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Objective To study growth and puberty in a multinational longitudinal prospective cohort of children with juvenile dermatomyositis (DM). Methods Children from 31 countries who were ages DM in active phase were studied, and analyses of height, weight, and pubertal development were conducted in those who had follow-up visits during a 2-year period and for whom anthropometric data was available. Results A total of 196 of 275 children (71%) were included. We found a significant reduction in parent-adjusted height Z score over time in female patients (P < 0.0001) and male patients (P = 0.001), but with catch-up growth at the final study visit. Median body mass index Z score peaked at 6 months (P < 0.0001) and was still significantly above baseline at the final study visit, which was at a median of 26 months after baseline (P = 0.007), with no difference between sexes. Female patients with a disease duration >= 12 months after onset had significantly lower parent-adjusted height Z score (P = 0.002) and no 2-year catch-up growth. At the final study visit, growth failure was seen in 20 of 97 female patients (21%) and in 11 of 73 male patients (15%). Height deflection ( increment height Z score less than -0.25/year) was observed in 29 of 116 female patients (25%) and 25 of 80 male patients (31.3%). Delayed puberty was seen in 20 of 55 female patients (36.4%) and in 11 of 31 male patients (35.5%). Children in early pubertal stage at baseline had the highest risk of growth failure. Conclusion Juvenile DM in the active phase and/or its treatment has a significant impact on growth and puberty in affected children. Children with recent onset of puberty or previous growth failure have the highest risk of delayed pubertal development and further growth retardation.

Background: To derive a list of opportunistic infections (OI) through the analysis of the juvenile idiopathic arthritis (JIA) patients in the Pharmachild registry by an independent Safety Adjudication Committee (SAC). Methods: The SAC (3 pediatric rheumatologists and 2 pediatric infectious disease specialists) elaborated and approved by consensus a provisional list of OI for use in JIA. Through a 5 step-procedure, all the severe and serious infections, classified as per MedDRA dictionary and retrieved in the Pharmachild registry, were evaluated by the SAC by answering six questions and adjudicated with the agreement of 3/5 specialists. A final evidence-based list of OI resulted by matching the adjudicated infections with the provisional list of OI. Results: A total of 772 infectious events in 572 eligible patients, of which 335 serious/severe/very severe non-OI and 437 OI (any intensity/severity), according to the provisional list, were retrieved. Six hundred eighty-two of 772 (88.3%) were adjudicated as infections, of them 603/682 (88.4%) as common and 119/682 (17.4%) as OI by the SAC. Matching these 119 opportunistic events with the provisional list, 106 were confirmed by the SAC as OI, and among them infections by herpes viruses were the most frequent (68%), followed by tuberculosis (27.4%). The remaining events were divided in the groups of non-OI and possible/patient and/or pathogen-related OI. Conclusions: We found a significant number of OI in JIA patients on immunosuppressive therapy. The proposed list of OI, created by consensus and validated in the Pharmachild cohort, could facilitate comparison among future pharmacovigilance studies. © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Aim of the work: To describe and compare sleep disturbance in children and adolescents with inactive juvenile idiopathic arthritis (JIA) and to study their relation to health-related quality of life (HRQoL). Patients and methods: Fifty JIA patients and 50 controls along with their parents were studied. Sleep disturbance was assessed by the Children's Sleep Habits Questionnaire (CSHQ) and HRQoL was assessed according to the revised KINDLR questionnaire. Results: The 50 JIA children were 14 boys (28%) and 36 girls (72%); 58% children and 42% adolescent. The mean age of participants was comparable between boys (11.6 ± 2.9 years) and girls (11.4 ± 3.3 years) either in JIA (p =.76) or control (p =.56). Patients enrolled had enthesitis-related arthritis in 6(12%), RF-positive polyarthritis in 8(16%), oligoarthritis in 32(64%), systemic arthritis in 2(4%) and psoriatic arthritis in 2(4%). Patients had higher CSHQ score (45.5 ± 8.2) and a lower KINDLR (72.4 ± 16.8) compared to the control (40.4 ± 3.4 and 78.3 ± 5.4; p

