Background: Juvenile idiopathic arthritis (JIA) is the most frequently encountered pediatric rheumatologic disorder with an unknown etiology. At present there is no published data regarding the frequency of uveitis in...Background: Juvenile idiopathic arthritis (JIA) is the most frequently encountered pediatric rheumatologic disorder with an unknown etiology. At present there is no published data regarding the frequency of uveitis in patients with JIA in Bangladesh. This study aimed to observe the frequency of JIA-associated uveitis (JIAU) and distribution of uveitis among different sub-categories of JIA at the Pediatric Rheumatology division, both outdoor and indoor patients, Department of Pediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU) in Bangladesh. Methods: This was a retrospective study of 1784 JIA patients at the Pediatric Rheumatology division, BSMMU from July 2010 to March 2023. Results: Among the 1784 enrolled JIA patients, we observed that 0.73% of cases had uveitis. Here, 61.5% of JIAU cases were male. Most of the cases (92.3%) had bilateral uveitis and only 7.7% cases had unilateral uveitis. Among JIAU patients, the majority were Oligo JIA (53.8%), followed by ERA 30.8%, Poly JIA RF(−) 7.7% and Systemic JIA 7.7% cases respectively. This study also revealed that 15.4% of JIAU patients had ANA positivity and 23% had HLA B-27 positivity. Here we also found ocular complications associated with uveitis such as band keratopathy (23.1%), posterior synechiae (15.4%) and cataract (15.4%). Conclusions: In this study, we observed only 0.73% of patients of JIA had developed uveitis which is lower than the frequency observed in other European studies. This study also showed various ocular complications amongst JIA-associated uveitis patients which signifies the importance of adherence to periodic ophthalmological follow-up to prevent these ocular complications.展开更多
Background: Juvenile Idiopathic Arthritis (JIA) is the most prevalent rheumatic disease in children. It is associated with abnormal levels of serum zinc (Zn) and copper (Cu) as during inflammation serum copper concent...Background: Juvenile Idiopathic Arthritis (JIA) is the most prevalent rheumatic disease in children. It is associated with abnormal levels of serum zinc (Zn) and copper (Cu) as during inflammation serum copper concentration increases and zinc decreases. Objective: To assess the serum Zn and Cu levels in different sub-types of JIA patients and their correlation with the disease duration. Methods: This cross-sectional study was conducted over twelve months at the Pediatric Rheumatology Division, Department of Paediatrics, Bangabandhu Sheikh Mujib Medical University. Sixty-nine JIA cases that fulfilled the International League of Association for Rheumatology (ILAR) criteria were taken as cases and age and sex-matched healthy children were considered as controls. The serum Zn and Cu tests were done using the spectrophotometric method with INDIKO PLUS Drug Analyzer. Data were recorded in a pre-designed questionnaire. Data were checked, verified and analyzed manually where continuous variables were analyzed using unpaired t-test and categorical variables using the ANOVA test. Pearson’s correlation coefficient test was used to see the correlation of serum zinc and copper levels with disease duration. Results: Boys were predominant in both case and control groups, with the majority within the 10 to 16-year-age group. Enthesitis-related arthritis (ERA) was the most common subtype followed by sJIA, Oligo JIA, Poly JIA (RF-) and unclassified subtypes. Disease duration was found less than 12 months in 30.4% of JIA patients. Serum analysis revealed a statistically significant reduction in mean zinc levels and increased copper levels in JIA patients compared to controls. This study observed a negative correlation between serum zinc levels and disease duration, whereas serum copper levels exhibited a positive correlation with disease duration. Conclusion: In conclusion, this study revealed that JIA patients exhibit alterations in serum zinc and copper levels. Serum copper levels showed a positive correlation and serum zinc le展开更多
Background: Systemic JIA (sJIA) is one of the subtypes of JIA, which is most difficult to treat among all JIA cases. About 50% of sJIA cases did not respond to traditional disease modifying anti-rheumatic drugs (DMAR...Background: Systemic JIA (sJIA) is one of the subtypes of JIA, which is most difficult to treat among all JIA cases. About 50% of sJIA cases did not respond to traditional disease modifying anti-rheumatic drugs (DMARDs)—metho-trexate (MTX). Thalidomide is an immunomodulating and anti-inflammatory drug that induces sustained improvement of refractory sJIA cases. Objectives: To evaluate the efficacy of thalidomide in refractory sJIA patients. Methods: This was a prospective interventional study carried out in the Paediatric Rheumatology and Immunology follow-up clinic run by the Department of Pediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from January 2019 to July 2020. Twenty-five sJIA patients who