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

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.

Correlação entre dois testes e a pontuação do Child Health Assessment Questionnaire em crianças com cardiopatia reumática

INTRODUÇÃO: As crianças que evoluem para cardiopatia reumática passam a conviver com limitações, tornam-se comumente restritas no desempenho de atividade do cotidiano. OBJETIVO Verificar a existência de correlação entre o desempenho no teste de caminhada de seis minutos (TC6M) e do degrau de três minutos (TD3) e a pontuação do child health assessment questionnaire (CHAQ) em criança com febre reumática. MÉTODOS: Estudo seccional sem grupo de comparação, descritivo e exploratório, realizado com 15 crianças. Foram avaliadas através dos testes submáximos, o TC6M e o TD3 e a avaliação da capacidade física sob a percepção do cuidador foi realizada por meio da aplicação do CHAQ . RESULTADOS: A média de idade 13,7 anos, desvio padrão 1,9 anos. A maioria dos acompanhantes eram mães, 66,7%, e uma parcela considerável dos cuidadores apresentou baixo nível socioeconômico e de escolaridade. O valor obtido na distância percorrida através do TC6M demonstrou um baixo desempenho, mediana (intervalo interquartil) 420 (101) metros que também foi observado no teste do degrau de três minutos, mediana (intervalo interquartil) 68 (6,5) degraus. Em relação ao questionário CHAQ foi observado ausência de comprometimento da capacidade física diante da percepção dos responsáveis com escore final do questionário de 0,1. A correlação entre o questionário e o teste de caminhada de seis minutos (correlação de Sperman = - 0,21) e, entre o questionário e o teste do degrau de três minutos, (correlação de Sperman = - 0,39). CONCLUSÃO: Não foi encontrada correlação dos testes submáximos, em relação à capacidade física obtida através da percepção dos responsáveis avaliada através do questionário. Esse resultado chama a atenção para a importância do fisioterapeuta inserir na sua prática clínica, nesse perfil de pacientes os testes submáximos.

Acute hematogenous osteomyelitis in children: a case series

Background Chronic osteomyelitis is still a major cause of morbidity and disability in children living in developing countries. Neglect of acute osteomyelitis and its progression to chronic osteomyelitis leads to significant morbidity. This report is the first series to describe such cases in Indonesia. Objective To describe 12 pediatric cases of chronic osteomyelitis in order to remind clinicians about the debilitating complications of musculoskeletal infection. Methods This report is a case series of 12 children with chronic osteomyelitis admitted to dr. Soetomo General Hospital, Surabaya, East Java, in 2011-2017. We acquired data from medical records. The patients’ quality of life was measured using the Child Health Assessment Questionnaire Disability Index (C-HAQ-DI). Results The patients’ mean age was eight years and they were predominantly male. The most common infection location was the femur (7/12). Microbial cultures were positive in 9/12 of cases, predominantly with Staphylococcus aureus. Erythrocyte sedimentation rate (ESR) was elevated in 11 patients. All patients were diagnosed late, with an average delay of presentation to Orthopedics of 10.5 months. Most of patients experienced mild to moderate disability after the disease, as assessed by the C-HAQ-DI. Conclusion Diagnosis of osteomyelitis in children is quite difficult, given the lack of specific diagnostic tests. Delayed diagnosis and inappropriate treatment may result in long-term morbidity and disability. Clinicians should have an increased awareness of the clinical features of osteomyelitis, including unusual presentations such as calcaneal osteomyelitis.

Validity of the Stage of Exercise Scale in Children with Rheumatologic Conditions

Objective.To determine the face, content, and construct validity of the Stages of Exercise Scale (SOES) in children with rheumatologic conditions [juvenile idiopathic arthritis (JIA) and juvenile dermatomyositis (JDM)], and if the validity of the SOES differs by disease type by comparing it with a disease control with a chronic respiratory illness [cystic fibrosis (CF)].Methods.Sixty-seven children and adolescents (43 female) ages 11 to 18 years with a diagnosis of either JDM (n = 15), JIA (n = 39), or CF (n = 13) completed the SOES; scales of sensibility, process of change, decisional balance, and self-efficacy; the Child Health Assessment Questionnaire; and patient/physician ratings of disease severity. Physical activity was measured by an accelerometer. Relationships among SOES and measured constructs were determined by ANOVA and with logistical modeling.Results.SOES, decisional balance, and self-efficacy as well as behavioral and cognitive processes from the process of change demonstrated significant differences across the staging subgroups. Disease groups did not significantly differ on the scoring across the SOES. Children and adolescents in higher stages participated in more minutes of vigorous physical activity compared with those in the lower stages.Conclusion.The SOES demonstrated good face, content, and construct validity in children and adolescents with rheumatic disease.

Land-Jump Performance in Patients with Juvenile Idiopathic Arthritis (JIA): A Comparison to Matched Controls

Objective. The purpose of this study was to determine if high functioning children with Juvenile Idiopathic Arthritis (JIA) with minimal disease activity have different biomechanics during high loading tasks compared to controls. Patients were included if they had minimal inflammation documented in one or both knees. Methods. The subject groups consisted of eleven patients with JIA and eleven sex, age, height, and weight matched controls. Sagittal plane kinematic and kinetics were calculated during a drop vertical jump maneuver. The Child Health Assessment Questionnaire (CHAQ) was collected on each patient with JIA. Results. The subjects with JIA had increased knee () and hip flexion () compared to control subjects. Subjects with JIA also demonstrated decreased knee extensor moments during take-off () and ankle plantar flexor moments during landing () and take-off (). In the JIA group, increased hip extensor moments were predictive of increased disability (, ).Conclusions. Patients with JIA may demonstrate underlying biomechanical deviations compared to controls. In addition, biomechanical assessment of hip extensor mechanics during dynamic tasks may provide an objective assessment tool to determine overall function in patients with JIA.