A Population-Based Study of Grade 12 Academic Performance in Adolescents with Childhood-onset Chronic Rheumatic Diseases

Objective 1) To compare grade 12 standards tests results of patients diagnosed with childhoodonset chronic rheumatic diseases (ChildCRD) and unaffected peers. 2) To identify factors associated with test results of ChildCRD patients and unaffected peers. Methods This was a population-based retrospective cohort study. All ChildCRD patients (juvenile arthritis and systemic autoimmune rheumatic diseases) from the only pediatric rheumatology centre in Manitoba for birth cohorts January 1979 to December 1998 were linked to the provincial administrative databases containing records of healthcare use and education outcomes Patients were matched by age, sex and postal codes to their peers who did not have ChildCRD. The primary outcomes were the grade 12 language arts achievement index (LAI) and the math achievement index (MAI) scores. ChildCRD, sociodemographic and mental health factors were tested for their associations with LAI and MAI scores using multivariable linear regression. Results 541 ChildCRD patients were matched to 2713 unaffected peers. ChildCRD patients had lower LAI and MAI scores compared to their peers. More ChildCRD patients failed or did not take the language arts (51% vs 41%, p<0.001) and maths (61% vs 55%, p=0.017) tests. On multivariable analysis, ChildCRD, lower socioeconomic status, younger maternal age at first childbirth, family income assistance, involvement with child welfare services, and mental health morbidities (between ChildCRD diagnosis and standards testing), were associated with worse LAI and MAI results. Conclusion This population-based study showed that ChildCRD patients performed less well than their peers on grade 12 standards tests results, independent of sociodemographic and mental health comorbidities.

Adverse drug reactions associated with treatment in patients with chronic rheumatic diseases in childhood: a retrospective real life review of a single center cohort

Background Adverse drug reactions (ADRs) are the sixth leading causes of death worldwide; monitoring them is fundamental, especially in patients with disorders like chronic rheumatic diseases (CRDs). The study aimed to describe the ADRs investigating their severity and associated factors and resulting interventions in pediatric patients with CRDs. Methods A retrospective, descriptive and analytical study was conducted on a cohort of children and adolescents with juvenile idiopathic arthritis (JIA), juvenile systemic lupus erythematosus (JSLE) and juvenile dermatomyositis (JDM). The study evaluated medical records of the patients to determine the causality and the management of ADRs. In order to investigate the risk factors that would increase the risk of ADRs, a logistic regression model was carried out on a group of patients treated with the main used drug. Results We observed 949 ADRs in 547 patients studied. Methotrexate (MTX) was the most frequently used medication and also the cause of the most ADRs, which occurred in 63.3% of patients, followed by glucocorticoids (GCs). Comparing synthetic disease-modifying anti-rheumatic drugs (sDMARDs) vs biologic disease-modifying anti-rheumatic drugs (bDMARDs), the ADRs attributed to the former were by far higher than the latter. In general, the severity of ADRs was moderate and manageable. Drug withdrawal occurred in almost a quarter of the cases. In terms of risk factors, most patients who experienced ADRs due to MTX, were 16 years old or younger and received MTX in doses equal or higher than 0.6 mg/kg/week. Patients with JIA and JDM had a lower risk of ADRs than patients with JSLE. In the multiple regression model, the use of GCs for over 6 months led to an increase of 0.5% in the number of ADRs. Conclusions Although the ADRs highly likely affect a wide range of children and adolescents with CRDs they were considered moderate and manageable cases mostly. However, triggers of ADRs need further investigations.