were refractory to conventional DMARDs were included in this study. These patients were prescribed thalidomide at a dose of 3 - 5 mg/kg/day for six months and efficacy was assessed by using juvenile arthritis disease activity score (JADAS 27) at 12<sup>th</sup> and 24<sup>th</sup> weeks of treatment. Result: Active joint counts and ESR improvement were observed in 90.69%, 97.67% and 69.84%, 100% of sJIA patients respectively at 12<sup>th</sup> and 24<sup>th</sup> weeks of treatment. Improvement of physicians and parent global assessment of VAS were 77.56%, 97.43% and 70.62% and 96.04% respectively at 12<sup>th</sup> and 24<sup>th</sup> weeks of treatment. Improvement of the total score of JADAS-27 was 77.51% at 12th week and 97.52% at 24<sup>th</sup> of week follow-up which was statistically significant. Somnolence, constipation and paresthesia were found as common adverse effect in this study. Conclusion: Efficacy of thalidomide was assessed by JADAS 27 criteria showed significant improvement in refractory sJIA patients in this study. It may be concluded that Thalidomide is safe and effective as an adjunct therapy of refractory sJIA patients.展开更多
Background: HLA alleles may have association with overall JIA including specific sub-types. Determation of HLA DRB1, DPB1, DQA1, DQB1 and B27, may be helpful to diagnose JIA cases where diagnostic dilemma is present. ...Background: HLA alleles may have association with overall JIA including specific sub-types. Determation of HLA DRB1, DPB1, DQA1, DQB1 and B27, may be helpful to diagnose JIA cases where diagnostic dilemma is present. The aim of the study was to find out the association of HLA alleles with JIA and its subtypes. Methods: This cross sectional study was conducted in the department of Pediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from April 2020 to March 2021. A total of 50 cases and 25 controls attending pediatric rheumatology clinic and pediatric OPD were enrolled in the study. Data were collected by a pre-designed questionnaire containing socio-demographic, clinical and laboratory parameters. HLA DR-B1, DQ-A1, DQ-B1 and B27 typing were done for the cases and controls from blood samples by polymerase chain reaction sequence specific primer (PCR-SSP) method. Data were analyzed by SPSS version 26. Frequency, percentage, chi square test and Fisher exact tests were done for statistical analysis. Results: HLA DR-B1_10 had significant positive association whereas HLA DR-B1_03 and B1_16 had negative association with overall JIA cases. Poly-articular JIA, oligo-articular JIA and ERA had association with HLA DRB1_01, B1_08 and B1_12 respectively. HLA DQA1-01 and A1_02 had positive association. However, DQ-A1_06 was negatively associated with JIA cases. Oligo JIA was positively associated with HLA DQ-A1_01, whereas poly JIA and ERA had association with A1_02. Though, HLA DQ_B1 had no association with overall JIA cases, analysis showed association of poly JIA with DQ-B1_04. Frequency of HLA DQ-B1_02 and 03 were higher among ERA cases, though not significant, but they had strong association with HLA B27. Conclusion: HLA associations were present with overall JIA and each sub-groups had different patterns of HLA associations including some protective roles.展开更多
Background:Growing pain (GP) is the most common form of nonspecific, recurrent leg pain in children aged 4 - 12 years. The exact etiology of GP is not known. However, some studies have found an association between vit...Background:Growing pain (GP) is the most common form of nonspecific, recurrent leg pain in children aged 4 - 12 years. The exact etiology of GP is not known. However, some studies have found an association between vitamin D and Bone Mineral Status (BMD) status with GP in their study. Objectives: To assess the serum level of vitamin D, and BMD and to determine their association with growing pain in children. Methods: This cross-sectional analytical study was conducted in the Department of Paediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU). Sixty children between the age of 6 - 12 years were included in the study from March 2020 to August 2021. Children who fulfilled the Evans criteria of GP were enrolled as cases and thirty age and sex matched healthy children were recruited as the control in the study. Informed written consent was obtained from patients and parents. Serum 25-hydroxy-vitamin-D levels and BMD were performed among cases and controls and subsequently compared to see their association in growing pain. A preformed semi-structured questionnaire was completed for each participant which included socio-demographic, clinical and laboratory characteristics. Appropriate statistical tests were applied for data analysis and performed by SPSS version 22. A p-value less than 0.05 was considered as significant at a 95% confidence interval. Results: In this study, 96.7% of growing pain patients had hypovitaminosis D and among them,<span style="font-family: "> the majority (86.7%) was vitamin D deficient. There was a significant association between vitamin D with GP compared to healthy control. BMD was significantly lower in the lumbar vertebra (L1 -<span style="font-family: "> L4) and femoral neck region (both right and left) among GP children compared to the control group. Conclusion: From this study, it may be concluded that the majority of children with GP had hypovitaminosis D and low BMD status compared to the control. Vitamin D deficiency and low BMD status were significantly associated with chi展开更多
