Search

Aim: Morphea, also known as localized scleroderma, is an immune-mediated disease and the most common form of scleroderma in children. It is a localized sclerosing disease of the skin, but can also involve such adjacent tissues as the fascia, muscle, bone, and underlying tissues. This multicenter study aimed to evaluate Turkish pediatric morphea patients, regarding demographics, treatments, and response to treatment. Materials and methods: The study was performed by the Pediatric Rheumatology Academy and included pediatric morphea patients from 6 Turkish pediatric rheumatology centers who were followed up for ≥6 months. Demographic, clinical, and laboratory findings and treatment modalities were analyzed. The patients were divided into 3 groups according to treatment response, as follows: group 1: topical treatment response, group 2: methotrexate response, and group 3: methotrexate resistance. Clinical findings were compared between the 3 groups. Results: The study included 76 patients, of which 53 (69.7%) were female. Mean age at diagnosis of morphea was 9.7 ± 4.3 years and mean duration of follow-up was 3.2 ± 2.9 years. Linear morphea was the most common form, accounting for 43.4% (n = 33) of the patients. Extracutaneous features were noted in 17 patients (22.4%) and anti-nuclear antibody positivity was noted in 32 (42.1%). In all, 14.4% of the patients received topical treatment only, whereas 86.6% received both topical and systemic treatment. The methotrexate response rate was 76.9% in the patients that received systemic immunosuppressive therapy. The overall relapse rate while under treatment was 19.7%. Conclusion: In this study, most of the pediatric morphea patients responded well to methotrexate. Bilateral lesions were more common in the methotrexate-resistant group. Multiple involvement, and bilateral lesions, were more common in relapsed patients than in non-relapsed patients. Key points • Most of the pediatric morphea patients respond well to MTX. • Multiple involvement, and bilateral involvement, were more common in relapsed patients than in non-relapsed patients. • Presence of extracutaneous findings in patients increased relapse rate 5.7 times.

Objective: One of the most frequently discussed physical parameters in juvenile idiopathic arthritis (JIA) is physical activity level. There is limited evidence about determinants of physical activity level in JIA. In this study, we aimed to investigate the determinants of physical activity level in children and adolescents with JIA. Materials and methods: Thirty-two JIA patients and 18 age- and sex-matched healthy individuals were included in the study. The age range was 8–18 years. Sociodemographic and clinical data of the participants were recorded. In both groups, anthropometry, fatigue, pain, knee extension muscle strength, gait variables, functional exercise capacity assessed by six-minute walk test (6MWT), and arterial stiffness were evaluated. Physical activity level was assessed by an accelerometer. Results: The disease activity level of the patients was low. Pain and fatigue scores were significantly higher in the JIA group compared to healthy controls (p < 0.05). Walking speed, physical activity level, time spent in low-intensity physical activity, time spent in moderate-to-vigorous-intensity physical activity, and 6MWT distance were significantly lower than in healthy controls (p < 0.05). Quadriceps muscle strength and arterial stiffness assessment results were similar in both groups (p > 0.05). In the JIA group, there was a positive correlation between physical activity and age, height, fat-free body mass, quadriceps muscle strength, and 6MWT distance (p < 0.05). Also, there was a negative correlation between physical activity and pain, fatigue, and cadence. Physical activity level was independently associated with 6MWT distance (42.9% of the variability). Conclusion: In mildly affected JIA patients, gait speed, functional exercise capacity, and physical activity level are affected. Functional exercise capacity is a determinant of physical activity level in JIA.

Background: Distal stabilization is an essential component for high qualityproximal movement. In this regard, scapular stabilization is important for upperextremity and hand functions. Moreover, scapular stabilization might have a roleas a support point for hand functions in patients with joint problems. However,the relationships between scapular stabilization and hand functions were notinvestigated in children with juvenile idiopathic arthritis (JIA).Objectives: To investigate the relationship between scapular stabilization andhand function in children with JIA with wrist arthritis history (JIAWrist+), and childrenwith JIA without wrist arthritis history (JIAWrist-).Methods: A total of forty children (20 children for each group) were included inthe study. Scapular stabilization was measured by using scapular muscle endurancetest. General functional status, subjective hand functions, and objectivehand functions were assessed by using Childhood Health Assessment Questionnaire(CHAQ), Duruoz Hand Index, and Purdue Pegboard Test, respectively.Results: JIAWrist+ patients reported poorer hand functions compared to JIAWrist-patients. No significant differences were detected for other parameters. Scapularmuscle endurance was moderately related to CHAQ Disability Index score,Purdue Pegboard Test (single hand score and assembly score) in JIAWrist+patients, while there was only a significant relationship between scapular muscleendurance and Purdue Pegboard Test both hand score in JIAWrist- patients.Conclusion: According to our results, scapular endurance was found morerelated to hand functions in wrist involved JIA patients. It seems that scapularstabilization contributes to hand functions differently related to joint involvementin JIA patients. It might be a beneficial strategy to work on scapular muscles inJIA patients with wrist involvement and poor hand functions.

