO) (2014) Pediatric Rheumatology 12, 18. doi: 10.1186/1546-0096-12-18. Granulomatosis with polyangiitis (GPA) is an uncommon condition in the pediatric age group. The authors describe a cohort comprising 56 children (68% girls) with GPA, the majority of who were Caucasians (82%). Data were collected both retrospectively
© 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd
S. Singh and D. Sharma
and prospectively. Mean age at onset of disease was 11.7 years with a median period of delay in diagnosis of 4.2 months. Constitutional symptoms were seen in as many as 89%. Major organ systems involved were the ears, nose and throat (91%), respiratory (79%), skin (64%), musculoskeletal (59%), eye (35%) and the kidneys (50%). Almost 2/3 of the children had antineutrophil cytoplasmic antibodies (ANCA) – PR3 positivity. The authors describe significant differences between adult and pediatric presentations of GPA. While adults had a lower female preponderance and lower occurrence rates of constitutional symptoms and systemic involvement (principally ear, nose, throat and respiratory involvement), they had higher occurrence rates of conductive deafness. The authors conclude that while children with GPA have similar patterns of clinical inviolvement, the relative frequencies of systemic involvement may vary.
702
Juvenile idiopathic arthritis and malignancy (Review). Ruperto N, Martini A. Rheumatology (2014) 53, 968– 974. Since 2010 biologics have been increasingly used in the treatment of juvenile idiopathic arthritis (JIA). While anti-interleukin-6 therapies are used widely in children with systemic onset JIA, anti-tumor necrosis factor a (TNF-a) therapy is the treatment of choice in polyarthritis and in some cases of oligoarthritis. There have been serious concerns about the use of anti-TNF-a agents in growing children because of the perceived risk of development of malignancies. In this review the authors dwell on a hypothesis that the disease (i.e., JIA) itself may predispose to malignancies and this risk may not be significantly enhanced by the concomitant use of anti-TNF-a agents. This is a piece of useful information for counselling anxious parents of children with JIA.
International Journal of Rheumatic Diseases 2014; 17: 701–702
Copyright of International Journal of Rheumatic Diseases is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