Background: Chronic inflammation of the joints in JIA patients is associated with raised levels of serum inflammatory biomarkers, which vary according to disease activity. Neutrophil count, platelet count, mean platel...Background: Chronic inflammation of the joints in JIA patients is associated with raised levels of serum inflammatory biomarkers, which vary according to disease activity. Neutrophil count, platelet count, mean platelet volume (MPV), platelet distribution width (PDW), ESR and CRP are the essential markers to evaluate the disease activity status of JIA patients. Objectives: To assess neutrophil count, platelet count, MPV, PDW, CRP and Juvenile Arthritis Disease Activity Score (JADAS) in JIA patients and determine their association at the initial visit and six months after treatment. Methods: This prospective observational study was conducted from March 2019 to December 2020 in the department of paediatrics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Fifty newly diagnosed JIA cases fulfilling the ILAR classification criteria were included in the study. Disease activity was assessed by JADAS 27. JADAS 27 and inflammatory biomarkers were measured at the initial visit and six months of treatment and these were compared. Results: Mean neutrophil count, platelet count, and CRP significantly decreased at follow-up after six months of treatment. MPV and PDW were increased after six months compared to the initial visit, and the change was significant. Mean JADAS 27 also decreased significantly at follow-up. Neutrophil count, Platelet indices and CRP had a significant association with JADAS 27. Conclusion: In this study, neutrophil count, platelet indices, and CRP after six months of treatment were improved. A significant association of JADAS 27 was found with platelet indices, neutrophil count and CRP.展开更多
Chronic recurrent multifocal osteomyelitis (CRMO), known as nonbacterial osteomyelitis, is an autoinflammatory disease with periodic exacerbations, also known as nonbacterial osteomyelitis. It is a rare, noninfectious...Chronic recurrent multifocal osteomyelitis (CRMO), known as nonbacterial osteomyelitis, is an autoinflammatory disease with periodic exacerbations, also known as nonbacterial osteomyelitis. It is a rare, noninfectious inflammatory disorder characterized by multifocal bony lesions with pain. Conventional X-ray and CT imaging show multiple osteolytic and sclerotic lesions in the affected limbs. It is a great challenge for pediatricians to diagnose this disease for its rarity. Early diagnosis, regular follow-up and appropriate treatments are mandatory to reduce morbidity and prevent these disease complications. We report here two cases of CRMO who presented with pain, swelling and redness of multiple sites of lower limbs from the Department of Paediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU). Clinical features, laboratory findings, and characteristic radiological findings were strongly suggestive of CRMO.展开更多
文摘Background: Juvenile idiopathic arthritis (JIA) is the most frequently encountered pediatric rheumatologic disorder with an unknown etiology. At present there is no published data regarding the frequency of uveitis in patients with JIA in Bangladesh. This study aimed to observe the frequency of JIA-associated uveitis (JIAU) and distribution of uveitis among different sub-categories of JIA at the Pediatric Rheumatology division, both outdoor and indoor patients, Department of Pediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU) in Bangladesh. Methods: This was a retrospective study of 1784 JIA patients at the Pediatric Rheumatology division, BSMMU from July 2010 to March 2023. Results: Among the 1784 enrolled JIA patients, we observed that 0.73% of cases had uveitis. Here, 61.5% of JIAU cases were male. Most of the cases (92.3%) had bilateral uveitis and only 7.7% cases had unilateral uveitis. Among JIAU patients, the majority were Oligo JIA (53.8%), followed by ERA 30.8%, Poly JIA RF(−) 7.7% and Systemic JIA 7.7% cases respectively. This study also revealed that 15.4% of JIAU patients had ANA positivity and 23% had HLA B-27 positivity. Here we also found ocular complications associated with uveitis such as band keratopathy (23.1%), posterior synechiae (15.4%) and cataract (15.4%). Conclusions: In this study, we observed only 0.73% of patients of JIA had developed uveitis which is lower than the frequency observed in other European studies. This study also showed various ocular complications amongst JIA-associated uveitis patients which signifies the importance of adherence to periodic ophthalmological follow-up to prevent these ocular complications.
