scholarly journals A pilot study of possible anti-inflammatory effects of the specific carbohydrate diet in children with juvenile idiopathic arthritis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Lillemor Berntson
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Health Assessment ◽  
Short Chain Fatty Acids ◽  
Carbohydrate Diet ◽  
Positive Effects ◽  
Link Type ◽  
Parents And Children ◽  
Inflammatory Proteins ◽  
Anti Inflammatory ◽  
Specific Carbohydrate Diet

Abstract Background To explore possible anti-inflammatory effects of the specific carbohydrate diet in children with juvenile idiopathic arthritis. This diet has shown anti-inflammatory effect in children with inflammatory bowel disease. Methods Twenty-two patients with juvenile idiopathic arthritis (age 6.3–17.3 years), with ≤2 inflamed joints and an erythrocyte sedimentation rate < 30 mm/h, were included in this explorative study. Fifteen children completing four weeks on the diet were evaluated. A dietician introduced parents and children to the diet, and two follow-ups were performed during the intervention. Conventional laboratory tests and multiplex analyses of 92 inflammatory proteins were used. Short-chain fatty acids in faecal samples were examined. Results The diet significantly decreased morning stiffness (p = 0.003) and pain (p = 0.048). Physical function, assessed through the child health assessment questionnaire, improved (p = 0.022). Arthritis improved in five of the seven children with arthritis; in those seven, multiplex analyses showed a significant decrease in nine inflammatory proteins, including TNF-alpha (p = 0.028), after four weeks. Faecal butyrate, analysed in all 15 participants, increased significantly (p = 0.020). Conclusion The specific carbohydrate diet may have significant positive effects on arthritis in children with juvenile idiopathic arthritis, but further studies are needed. Clinical trials identifier NCT04205500, 2019/12/17, retrospectively registered. URL: https://register.clinicaltrials.gov

scholarly journals A Pilot Study of Possible Anti-Inflammatory Effects of The Specific Carbohydrate Diet in Children with Juvenile Idiopathic Arthritis

2021 ◽  
Author(s):  
Lillemor Berntson
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Health Assessment ◽  
Short Chain Fatty Acids ◽  
Carbohydrate Diet ◽  
Positive Effects ◽  
Parents And Children ◽  
Inflammatory Proteins ◽  
Anti Inflammatory ◽  
Child Health Assessment Questionnaire ◽  
Specific Carbohydrate Diet

Abstract Background: To explore possible anti-inflammatory effects of the specific carbohydrate diet in children with juvenile idiopathic arthritis. This diet has shown anti-inflammatory effect in children with inflammatory bowel disease.Methods: Twenty-two patients with juvenile idiopathic arthritis (age 6.3–17.3 years), with ≤ 2 inflamed joints and an erythrocyte sedimentation rate < 30 mm/h, were included in this explorative study. Fifteen children completing four weeks on the diet were evaluated. A dietician introduced parents and children to the diet, and two follow-ups were performed during the intervention. Conventional laboratory tests and multiplex analyses of 92 inflammatory proteins were used. Short-chain fatty acids in faecal samples were examined.Results: The diet significantly decreased morning stiffness (p = 0.003) and pain (p = 0.048). Physical function, assessed through the child health assessment questionnaire, improved (p = 0.022). Arthritis improved in five of the seven children with arthritis; in those seven, multiplex analyses showed a significant decrease in nine inflammatory proteins, including TNF-alpha (p = 0.028), after four weeks. Faecal butyrate, analysed in all 15 participants, increased significantly (p = 0.020).Conclusion: The specific carbohydrate diet may have significant positive effects on arthritis in children with juvenile idiopathic arthritis, but further studies are needed.Clinical Trials Identifier: NCT04205500, 2019/12/17, retrospectively registered. URL:https://register.clinicaltrials.gov.

scholarly journals Anti-inflammatory effect of the specific carbohydrate diet in children with juvenile idiopathic arthritis

2020 ◽  
Author(s):  
Lillemor Berntson
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Physical Function ◽  
Dietary Intervention ◽  
Morning Stiffness ◽  
Short Chain Fatty Acids ◽  
Carbohydrate Diet ◽  
Intestinal Immune System ◽  
Anti Inflammatory ◽  
Specific Carbohydrate Diet ◽  
Inflammatory Effect