A 4.5-year-old girl presented to the emergency department with a 5-day history of high fever, fatigue, and rash. Because of pneumonia with pleural empyema and sepsis caused by Streptococcus pyogenes, she was admitted to the pediatric intensive care unit. After initial improvement and on the eighth day, she became febrile again and also developed conjunctivitis, rash, cervical lymphadenopathy, periungual desquamation, and elevated inflammatory markers. A cardiac echo revealed a limited dilatation of the left main coronary artery. Because of suspicion of secondary Kawasaki disease, she received intravenous immunoglobulin and acetylsalicylic acid. There was an immediate clinical response with improvement of all clinical manifestations and laboratory findings. During follow-up examination 1 month later, the diameter of the left main coronary artery was within normal limits. A high index of suspicion of Kawasaki disease in children is required upon development of fever and compatible signs and symptoms in patients with serious streptococcal disease. © 2018 Wolters Kluwer Health, Inc. All rights reserved.

OBJECTIVE: To identify which laboratory tests that change over time are most valuable for the timely diagnosis of macrophage activation syndrome (MAS) complicating systemic juvenile idiopathic arthritis (sJIA).METHODS: A multistep process, based on a combination of expert consensus and analysis of real patient data, was conducted. A panel of experts was first asked to evaluate 115 profiles of patients with MAS, which included the values of laboratory tests at the pre-MAS visit and at MAS onset, and the change in values between the two time points. The experts were asked to choose the 5 laboratory tests in which change was most important for the diagnosis of MAS and to rank the 5 selected tests in order of importance. The relevance of change in laboratory parameters was further discussed and ranked by the same experts at a consensus conference.RESULTS: Platelet count was the most frequently selected test, followed by ferritin level, aspartate aminotransferase (AST), white cell count, neutrophil count, and fibrinogen and erythrocyte sedimentation rate. Ferritin was most frequently assigned the highest score. At the end of the process, platelet count, ferritin level and AST were the laboratory tests in which the experts found change over time to be most important.CONCLUSIONS: We identified the laboratory tests in which change over time is most valuable for the early diagnosis of MAS in sJIA. The dynamics of laboratory values during the course of MAS should be further scrutinised in a prospective study in order to establish the optimal cut-off values for their variation.

OBJECTIVES: To evaluate the performance of the Birmingham Vasculitis Activity Score (BVAS) v3 and the Disease Extent Index (DEI) for the assessment of disease activity in 4 primary childhood (c-) systemic vasculitides. METHODS: Patients fulfilling the EULAR/PRINTO/PRES (Ankara) c-vasculitis classification criteria for Henoch-Schönlein purpura (HSP), childhood (c) polyarteritis nodosa (c-PAN), c-Wegener's granulomatosis (c-WG) and c-Takayasu arteritis (c-TA) with disease duration at the time of diagnosis ≤3 months were extracted from the PRINTO database. The performance of the BVAS and DEI were examined by assessing convergent validity, the pattern of disease involvement, and responsiveness. We also evaluated alternative unweighted scoring methods for both tools. RESULTS: The analysis set included 796 patients with 669 HSP, 80 c-PAN, 25 c-WG and 22 c-TA. The median age at diagnosis was 6.9 years (6.6-12) and median delay in making the diagnosis from the onset of signs/symptoms was 0.01 (0.003-0.027) years. A strong correlation was found between the BVAS and DEI (rs=0.78) while correlation with the physician global assessment was moderate (rs=0.48) with BVAS and poor with DEI (rs=0.25). Both the BVAS and DEI sub-scores and total scores were able to descrive the disease involvement in the 4 childhood vasculitides. Responsiveness was large (>1.5) for both tools. The performance characteristics of the BVAS and DEI with the unweighted methods were comparable. CONCLUSIONS: This study demonstrates that both the BVAS and DEI are valid tools for the assessment of the level of disease activity in a large cohort of childhood acute and chronic vasculitides.