文摘Background: Juvenile Idiopathic Arthritis (JIA) is the most prevalent rheumatic disease in children. It is associated with abnormal levels of serum zinc (Zn) and copper (Cu) as during inflammation serum copper concentration increases and zinc decreases. Objective: To assess the serum Zn and Cu levels in different sub-types of JIA patients and their correlation with the disease duration. Methods: This cross-sectional study was conducted over twelve months at the Pediatric Rheumatology Division, Department of Paediatrics, Bangabandhu Sheikh Mujib Medical University. Sixty-nine JIA cases that fulfilled the International League of Association for Rheumatology (ILAR) criteria were taken as cases and age and sex-matched healthy children were considered as controls. The serum Zn and Cu tests were done using the spectrophotometric method with INDIKO PLUS Drug Analyzer. Data were recorded in a pre-designed questionnaire. Data were checked, verified and analyzed manually where continuous variables were analyzed using unpaired t-test and categorical variables using the ANOVA test. Pearson’s correlation coefficient test was used to see the correlation of serum zinc and copper levels with disease duration. Results: Boys were predominant in both case and control groups, with the majority within the 10 to 16-year-age group. Enthesitis-related arthritis (ERA) was the most common subtype followed by sJIA, Oligo JIA, Poly JIA (RF-) and unclassified subtypes. Disease duration was found less than 12 months in 30.4% of JIA patients. Serum analysis revealed a statistically significant reduction in mean zinc levels and increased copper levels in JIA patients compared to controls. This study observed a negative correlation between serum zinc levels and disease duration, whereas serum copper levels exhibited a positive correlation with disease duration. Conclusion: In conclusion, this study revealed that JIA patients exhibit alterations in serum zinc and copper levels. Serum copper levels showed a positive correlation and serum zinc le
文摘Background: Systemic JIA (sJIA) is one of the subtypes of JIA, which is most difficult to treat among all JIA cases. About 50% of sJIA cases did not respond to traditional disease modifying anti-rheumatic drugs (DMARDs)—metho-trexate (MTX). Thalidomide is an immunomodulating and anti-inflammatory drug that induces sustained improvement of refractory sJIA cases. Objectives: To evaluate the efficacy of thalidomide in refractory sJIA patients. Methods: This was a prospective interventional study carried out in the Paediatric Rheumatology and Immunology follow-up clinic run by the Department of Pediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from January 2019 to July 2020. Twenty-five sJIA patients who were refractory to conventional DMARDs were included in this study. These patients were prescribed thalidomide at a dose of 3 - 5 mg/kg/day for six months and efficacy was assessed by using juvenile arthritis disease activity score (JADAS 27) at 12<sup>th</sup> and 24<sup>th</sup> weeks of treatment. Result: Active joint counts and ESR improvement were observed in 90.69%, 97.67% and 69.84%, 100% of sJIA patients respectively at 12<sup>th</sup> and 24<sup>th</sup> weeks of treatment. Improvement of physicians and parent global assessment of VAS were 77.56%, 97.43% and 70.62% and 96.04% respectively at 12<sup>th</sup> and 24<sup>th</sup> weeks of treatment. Improvement of the total score of JADAS-27 was 77.51% at 12th week and 97.52% at 24<sup>th</sup> of week follow-up which was statistically significant. Somnolence, constipation and paresthesia were found as common adverse effect in this study. Conclusion: Efficacy of thalidomide was assessed by JADAS 27 criteria showed significant improvement in refractory sJIA patients in this study. It may be concluded that Thalidomide is safe and effective as an adjunct therapy of refractory sJIA patients.
文摘Background: HLA alleles may have association with overall JIA including specific sub-types. Determation of HLA DRB1, DPB1, DQA1, DQB1 and B27, may be helpful to diagnose JIA cases where diagnostic dilemma is present. The aim of the study was to find out the association of HLA alleles with JIA and its subtypes. Methods: This cross sectional study was conducted in the department of Pediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from April 2020 to March 2021. A total of 50 cases and 25 controls attending pediatric rheumatology clinic and pediatric OPD were enrolled in the study. Data were collected by a pre-designed questionnaire containing socio-demographic, clinical and laboratory parameters. HLA DR-B1, DQ-A1, DQ-B1 and B27 typing were done for the cases and controls from blood samples by polymerase chain reaction sequence specific primer (PCR-SSP) method. Data were analyzed by SPSS version 26. Frequency, percentage, chi square test and Fisher exact tests were done for statistical analysis. Results: HLA DR-B1_10 had significant positive association whereas HLA DR-B1_03 and B1_16 had negative association with overall JIA cases. Poly-articular JIA, oligo-articular JIA and ERA had association with HLA DRB1_01, B1_08 and B1_12 respectively. HLA DQA1-01 and A1_02 had positive association. However, DQ-A1_06 was negatively associated with JIA cases. Oligo JIA was positively associated with HLA DQ-A1_01, whereas poly JIA and ERA had association with A1_02. Though, HLA DQ_B1 had no association with overall JIA cases, analysis showed association of poly JIA with DQ-B1_04. Frequency of HLA DQ-B1_02 and 03 were higher among ERA cases, though not significant, but they had strong association with HLA B27. Conclusion: HLA associations were present with overall JIA and each sub-groups had different patterns of HLA associations including some protective roles.