Abstract Background Diet has an effect on the intestinal immune system, which may have consequences for inflammatory diseases. Specific carbohydrate diet (SCD) is an effective anti-inflammatory treatment for inflammatory bowel disease in children. We explored the anti-inflammatory effect of SCD in children with juvenile idiopathic arthritis (JIA). Methods Twenty-two patients with JIA (age 6.3–17.3 years), with stable, low-to-medium disease activity, were included in the study. Seven children dropped out within two weeks from the start of SCD, and fifteen patients, who completed four to five weeks of SCD, were evaluated in the final analyses. A dietician introduced parents and children to SCD with written and verbal instructions, and regular follow-ups were performed during the intervention period. Patients were studied with clinical and laboratory examinations before, during and after the intervention. In addition to conventional JIA laboratory tests, analyses were performed of short chain fatty acids in faecal samples at inclusion and after two and four weeks of SCD. Results SCD significantly decreased morning stiffness (p = 0.003) and pain (p = 0.048), and improved physical function assessed through the child health assessment questionnaire (p = 0.022). Arthritis improved in five of the seven children with arthritis at inclusion. Faecal butyrate increased significantly (p = 0.020). Conclusions SCD has significant positive effect on arthritis activity, morning stiffness, pain and physical function in children with JIA. Our results suggest that change in bacterial activity of the intestinal canal by dietary intervention may provide an effective and feasible complementary treatment for JIA.

scholarly journals Anti-inflammatory effect of the specific carbohydrate diet in children with juvenile idiopathic arthritis

2020 ◽  
Author(s):  
Lillemor Berntson
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Physical Function ◽  
Dietary Intervention ◽  
Morning Stiffness ◽  
Short Chain Fatty Acids ◽  
Carbohydrate Diet ◽  
Intestinal Immune System ◽  
Anti Inflammatory ◽  
Specific Carbohydrate Diet ◽  
Inflammatory Effect

Abstract Background Diet has an effect on the intestinal immune system, which may have consequences for inflammatory diseases. Specific carbohydrate diet (SCD) is an effective anti-inflammatory treatment for inflammatory bowel disease in children. We explored the anti-inflammatory effect of SCD in children with juvenile idiopathic arthritis (JIA). Methods Twenty-two patients with JIA (age 6.3–17.3 years), with stable, low-to-medium disease activity, were included in the study. Seven children dropped out within two weeks from the start of SCD, and fifteen patients, who completed four to five weeks of SCD, were evaluated in the final analyses. A dietician introduced parents and children to SCD with written and verbal instructions, and regular follow-ups were performed during the intervention period. Patients were studied with clinical and laboratory examinations before, during and after the intervention. In addition to conventional JIA laboratory tests, analyses were performed of short chain fatty acids in faecal samples at inclusion and after two and four weeks of SCD. Results SCD significantly decreased morning stiffness (p = 0.003) and pain (p = 0.048), and improved physical function assessed through the child health assessment questionnaire (p = 0.022). Arthritis improved in five of the seven children with arthritis at inclusion. Faecal butyrate increased significantly (p = 0.020). Conclusions SCD has significant positive effect on arthritis activity, morning stiffness, pain and physical function in children with JIA. Our results suggest that change in bacterial activity of the intestinal canal by dietary intervention may provide an effective and feasible complementary treatment for JIA.

scholarly journals Enhanced Bilosomal Properties Resulted in Optimum Pharmacological Effects by Increased Acidification Pathways

Pharmaceutics ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1184
Author(s):  
Armin Mooranian ◽  
Thomas Foster ◽  
Corina M Ionescu ◽  
Daniel Walker ◽  
Melissa Jones ◽  
...  
Keyword(s):  
Bile Acids ◽  
Biological Effects ◽  
Cellular Respiration ◽  
Full Potential ◽  
Protective Effects ◽  
Pharmacological Effects ◽  
Β Cells ◽  
Positive Effects ◽  
Wide Range ◽  
Anti Inflammatory

Introduction: Recent studies in our laboratory have shown that some bile acids, such as chenodeoxycholic acid (CDCA), can exert cellular protective effects when encapsulated with viable β-cells via anti-inflammatory and anti-oxidative stress mechanisms. However, to explore their full potential, formulating such bile acids (that are intrinsically lipophilic) can be challenging, particularly if larger doses are required for optimal pharmacological effects. One promising approach is the development of nano gels. Accordingly, this study aimed to examine biological effects of various concentrations of CDCA using various solubilising nano gel systems on encapsulated β-cells. Methods: Using our established cellular encapsulation system, the Ionic Gelation Vibrational Jet Flow technology, a wide range of CDCA β-cell capsules were produced and examined for morphological, biological, and inflammatory profiles. Results and Conclusion: Capsules’ morphology and topographic characteristics remained similar, regardless of CDCA or nano gel concentrations. The best pharmacological, anti-inflammatory, and cellular respiration, metabolism, and energy production effects were observed at high CDCA and nano gel concentrations, suggesting dose-dependent cellular protective and positive effects of CDCA when incorporated with high loading nano gel.