Η eυλογιά του προβάτου eίναι λοιμώδeς νόσημα υψηλής μeταδοτικότητας, το οποίο eκδηλώνeται σποραδικά σe ορισμένeς πeριοχές της χώρας μας τα τeλeυταία χρόνια. Πιστeύeται ότι eισάγeται στη χώρα μας από γeιτονικές χώρeς, μέσω των διασυνοριακών μeτακινήσeων ζώων και πιθανώς ανθρώπων. Στην ανακοίνωση μας αυτή παρατίθeνται eπιζωοτιολογικά στοιχeία των τeλeυταίων 17 eτών, έτσι ώστe να eίναι δυνατή η παρακολούθηση της eξέλιξης του νοσήματος και η eξαγωγή συμπeρασμάτων. Από το 1982 έως το 1986 δeν υπήρχαν κρούσματα eυλογιάς στη χώρα. Η πρώτη eστία eμφανίσθηκe στο Νομό Λέσβου το 1987, αλλά δeν eπeκτάθηκe. Το 1988 σημeιώθηκαν eστίeς στο Νομό Έβρου, όπου και πάλι το νόσημα πeριορίστηκe έγκαιρα. Το 1994 eπανeμφανίσθηκe μία μόνο eστία στο Νομό Έβρου. Από το 1995 έως το 1998 eμφανίστηκαν πολλές eστίeς στο Νομό Έβρου, καθώς και σe άλλeς πeριοχές, όπως στο Νομό Θeσσαλονίκης (1995), στους Νομούς Λάρισας, Ξάνθης, Ροδόπης, Καβάλας, Μαγνησίας και στη Λήμνο (1996). Το 1997 υπήρξαν κρούσματα eυλογιάς eκτός του Νομοΰ Eβρου, στους Νομούς Καβάλας, Μαγνησίας, Χαλκιδικής και στη Σαμοθράκη. Το 1998 οι eστίeς πeριορίστηκαν και σe αριθμό και σe έκταση και παρέμeιναν στα όρια του Νομού Έβρου.

Greece has been rabies free since 1987 while no human cases have been seen since 1970. The re-emergence of rabies in Northern Greece during 2012-2013 in wild and domestic animals prompted a systematic review of historical evidence of the presence of the disease in the country from ancient years till the present. Historical data is presented along with efforts to prevent disease in animals and humans especially during the high prevalent periods in the country in the mid-20th century. These efforts serve as a guide to current extensive efforts to prevent spread especially in the wild and domestic animal populations. © 2014 Elsevier Ltd.

Item does not contain fulltext OBJECTIVE: To evaluate the response to treatment of autoinflammatory diseases from an international registry and an up-to-date literature review. METHODS: The response to treatment was studied in a web-based registry in which clinical information on anonymised patients with autoinflammatory diseases was collected retrospectively as part of the Eurofever initiative. Participating hospitals included paediatric rheumatology centres of the Paediatric Rheumatology International Trial Organisation network and adult centres with a specific interest in autoinflammatory diseases. The following diseases were included: familial Mediterranean fever (FMF), cryopyrin-associated periodic syndromes (CAPS), tumour necrosis factor (TNF)-receptor associated periodic syndrome (TRAPS), mevalonate kinase deficiency (MKD), pyogenic arthritis pustulosis acne (PAPA) syndrome, deficiency of interleukin-1 receptor antagonist (DIRA), NLRP12-related periodic fever and periodic fever aphthosis pharyngitis adenitis (PFAPA) syndrome. Cases were independently validated by experts for each disease. A literature search regarding treatment of the abovementioned diseases was also performed using Medline and Embase. RESULTS: 22 months from the beginning of the enrolment, complete information on 496 validated patients was available. Data from the registry in combination with evidence from the literature confirmed that colchicine is the treatment of choice for FMF and IL-1 blockade for DIRA and CAPS. Corticosteroids on demand probably represent a valid therapeutic strategy for PFAPA, but also for MKD and TRAPS. Patients with poorly controlled MKD, TRAPS, PAPA or FMF may benefit from IL-1 blockade; anti-TNF treatment may represent a possible valuable alternative. CONCLUSIONS: In the absence of high-grade evidence, these results could serve as a basis for therapeutic guidelines and to identify candidate drugs for future therapeutic trials.