文摘Background:Growing pain (GP) is the most common form of nonspecific, recurrent leg pain in children aged 4 - 12 years. The exact etiology of GP is not known. However, some studies have found an association between vitamin D and Bone Mineral Status (BMD) status with GP in their study. Objectives: To assess the serum level of vitamin D, and BMD and to determine their association with growing pain in children. Methods: This cross-sectional analytical study was conducted in the Department of Paediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU). Sixty children between the age of 6 - 12 years were included in the study from March 2020 to August 2021. Children who fulfilled the Evans criteria of GP were enrolled as cases and thirty age and sex matched healthy children were recruited as the control in the study. Informed written consent was obtained from patients and parents. Serum 25-hydroxy-vitamin-D levels and BMD were performed among cases and controls and subsequently compared to see their association in growing pain. A preformed semi-structured questionnaire was completed for each participant which included socio-demographic, clinical and laboratory characteristics. Appropriate statistical tests were applied for data analysis and performed by SPSS version 22. A p-value less than 0.05 was considered as significant at a 95% confidence interval. Results: In this study, 96.7% of growing pain patients had hypovitaminosis D and among them,<span style="font-family: "> the majority (86.7%) was vitamin D deficient. There was a significant association between vitamin D with GP compared to healthy control. BMD was significantly lower in the lumbar vertebra (L1 -<span style="font-family: "> L4) and femoral neck region (both right and left) among GP children compared to the control group. Conclusion: From this study, it may be concluded that the majority of children with GP had hypovitaminosis D and low BMD status compared to the control. Vitamin D deficiency and low BMD status were significantly associated with chi
文摘Background: Chronic inflammation of the joints in JIA patients is associated with raised levels of serum inflammatory biomarkers, which vary according to disease activity. Neutrophil count, platelet count, mean platelet volume (MPV), platelet distribution width (PDW), ESR and CRP are the essential markers to evaluate the disease activity status of JIA patients. Objectives: To assess neutrophil count, platelet count, MPV, PDW, CRP and Juvenile Arthritis Disease Activity Score (JADAS) in JIA patients and determine their association at the initial visit and six months after treatment. Methods: This prospective observational study was conducted from March 2019 to December 2020 in the department of paediatrics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Fifty newly diagnosed JIA cases fulfilling the ILAR classification criteria were included in the study. Disease activity was assessed by JADAS 27. JADAS 27 and inflammatory biomarkers were measured at the initial visit and six months of treatment and these were compared. Results: Mean neutrophil count, platelet count, and CRP significantly decreased at follow-up after six months of treatment. MPV and PDW were increased after six months compared to the initial visit, and the change was significant. Mean JADAS 27 also decreased significantly at follow-up. Neutrophil count, Platelet indices and CRP had a significant association with JADAS 27. Conclusion: In this study, neutrophil count, platelet indices, and CRP after six months of treatment were improved. A significant association of JADAS 27 was found with platelet indices, neutrophil count and CRP.
文摘Chronic recurrent multifocal osteomyelitis (CRMO), known as nonbacterial osteomyelitis, is an autoinflammatory disease with periodic exacerbations, also known as nonbacterial osteomyelitis. It is a rare, noninfectious inflammatory disorder characterized by multifocal bony lesions with pain. Conventional X-ray and CT imaging show multiple osteolytic and sclerotic lesions in the affected limbs. It is a great challenge for pediatricians to diagnose this disease for its rarity. Early diagnosis, regular follow-up and appropriate treatments are mandatory to reduce morbidity and prevent these disease complications. We report here two cases of CRMO who presented with pain, swelling and redness of multiple sites of lower limbs from the Department of Paediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU). Clinical features, laboratory findings, and characteristic radiological findings were strongly suggestive of CRMO.