scholarly journals Stromal Vascular Fraction for Osteoarthritis of the Knee Regenerative Engineering

2021 ◽  
Author(s):  
Chinedu C. Ude ◽  
Shiv Shah ◽  
Kenneth S. Ogueri ◽  
Lakshmi S. Nair ◽  
Cato T. Laurencin
Keyword(s):  
Quality Of Life ◽  
Clinical Evidence ◽  
Point Of Care ◽  
Stromal Vascular Fraction ◽  
Clinic Visit ◽  
Osteoarthritis Of The Knee ◽  
Clinical Patient ◽  
Inflammatory Proteins ◽  
Anti Inflammatory

Abstract Purpose The knee joint is prone to osteoarthritis (OA) due to its anatomical position, and several reports have implicated the imbalance between catabolic and anabolic processes within the joint as the main culprit, thus leading to investigations towards attenuation of these inflammatory signals for OA treatment. In this review, we have explored clinical evidence supporting the use of stromal vascular fraction (SVF), known for its anti-inflammatory characteristics for the treatment of OA. Methods Searches were made on PubMed, PMC, and Google Scholar with the keywords “adipose fraction knee regeneration, and stromal vascular fraction knee regeneration, and limiting searches within 2017–2020. Results Frequently found interventions include cultured adipose-derived stem cells (ADSCs), SVF, and the micronized/microfragmented adipose tissue-stromal vascular fraction (MAT-SVF). Clinical data reported that joints treated with SVF provided a better quality of life to patients. Currently, MAT-SVF obtained and administered at the point of care is approved by the Food and Drug Administration (FDA), but more studies including manufacturing validation, safety, and proof of pharmacological activity are needed for SVF. The mechanism of action of MAT-SVF is also not fully understood. However, the current hypothesis indicates a direct adherence and integration with the degenerative host tissue, and/or trophic effects resulting from the secretome of constituent cells. Conclusion Our review of the literature on stromal vascular fraction and related therapy use has found evidence of efficacy in results. More research and clinical patient follow-up are needed to determine the proper place of these therapies in the treatment of osteoarthritis of the knee. Lay Summary Reports have implicated the increased inflammatory proteins within the joints as the main cause of osteoarthritis (OA). This has attracted interest towards addressing these inflammatory proteins as a way of treatment for OA. The concentrated cell-packed portion of the adipose product stromal vascular fraction (SVF) from liposuction or other methods possesses anti-inflammatory effects and has been acclaimed to heal OA. Thus, we searched for clinical evidence supporting their use, for OA treatment through examining the literature. Data from various hospitals support that joints treated with SVF provided a better quality of life to patients. Currently, there is at least one version of these products that are obtained and given back to patients during a single clinic visit, approved by the FDA.

scholarly journals Short-chain fatty acids contribute to neuropathic pain via regulating microglia activation and polarization

2021 ◽  
Vol 17 ◽  
pp. 174480692199652
Author(s):  
Feng Zhou ◽  
Xian Wang ◽  
Baoyu Han ◽  
Xiaohui Tang ◽  
Ru Liu ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Thermal Hyperalgesia ◽  
Short Chain Fatty Acids ◽  
Antibiotic Administration ◽  
Tnf Α ◽  
Microglia Polarization ◽  
Inflammatory Phenotype ◽  
Phenotype Markers ◽  
Anti Inflammatory

