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Genova, Italy

Martinoli C.,University of Genoa | Valle M.,Radiologia | Malattia C.,Pediatria II | Beatrice Damasio M.,Radiologia | Tagliafico A.,Italian National Cancer Institute
Pediatric Radiology | Year: 2011

US is a technique particularly suited to the investigation of musculoskeletal disorders in children and adolescents. This review paper describes a range of clinical settings beyond the hip joint where US has a significant role to play, including sports injuries, infectious diseases, inflammatory and degenerative conditions, congenital and developmental disorders, acute trauma of bone and joints, and peripheral nerve injuries. In some circumstances, US can be regarded as the most effective means of diagnostic imaging, whereas in other instances, it is an alternative or supplement to other more comprehensive imaging modalities, like MRI and CT. Although MRI offers superior soft-tissue contrast resolution, US is low-cost, non-invasive and has higher spatial resolution and real-time capability for the assessment of musculoskeletal structures during joint movement and stress manoeuvres. © 2011 Springer-Verlag.

Ruperto N.,Pediatria II | Martini A.,University of Genoa
Archives of Disease in Childhood | Year: 2011

Networking is key to overcoming the logistical, methodological and ethical problems related to the implementation of paediatric studies. The adoption of legislation to encourage paediatric clinical trials by the American and European regulatory agencies has opened a new era in the assessment of drug safety and efficacy in children. Two very large international trial networks - the Pediatric Rheumatology Collaborative Study Group (PRCSG) and the Paediatric Rheumatology International Trials Organisation (PRINTO) - have played a critical role in the implementation of this legislation and have facilitated several successful controlled studies on the safety and the efficacy of new and old drugs in paediatric rheumatic diseases. The PRINTO and PRCSG networks can be seen as a model for international co-operation in other paediatric subspecialties.

Ruperto N.,Pediatria II | Martini A.,Pediatria II | Martini A.,University of Genoa
Rheumatology (United Kingdom) | Year: 2014

Biologic agents represent a major advance in the treatment of JIA. In 2008 a US Food and Drug Administration (FDA) warning raised the hypothesis that anti-TNF therapies may be associated with an increased incidence of malignancies in children. More recent data seem to suggest that JIA itself, as in the case of RA, is associated with an increased risk of malignancy and that this risk is not further increased with anti-TNF treatment. However, only long-term prospective data on a very large number of patients will provide a definite answer. This article summarizes the current evidence in order to help health professionals properly advise patients and their families about the possible risk of malignancies in JIA treated with biologic agents. © The Author 2013. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.

Lanni S.,Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo | Bertamino M.,University of Genoa | Consolaro A.,Pediatria II | Pistorio A.,Direzione Scientifica | And 6 more authors.
Rheumatology | Year: 2011

Objectives: To investigate the efficacy of IA CS (IAC) therapy in single and multiple joints in children with JIA and to seek for predictors of synovitis flare. Methods: The clinical charts of patients who received their first IAC injection between January 2002 and December 2008 were reviewed. The CS used was triamcinolone hexacetonide for large joints and methylprednisolone acetate for small or difficult to access joints. Patients were stratified as follows: one joint injected; two joints injected; and three or more joints injected. Predictors included sex, age at disease onset, JIA category, age and disease duration, ANA status, iridocyclitis, general anaesthesia, number and type of injected joints, acute-phase reactants and concomitant MTX therapy. Results: The cumulative probability of survival without synovitis flare for patients injected in one, two, or three or more joints was 70, 45 and 44%, respectively, at 1 year; 61, 32 and 30%, respectively, at 2 years; and 37, 22 and 19%, respectively, at 3 years. On Cox regression analysis, positive CRP, negative ANA and injection in the ankle were the strongest predictors for synovitis flare. The only significant side effect was skin hypopigmentation or s.c. atrophy, which occurred in <2% of patients. Conclusion: IAC therapy-induced sustained remission of synovitis in a substantial proportion of patients injected either in single or multiple joints, with a good safety profile. The risk of synovitis flare was higher in patients who had positive CRP, negative ANA and were injected in the ankle. © The Author 2011. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.

Van Dijkhuizen E.H.P.,Pediatria II | Van Dijkhuizen E.H.P.,University Utrecht | Wulffraat N.M.,University Utrecht
Annals of the Rheumatic Diseases | Year: 2015

Objectives: Juvenile idiopathic arthritis (JIA) is subdivided into seven categories. Even within these categories, the prognosis varies markedly. To start appropriate treatment in patients with JIA and to inform patients and their parents correctly, it is essential to know the individual prognosis, preferably at the time of diagnosis. The aim of this study was to identify variables that predict disease activity, joint damage, functional ability and quality of life (QoL) early in the disease course. Methods: A systematic literature review was performed, and 3679 articles were identified. The results were screened and critically appraised using predefined criteria. Articles that described validated outcomes, such as the Wallace criteria, the childhood health assessment questionnaire (CHAQ) and the juvenile arthritis damage index (JADI), and that determined predictors in the first 6months of disease were selected.Results: Forty mostly retrospective articles were selected.Polyarticular onset predicted a worse prognosis for all outcomes, except QoL. A diagnostic delay and the systemic category predicted continuation of active disease. Notably, antinuclear antibodies (ANA) did not predict disease activity. Symmetric involvement and rheumatoid factor positivity predicted less damage. More disease activity was mainly associated with worse functional outcome. However, most predictors were not validated. Conclusions: Few predictors for the selected outcomes were found. Prospective, longitudinal studies using standardised outcome measurements, and evaluating a broader range of predictors, such as genetics, immunological and imaging data, should be performed. For the outcomes joint assessment and quality of life, standardised and validated outcomes should be developed.

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