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This study represents the first multicenter study of school attendance and service needs of children with rheumatic disease. Utilizing a standardized form in seven pediatric rheumatology centers, over 90% of 1135 patients were reported as attending school full time with an average of 3.9 days absent from school for health reasons during a 2-month period (national average, 1.1 days). At least one-third of the patients with juvenile rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis, spondyloarthropathy, scleroderma, and vasculitis exceeded 1.25 days absent in 2 months (national average, + 2 SEM). Less than one-half of the eligible school-aged patients with rheumatic disease are receiving school-based physical or occupational therapy and adaptive physical education services more than a decade after the passage of P.L. 94–142 (the Education for All Handicapped Children Act of 1975). Only 8% of rheumatic disease patients at least 15 years of age are receiving services by vocational and rehabilitation workers. This study documents both the ongoing need for efforts to increase school services for children with rheumatic disease and the increased frequency of school absence in childhood rheumatic disease. Suggestions are made for improving habilitative and rehabilitative school services.

Ninety-two children with juvenile rheumatoid arthritis were randomly assigned to treatment in a multicenter, double-blind, 12-week trial designed to compare the efficacy and safety of a liquid formulation of ibuprofen at a dosage of 30 to 40 mg/kg/day versus those of aspirin at a dosage of 60 to 80 mg/kg/day. No significant intergroup differences in response rates or in the amount of improvement in articular indexes of disease activity were observed. More children treated with aspirin discontinued treatment early because of adverse reactions. After this trial, 84 additional patients with juvenile rheumatoid arthritis entered a 24-week, multidose (30, 40, and 50 mg/kg/day), open trial of ibuprofen suspension. Favorable response rates for the three groups were similar, and continued improvement was observed throughout the 24-week period. A dose-response relationship was observed with respect to adverse reactions of the upper gastrointestinal tract. We conclude that ibuprofen suspension is an effective nonsteroidal antlinflammatory drug and that its tolerability in children is acceptable.

The objective of this study was to compare the responsiveness of human subjects to the anabolic effects of human growth hormone (HGH) administered at 8 a.m. or at 11 p.m. Three doses of HGH were used: A, 0.0168 U/kg body weight (BW)(3/4) per day; B, 0.0532 U/kg BW(3/4) per day; C, 0.168 U/kg BW(3/4) per day. The effect of each dose on daily balances of N, P, Na, and K and on BW was measured. The subjects were of two groups: (a) seven GH-deficient children, of whom three were deficient in ACTH; and (b) three patients with limb-girdle dystrophy. ACTH-deficient patients in group (a) received exogenous cortisol at 7 a.m. In all 10 subjects, the anabolic effects of dose C, and sometimes of B and A, administered at 11 p.m. were significantly (P < 0.05) greater than when administered at 8 a.m. In these experiments plasma cortisol concentration averaged 3 times greater at 8 a.m. than at 11 p.m. In the next experiments, exogenous cortisol was administered to the three ACTH-deficient patients at 10 p.m. and the responsiveness to HGH injected at 11 p.m. vs. 8 a.m. was again compared. Under these conditions, when plasma cortisol concentration averaged 3 times greater at 11 p.m. than at 8 a.m., HGH injected at 8 a.m. caused significantly greater anabolic responses than HGH injected at 11 p.m. These findings indicate that the magnitude of the anabolic response to exogenous HGH is inversely related to the plasma cortisol concentration at the time of HGH injection.

Granulomatous arteritis, which occurs through cell-mediated immune mechanisms, can be seen in several disease states. This chronic process is not regarded as an inherited phenomenon. We report on a...

In 3 types of short children, the effect of 7 days' treatment with human growth hormone (hGH) on daily balances of N, P, Na and K and on body weight was measured. Group I consisted of 17 children with short stature (

Previous studies have shown that growth hormone (GH)-deficient children are more responsive to exogenous human growth hormone (HGH) than non-GH-deficient children. In six GH-deficient children, velocity of linear growth was less than 2.5 cm/yr. By the metabolic balance study technique, anabolic responses (increments in elemental balances) were measured to a 7 day course of 0.0532 U HGH/kg body weight (BW)3/4 per day (dose B) and to 0.168 U/kg BW3/4 per day (dose C). They were then treated for 1 yr with HGH at a dose intermediate between B and C. Velocity of linear growth accelerated to 15-25 cm/yr for the first 4-7 mo, then declined to 0-8 cm/yr. At 12 mo, responsiveness to doses B and C was measured again; the responses were only 20-60% as great as before treatment. After 3 mo without HGH treatment, responsiveness to the anabolic effects of doses B and C returned to the magnitudes observed before treatment. A low titer of plasma antibodies to HGH was detected in two of the six children at the end of the year's treatment; these titers showed little change after 3 mo without HGH. Thus the hyperresponsiveness of GH-deficient subjects to exogenous HGH, compared to non-GH-deficient individuals, declines during long-term HGH treatment and is restored by 3 mo interruption of treatment. These changes in peripheral responsiveness may be related to the decline in velocity of linear growth which occurs after 4-7 mo of continuous treatment. When HGH was withdrawn after 12 mo, all six patients exhibited negative balances of N, P, Na, and K and loss of BW. Ratios of elemental balances showed about half the weight loss to represent protoplasm, and about half extracellular fluid. These observations indicate a role of GH in the continuing regulation of nitrogen and mineral metabolism in addition to its function as a growth-promoting hormone.