Microglia activation and subsequent pro-inflammatory responses play a key role in the development of neuropathic pain. The process of microglia polarization towards pro-inflammatory phenotype often occurs during neuroinflammation. Recent studies have demonstrated an active role for the gut microbiota in promoting microglial full maturation and inflammatory capabilities via the production of Short-Chain Fatty Acids (SCFAs). However, it remains unclear whether SCFAs is involved in pro-inflammatory/anti-inflammatory phenotypes microglia polarization in the neuropathic pain. In the present study, chronic constriction injury (CCI) was used to induce neuropathic pain in mice, the mechanical withdrawal threshold, thermal hyperalgesia were accomplished. The levels of microglia markers including ionized calcium-binding adaptor molecule 1 (Iba1), cluster of differentiation 11b (CD11b), pro-inflammatory phenotype markers including CD68, interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and anti-inflammatory phenotype markers including CD206, IL-4 in the hippocampus and spinal cord were determined on day 21 after CCI. The results showed that CCI produced mechanical allodynia and thermal hyperalgesia, and also increased the expressions of microglia markers (Iba1, CD11b) and pro-inflammatory phenotype markers (CD68, IL-1β, and TNF-α), but not anti-inflammatory phenotype marker (CD206, IL-4) in the hippocampus and spinal cord, accompanied by increased SCFAs in the gut. Notably, antibiotic administration reversed these abnormalities, and its effects was also bloked by SCFAs administration. In conclusion, data from our study suggest that CCI can lead to mechanical and thermal hyperalgesia, while SCFAs play a key role in the pathogenesis of neuropathic pain by regulating microglial activation and subsequent pro-inflammatory phenotype polarization. Antibiotic administration may be a new treatment for neuropathic pain by reducing the production of SCFAs and further inhibiting the process of microglia polarization.

scholarly journals Beyond the guidelines management of juvenile idiopathic arthritis: a case report of a girl with polyarticular disease refractory to multiple treatment options and Leri Weill syndrome

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Vana Vukić ◽  
Ana Smajo ◽  
Mandica Vidović ◽  
Rudolf Vukojević ◽  
Miroslav Harjaček ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Case Report ◽  
Treatment Options ◽  
Janus Kinase ◽  
Musculoskeletal Symptoms ◽  
Multiple Treatment ◽  
Number Of Patients ◽  
Systemic Glucocorticoids ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Abstract Background The last two decades brought new treatment options and high quality guidelines into the paediatric rheumatologic practice. Nevertheless, a number of patients still present a diagnostic and therapeutic challenge due to combination of vague symptoms and unresponsiveness to available treatment modalities. Case presentation We report a case of sixteen years old girl suffering from polyarticular type of juvenile idiopathic arthritis refractory to multiple treatment options. She first presented at the age of 4 with swelling and contractures of both knees. Her symptoms were initially unresponsive to nonsteroidal anti-inflammatory drugs and progressed despite treatment with intraarticular and systemic glucocorticoids and methotrexate. Throughout the years, she received several biologics together with continuous administration of nonsteroidal anti-inflammatory drugs and disease modifying anti-rheumatic drugs as well as intraarticular and systemic glucocorticoids in disease flares. However, none of this options  provided a permanent remission, so various other modalities, as well as other possible diagnoses were constantly being considered. Eventually she became dependent on a daily dose of systemic glucocorticoids. In 2018, the treatment with Janus kinase inhibitor tofacitinib was initiated, which led to gradual amelioration of musculoskeletal symptoms, improvement of inflammatory markers and overall well-being, as well as to the weaning of systemic glucocorticoids. As the swelling of the wrists subsided for the first time in many years, Madelung’s deformity was noticed, first clinically, and later radiographically as well. Genetic analysis revealed short-stature homeobox gene deficiency and confirmed the diagnosis of Leri Weill syndrome. Conclusions This case report emphasizes the need for reporting refractory, complicated cases from everyday clinical practice in order to build-up the overall knowledge and share experience which is complementary to available guidelines. Individual reports of difficult to treat cases, especially when additional diagnoses are involved, can be helpful for physicians treating patients with common rheumatological diseases such as juvenile idiopathic arthritis.

scholarly journals FRI0591 VALIDITY OF THE GERMAN VERSION OF BOTH THE PARENT ADHERENCE REPORT QUESTIONNAIRE (PARC) AND THE CHILD ADHERENCE REPORT QUESTIONNAIRE (CARQ) - DATA OF THE INCEPTION COHORT OF NEWLY DIAGNOSED PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS (ICON)

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 901.2-901
Author(s):  
S. Kirchner ◽  
C. Sengler ◽  
J. Klotsche ◽  
I. Liedmann ◽  
M. Niewerth ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Disease Activity ◽  
Intraclass Correlation ◽  
General Level ◽  
German Version ◽  
Inception Cohort ◽  
Research Support ◽  
Validated Questionnaire ◽  
Parents And Children ◽  
Perceived Helpfulness