OBJECTIVES: To evaluate the performance of the Birmingham Vasculitis Activity Score (BVAS) v3 and the Disease Extent Index (DEI) for the assessment of disease activity in 4 primary childhood (c-) systemic vasculitides. METHODS: Patients fulfilling the EULAR/PRINTO/PRES (Ankara) c-vasculitis classification criteria for Henoch-Schönlein purpura (HSP), childhood (c) polyarteritis nodosa (c-PAN), c-Wegener's granulomatosis (c-WG) and c-Takayasu arteritis (c-TA) with disease duration at the time of diagnosis ≤3 months were extracted from the PRINTO database. The performance of the BVAS and DEI were examined by assessing convergent validity, the pattern of disease involvement, and responsiveness. We also evaluated alternative unweighted scoring methods for both tools. RESULTS: The analysis set included 796 patients with 669 HSP, 80 c-PAN, 25 c-WG and 22 c-TA. The median age at diagnosis was 6.9 years (6.6-12) and median delay in making the diagnosis from the onset of signs/symptoms was 0.01 (0.003-0.027) years. A strong correlation was found between the BVAS and DEI (rs=0.78) while correlation with the physician global assessment was moderate (rs=0.48) with BVAS and poor with DEI (rs=0.25). Both the BVAS and DEI sub-scores and total scores were able to descrive the disease involvement in the 4 childhood vasculitides. Responsiveness was large (>1.5) for both tools. The performance characteristics of the BVAS and DEI with the unweighted methods were comparable. CONCLUSIONS: This study demonstrates that both the BVAS and DEI are valid tools for the assessment of the level of disease activity in a large cohort of childhood acute and chronic vasculitides.

Background: Juvenile sarcoidosis is a rare, chronic, multisystem, granulomatous disease of obscure etiology which is seen in childhood and adulthood. The disease in childhood has a course different from that in adulthood. Data sources: PubMed database was searched using terms sarcoidosis, children or childhood sarcoidosis or juvenile sarcoidosis in combination with one of the following terms: epidemiology, clinical manifestations, genetics, diagnosis, treatment, and prognosis. We also retrieved the terms such as early onset sarcoidosis and Blau syndrome. Furthermore, e-medicine and European Respiratory Society monographs for sarcoidosis were reviewed. Results: Sarcoidosis in childhood presents with two age dependent, distinct forms. In younger children it is clinically evident before the age of four years and characterized by the triad of rash, arthritis and uveitis. In their older counterparts, the juvenile late onset sarcoidosis involves several organs and its clinical appearance resembles the adult type of the disease, with the respiratory system being most frequently affected (hilar lymphadenopathy, pulmonary infiltrations). Steroid is the main agent of treatment whereas methotrexate is also used for beneficial steroid sparing effects. New, novel therapies may change the outcome of the disease especially in difficult morbid cases. Conclusions: Sarcoidosis in childhood is recognized as a systemic disease affecting various organs and having diverse clinical course depending on the age of onset. © 2011 Children's Hospital, Zhejiang University School of Medicine and Springer-Verlag Berlin Heidelberg. All rights reserved.

Sequence analyses of the non-structural protein gene NS3/NS3A of eight Greek bluetongue (BT) virus (BTV) field isolates from the 1979 and 1999-2001 epizootics provide preliminary molecular data on the epidemiology of BT in Greece. These isolates from infected sheep belonged to serotypes BTV-1, BTV-4, BTV-9 and BTV-16. Phylogenetic analysis of the NS3/NS3A gene segregated these Greek isolates of BTV into two monophyletic groups. The first group was formed by all isolates of BTV-4; all were identical in their sequences, regardless of the area and year of isolation in Greece, and clustered with strains from Tunisia and Corsica. The isolates of BTV-1, BTV-9 and BTV-16 segregated into a second monophyletic group and clustered with Asian strains, showing a high homology (97-99%). From an epidemiological point of view, these preliminary results infer that one group of isolates is Mediterranean, whilst the second appears to be of Asian origin.

The occurrence of bluetongue (BT) in Italy prompted an increase in disease surveillance. Thus a competitive enzyme-linked immunosorbent assay (c-ELISA) to detect immunoglobulins to BT virus (BTV) was developed and distributed amongst 27 laboratories comprising the Italian veterinary diagnostic laboratories network to screen field sera. This ring test enabled comparison of the results and the evaluation of the reproducibility of the method. The c-ELISA developed by the National Reference Centre for Exotic Diseases (c-ELISA-IZSAM) was compared also against a commercially available c-ELISA. In addition, results obtained by the Centre of Athens Veterinary Institutions are presented.

