Pediatric clinical research

Abstract

Purpose of review: This review will focus on childhood-onset systemic lupus erythematosus, juvenile idiopathic arthritis, and juvenile dermatomyositis, with special interest on strategies to improve the health-related quality of life in these conditions.

Recent findings: The contribution of plasma insulin levels, lipoproteins, markers of oxidized state (including nitric oxide metabolites, isoprostanes) and autoantibodies to oxidized low-density lipoprotein to risk for atherosclerosis has been studied in childhood-onset systemic lupus erythematosus. Elevated serum levels of myeloid-related protein-8 (also called S100A8) and myeloid-related protein-14 (S100A9) in children with juvenile idiopathic arthritis can indicate clinically occult disease activity. Serum levels of S100A12 correlate with disease activity in juvenile idiopathic arthritis. Magnetic resonance imaging T2 relaxation times in weight-bearing cartilage in patients with juvenile idiopathic arthritis may help with early detection of cartilage changes. Quantitative computed tomography commonly shows decreased muscle mass and abnormal bone geometry in juvenile idiopathic arthritis patients. In patients with juvenile idiopathic arthritis who do not respond to oral methotrexate, subcutaneous methotrexate dosing was frequently successful. Duration of inactive disease while a patient is receiving methotrexate does not decrease the frequency of flaring of disease once methotrexate is discontinued. Residual synovial inflammation seems to be a stronger influence on the rate of relapse. In juvenile dermatomyositis, the quantitative magnetic resonance imaging T2 relaxation time and overexpression of Class I major histocompatibility complex in early juvenile dermatomyositis are reported. Intravenous cyclophosphamide in refractory juvenile dermatomyositis and tacrolimus ointment for the dermatologic manifestations of juvenile dermatomyositis seem promising.

Summary: Progress has been made in the diagnosis and treatment of childhood-onset systemic lupus erythematosus, juvenile idiopathic arthritis, and juvenile dermatomyositis.