Background:Juvenile idiopathic arthritis (JIA) is the most common chronic inflammatory rheumatic disease in childhood. A multimodal treatment is needed to reduce pain, control inflammation and maintain joint functioning. Adherence to prescribed therapies is necessary for an optimal outcome. Measuring adherence in children with JIA and their caregivers by a validated questionnaire provides important information about benefits and problems with treatment.Objectives:To evaluate adherence in JIA patients and to validate the German version of both the parent adherence report questionnaire (PARQ) and the child adherence report questionnaire (CARQ).Methods:The PARQ and CARQ were translated from its original English version into German and cross-culturally adapted. Parents and children completed the PARQ and CARQ 4 years after enrolment in the Inception cohort ICON. These questionnaires measure child ability (by VAS 0-100, 100 = best) related to i) general level of difficulty in following treatment, ii) frequency of following treatment, iii) negative reactions in response to treatment [i)-iii) summarized to child ability total score], iv) perceived helpfulness of treatment, and 4 categorical questions on errors in medication behavior. Reliability was tested by re-administering the questionnaire after a mean of 13 days. Reproducibility was analysed using intraclass correlation coefficients (ICC). VAS scores were correlated with the Pediatric Quality of Life Inventory (PedsQL) treatment scale items for convergent validity, and with sociodemographic parameters for discriminant validity.Results:481 parents and 465 children completed the PARQ and the CARQ, respectively, 56 parents and 37 children took part in the re-test. The mean age at assessment was 10.1±3.7 years, mean disease duration was 4.7±0.8 years. The majority of patients suffered from oligoarthritis (49%), followed by rheumatoid-factor negative polyarthritis (30%). Treatment with a DMARD received 60% (MTX 46%), 28% received a biological drug, 16% both. Disease activity measured by the clinical juvenile arthritis disease activity score-10 (cJADAS-10) was 2.6 ± 3.4 (range 0 – 30, best = 0), functional status was good (mean CHAQ 0.2 ± 0.4). Exercise and splints were prescribed to 57% and 21% of patients, respectively.PARQ/CARQ mean child ability total scores for medication were 73.1 ± 23.3/76.5 ± 24.2, for exercise: 85.6 ± 16.5/90.3 ± 15.0, for splints: 72.9 ± 24.2/82.9 ± 16.5. About a third of parents and children reported any error in medication behavior. Perceived helpfulness was highest for medication (PARQ/CARQ 87.4 ± 20.6/83.6 ± 26.1) and lowest for splints. (PARQ/CARQ 80.8 ± 28.4/73.5 ± 33.6).ICCs related to medication indicated good to excellent concordance (PARQ ICC = 0.69 - 0.96; CARQ ICC = 0.53 - 0.75), to exercise moderate (PARQ ICC = 0.28 - 0.45; CARQ ICC = 0.67 - 0.93) and to splints disparate concordance (PARQ ICC = 0.01 - 0.90, CARQ ICC = 0.86 - 0.93).Scores for medications (PARQ: r 0.06 - 0.38, CARQ: 0.06 - 0.49), exercise (PARQ: r 0.03 - 0.30, CARQ: 0.01 - 0.34) and splints (PARQ: r 0.09 - 0.52, CARQ: 0.11 - 0.62) showed a fair to good correlation with the PedsQL scales. Gender and socioeconomic status were not associated with the level of adherence.Conclusion:The German version of the PARQ and CARQ appears to be a valuable tool to measure adherence in patients with JIA and to evaluate helpfulness of treatments.Acknowledgments:ICON is funded by the Federal Ministry of Research (FKZ:01ER0812)Disclosure of Interests:Sabine Kirchner: None declared, Claudia Sengler: None declared, Jens Klotsche: None declared, Ina Liedmann: None declared, Martina Niewerth: None declared, Daniel Windschall: None declared, Tilmann Kallinich Grant/research support from: Novartis, Consultant of: Sobi, Roche, Novartis, Gerd Horneff Grant/research support from: AbbVie, Chugai, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Speakers bureau: AbbVie, Bayer, Chugai, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Toni Hospach: None declared, Frank Dressler: None declared, J. B. Kuemmerle-Deschner Grant/research support from: Novartis, AbbVie, Sobi, Consultant of: Novartis, AbbVie, Sobi, Kirsten Minden Consultant of: GlaxoSmithKline, Sanofi, Speakers bureau: Roche

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