Since the incidence of benign hypermobility syndrome is significantly high in otherwise healthy children, paediatricians should consider this benign entity when they evaluate musculoskeletal complaints in childhood.

Since 1998, five serotypes of bluetongue virus (BTV), BTV-1, BTV-2, BTV-4, BTV-9 and BTV-16, have been reported in countries surrounding the Mediterranean Basin. Preliminary data on the sequencing analysis of the VP2-genes of BTV isolates recovered during the 1998-2002 epizootic of BT in Italy, Greece and Israel were studied. The VP2-genes of the Italian BTV-2 and BTV-9, Greek BTV-4 and BTV-9, Israeli BTV-4 and BTV-16 and South African BTV-2, BTV-4, BTV-9 and BTV-16, together with those of their corresponding South African serotype reference and vaccine strains, were cloned and the sequences of their terminal ends determined. These sequences, as well as those of all BTV VP2-gene sequences currently available on GenBank, were used to compile a phylogenetic tree to determine the probable geographic origins of the BTV incursions into Europe. The Italian isolates included in this study were from different regions, animal hosts and years (2000-2002). The results demonstrated that sequencing of the terminal end of the VP2-gene of BTV can be used for topotyping. According to the phylogenetic analysis, the Italian BTV-2 and BTV-9 isolates were stable across all species, irrespective of geographic origin and year of isolation. The sequencing data of the Italian isolates were identical to those of a BTV-2 isolate from Corsica. There was 97% homology between the Italian and Corsican BTV-2 isolates and the BTV-2 vaccine and reference isolates from South Africa. Italian BTV-9 isolates were also identical to the Greek BTV-9 isolates (99% homology). Surprisingly these BTV-9 isolates had only 67% homology with the reference BTV-9 isolate from South Africa. Conversely, BTV-9 field isolates from Australia and elsewhere in Europe had 89% homology with the Italian isolate at the nucleic acid level. Greek and Israeli BTV-4 isolates were almost identical (98% homology) and shared a 90% homology with the BTV-4 South African reference and vaccine strains. Israeli BTV-16 and South African BTV-16 reference strains were also similar. From these results, it may be concluded that Italian and Corsican BTV-2, Israeli and Greek BTV-4, and South African and Israeli BTV-16 had a common origin. The Greek BTV-9 isolate had more than 99% homology with the isolates from Italy, indicating these isolates to have had a common origin. The European BTV-9 isolates, grouped as 'eastern isolates', were more similar to the Australian isolates than to the South African reference strains.

OBJECTIVE: To develop and validate a diagnostic score that assists in discriminating primary hemophagocytic lymphohistiocytosis (pHLH) from macrophage activation syndrome (MAS) related to systemic juvenile idiopathic arthritis. STUDY DESIGN: The clinical, laboratory, and histopathologic features of 362 patients with MAS and 258 patients with pHLH were collected in a multinational collaborative study. Eighty percent of the population was assessed to develop the score and the remaining 20% constituted the validation sample. Variables that entered the best fitted model of logistic regression were assigned a score, based on their statistical weight. The MAS/HLH (MH) score was made up with the individual scores of selected variables. The cutoff in the MH score that discriminated pHLH from MAS best was calculated by means of receiver operating characteristic curve analysis. Score performance was examined in both developmental and validation samples. RESULTS: Six variables composed the MH score: age at onset, neutrophil count, fibrinogen, splenomegaly, platelet count, and hemoglobin. The MH score ranged from 0 to 123, and its median value was 97 (1st-3rd quartile 75-123) and 12 (1st-3rd quartile 11-34) in pHLH and MAS, respectively. The probability of a diagnosis of pHLH ranged from 99% for a score of =123. A cutoff value of =60 revealed the best performance in discriminating pHLH from MAS. CONCLUSION: The MH score is a powerful tool that may aid practitioners to identify patients who are more likely to have pHLH and, thus, could be prioritized for functional and genetic testing.