Background: Low bone mineral density is a common finding in children with systemic connective tissue diseases, including juvenile idiopathic arthritis (JIA). The influence of the ongoing process of bone remodeling on the disease course merits further investigation. The aim of this study was to assess the clinical relevance of markers of bone turnover and their potential role as predictors of higher fracture risk and, by extension, risk of osteoporosis. Materials and Methods: Blood samples were collected from 59 patients diagnosed with JIA in order to determine serum levels of the following markers of bone turnover: Beta-Crosslaps, osteocalcin, bone alkaline phosphatase, osteoprotegerin and receptor activator for nuclear factor kappa-B ligand. The values were analyzed with laboratory parameters and results of dual X-ray absorptiometry (DXA). Results: Osteoprotegerin and bone alkaline phosphatase levels were age-dependent. Beta-Crosslaps values were significantly higher in patients with positive JADAS27 score (p=0.0410). Osteoprotegerin levels were higher in patients treated with biological agents than only with disease-modifying anti-rheumatic drugs (p=0.0273). There was no relation between markers of bone turnover and sex, DXA results, dosage of glucocorticosteroids and disease duration. Conclusions: The authors postulate performing DXA measurements every 6 months in patients with higher disease activity. The potential lower fracture risk in children with JIA within biological treatment needs further assessment. Age- and sex-adjusted reference rates of bone turnover markers need to be developed for Central European patients in order to assess individual values properly.
Background: Juvenile idiopathic arthritis (JIA) is a chronic, heterogenous inflammatory disease of unclear pathogenesis. JIA is hypothesized to be linked to a defective immune regulation. Anti-inflammatory cytokines belong to the best known regulatory factors. T-regulatory cells are a crucial cellular component of immune tolerance. One of their functions is synthesis of interleukin 10 (IL-10) and transforming growth factor beta1 (TGF-β1). The aim of this study was to determine the proportion of T-regulatory cells (CD4+CD25highFOXP3+) in peripheral blood, and serum levels of TGF-β1 and IL-10 in patients with JIA. Methods: The study included 25 patients with newly diagnosed JIA: oligoarthritis (n=17) and polyarthritis (n=8). The control group was comprised of 17 healthy children. CD4+CD25highFOXP3+ T cells in peripheral blood were quantified by means of three-color flow cytometry. Serum concentrations of TGF-β1 and IL-10 were estimated with ELISA. Results: The proportion of peripheral CD4+CD25highFOXP3+ cells in patients with JIA was significantly higher than in the controls (p=0.04). The two groups did not differ significantly in terms of their TGF-β1 and IL-10 concentrations. Conclusions: At the time of diagnosis, children with JIA presented with an elevated proportion of T-regulatory cells (CD4+CD25highFOXP3+) in peripheral blood. Anti-inflammatory cytokines, IL-10 and TGF-β1, are not upregulated in the serum of patients with JIA, and therefore should not be considered as biomarkers of this condition.
Th17 cells are newly described population of lymphoctyes, that recruits neutrophils to the site of inflammation and activate inflammatory phenotype of various tissues. They also play a pivotal role in autoimmune diseases and cancers. These cells secrete mainly different isoforms of IL-17, but also IL-21 and IL-22. Rheumatoid arthritis and juvenile idiopathic arthritis are the most common autoimmune joints’ inflammatory disease, affecting respectively adults and children. For a long time the immunopathogenesis of autoimmune diseases has been associated with Th1 lymphocytes. This hypothesis has changed after the discovery of Th17 cells, which are thought to be key mediators of autoimmune arthritides
The application of 3D imaging in pediatric rheumatology helps to make the assessment of infl ammatory changes more objective and to estimate accurately their volume and the actual response to treatment in the course of follow-up examinations. Additional interesting opportunities are opened up by the vascularity analysis with the help of power Doppler and color Doppler in 3D imaging. Contrast-enhanced ultrasound examinations enable a more sensitive assessment of the vascularity of infl amed structures of the locomotor system, and a more accurate analysis of treatment’s effect on changes in vascularity, and thereby the infl ammation process activity, as compared to the classical options of power and color Doppler. The equipment required, time limitations, as well as the high price in the case of contrast-enhanced ultrasound, contribute to the fact that the 3D analysis of infl ammatory changes and contrast-enhanced ultrasound examinations are not routinely applied for pediatric patients.
PL
Zastosowanie obrazowania trójwymiarowego w reumatologii dziecięcej pozwala na zobiektywizowanie oceny zmian zapalnych i dokładne oszacowanie ich objętości oraz realną ocenę odpowiedzi na leczenie w badaniach kontrolnych. Dodatkowe interesujące możliwości otwiera analiza unaczynienia dopplerem mocy i kolorowym dopplerem w obrazowaniu trójwymiarowym. Badania kontrastujące z wykorzystaniem ultrasonografi cznych środków kontrastujących umożliwiają czulszą ocenę unaczynienia zapalnie zmienionych struktur narządu ruchu oraz dokładniejszą analizę wpływu leczenia na zmiany unaczynienia, a tym samym aktywności procesu zapalnego, w porównaniu z klasycznymi opcjami dopplera mocy i kolorowego dopplera. Wymagania sprzętowe oraz ograniczenia czasowe, zaś w przypadku badań z wykorzystaniem ultrasonografi cznych środków kontrastujących wysoka cena sprawiają, że trójwymiarowa analiza zmian zapalnych oraz badania kontrastowe z wykorzystaniem ultrasonografi cznych środków kontrastujących nie są rutynowo stosowane w badaniach ultrasonografi cznych u dzieci.
Kostniak kostnawy jest częstym łagodnym nowotworem kości. Klasyczna prezentacja objawów obejmuje ból nocny, dobrze reagujący na niesteroidowe leki przeciwzapalne. Kostniak kostnawy może naśladować wiele schorzeń, m.in. młodzieńcze idiopatyczne zapalenie stawów, infekcję, nowotwór złośliwy, stan pourazowy. Przedstawiamy przypadek 14-letniej dziewczynki z wielomiesięczną historią bólu z ograniczeniem ruchomości lewego stawu biodrowego. Pacjentka przeszła kilka nieprawidłowych ścieżek diagnostyczno-leczniczych. Początkowo rozpoznano stan pourazowy, następnie gruźlicę latentną oraz młodzieńcze idiopatyczne zapalenie stawów. Liczne hospitalizacje, badania laboratoryjne, obrazowe oraz niedostosowane leczenie spowodowały opóźnienie rozpoznania i wdrożenie odpowiedniego postępowania o 2 lata. Ostatecznie wykonanie badania TK stawów biodrowych umożliwiło postawienie prawidłowego rozpoznania. Wyleczenie uzyskano za pomocą ablacji termicznej z śródoperacyjną nawigacją 3D.
EN
Osteoid osteoma is a common benign bone tumor. The classic presentation includes nocturnal pain that responds well to nonsteroidal anti-inflammatory drugs. Osteoid osteoma can mimic many conditions, including juvenile idiopathic arthritis, infection, malignant neoplasm, and post-traumatic condition. We present the case of a 14-year-old girl with a months-long history of pain with limited mobility of the left hip joint. The patient was subject to several incorrect diagnoses followed by incorrect treatment pathways. Initially, a post-traumatic condition was diagnosed, then latent tuberculosis and juvenile idiopathic arthritis. Numerous hospitalizations, laboratory and imaging studies, and inappropriate treatment delayed the diagnosis and appropriate management by 2 years. Ultimately, a CT scan of the hip joints enabled the correct diagnosis to be made. Thermal ablation with intraoperative 3D navigation was utilized to successfully treat the lesion.
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