Background: Joint position sense is a marker of proprioception and is definedas being aware of the body position and individual body parts in the space. Positionsense in the wrist joint is especially important for the manual dexterity. A possible damage due to arthritis may lead a decrease in joint position sense.However, the status of joint position sense was not investigated in children withjuvenile idiopathic arthritis (JIA).Objectives: To compare the wrist position sense and a motor performancetest related to manual dexterity among children with JIA with wrist arthritis history(JIAWrist+), children with JIA without wrist arthritis history (JIAWrist-), andhealthy controls.Methods: A total of sixty children (20 children for each group) were includedin the study. Wrist joint position sense was evaluated by measuring joint re-positionerror. The wrist was passively placed in a pre-determined position (30ofor flexion, 30o for extension, 10o for radial deviation, and 15o for ulnar deviation).Then passively was returned to baseline position. The patient was askedto reposition their wrist into the target degree actively. The absolute error indegrees between each position and reposition was calculated. Manual dexteritywas evaluated by using Purdue Pegboard Test. The test was repeatedthree times and the average number of the correctly placed pines was usedin the analysis.Results: Joint position sense (in all directions except radial deviation) andmanual dexterity (except assembly) was found negatively affected in JIAWrist+patients compared to healthy controls. No differences (except radial deviation)were observed between JIAWrist- patients and healthy controls.Conclusion: Joint position sense and related manual dexterity is diminishedin JIA patients with wrist involvement. The results of this study suggested thatchildren with wrist arthritis should be followed with special attention focusingon manual abilities. Hand therapy programs might help improving joint positionsense acuity.

Background and Purpose: The aim is to determine the effect of the communication skills training (CST) using interactive synchronous and asynchronous methods, which was applied for the first time on medical students’ empathy levels. Methods: This study is a cross-sectional-analytical, self-controlled intervention. The distance CST program was applied to first-year medical students. The change in students’ empathy levels was measured with the student version of the Jefferson Empathy Scale. Results: 241 students’ forms were included. Empathy mean score increased significantly, this increase was higher in women. Conclusion: The distance CST produced a positive effect on empathy levels. While interactive PowerPoint® presentations, videos, movie clips, cartoons, real-life examples, written/audio question- answer activities, surveys, feedback and, small group work were used in live lessons; in the asynchronous process, student-based techniques (self-assessment, homework, WhatsApp® sharing) were used to support the online learning climate. We believe that all of them support the cognitive and social existence of students throughout the training. We propose our program as a model that can be used during situations where face-to-face education is not possible and to support face-to-face education in medical education.

ObjectiveTo evaluate the number of episodes in the past 12 months as an indicator of the overall disease activity status in Familial Mediterranean fever (FMF).MethodsIn this cross-sectional study, patients were recruited from tertiary pediatric hospitals. Demographic data, main clinical symptoms of the episodes, treatment modalities, and genetic mutations were recorded. The patients were grouped as no episodes (Group 1), 1–4 episodes (Group 2), and more than 4 episodes (Group 3) according to the number of episodes in the past 12 months. The Pediatric Quality Life Inventory (PedsQL), the Children’s Depression Inventory (CDI), and the Wong-Baker FACES Pain Rating Scale (FACES) scores were compared between groups. Concurrent validity between the number of episodes and the patient-reported outcome measures (PROMs) was assessed using Spearman’s rank correlation coefficient (ρ).ResultsA total of 239 patients were included. There were 74 patients (31%) in Group 1, 99 (41.4%) in Group 2, and 66 (27.6%) in Group 3. Groups were similar according to age, age at diagnosis, gender, consanguinity, family history, history of amyloidosis, clinical symptoms, and in terms of allele frequency (p > 0.05). According to PROMs completed by parents, moderate correlations were found between the number of episodes and the PedsQL score (ρ = −0.48; 95% CI = −0.58 to −0.35, p < 0.001) and between the number of episodes and the Wong-Baker FACES score (ρ = 0.47, 95% CI = 0.35–0.57, p < 0.001).ConclusionThe number of episodes was positively and moderately correlated with patient- and parent-reported outcomes in our cohort. The number of episodes in patients with FMF can be used as a single measure to assess disease activity.