Preliminary Definitions for Sacroiliac Joint Pathologies in the OMERACT Juvenile Idiopathic Arthritis Magnetic Resonance Imaging Score (OMERACT JAMRIS-SIJ)

OBJECTIVE

To develop definitions for the assessment of magnetic resonance imaging (MRI) pathologies of the sacroiliac joints (SIJ) in juvenile idiopathic arthritis.

METHODS

An Outcome Measures in Rheumatology (OMERACT) consensus-driven methodology consisting of iterative surveys and focus group meetings within an international group of rheumatologists and radiologists.

RESULTS

Two domains, inflammation and structural, were identified. Definitions for bone marrow edema, joint space inflammation, capsulitis, and enthesitis were derived for joint inflammation; sclerosis, erosion, fatty lesion, and ankylosis were defined for assessing structural joint changes.

CONCLUSION

Preliminary consensus-driven definitions for inflammation and structural elements have been derived, underpinning the ongoing development of the OMERACT Juvenile Arthritis MRI SIJ scoring system (OMERACT JAMRIS-SIJ).

EULAR-PReS points to consider for the use of imaging in the diagnosis and management of juvenile idiopathic arthritis in clinical practice

To develop evidence based points to consider the use of imaging in the diagnosis and management of juvenile idiopathic arthritis (JIA) in clinical practice. The task force comprised a group of paediatric rheumatologists, rheumatologists experienced in imaging, radiologists, methodologists and patients from nine countries. Eleven questions on imaging in JIA were generated using a process of discussion and consensus. Research evidence was searched systematically for each question using MEDLINE, EMBASE and Cochrane CENTRAL. Imaging modalities included were conventional radiography, ultrasound, MRI, CT, scintigraphy and positron emission tomography. The experts used the evidence obtained from the relevant studies to develop a set of points to consider. The level of agreement with each point to consider was assessed using a numerical rating scale. A total of 13 277 references were identified from the search process, from which 204 studies were included in the systematic review. Nine points to consider were produced, taking into account the heterogeneity of JIA, the lack of normative data and consequent difficulty identifying pathology. These encompassed the role of imaging in making a diagnosis of JIA, detecting and monitoring inflammation and damage, predicting outcome and response to treatment, use of guided therapies, progression and remission. Level of agreement for each proposition varied according to the research evidence and expert opinion. Nine points to consider and a related research agenda for the role of imaging in the management of JIA were developed using published evidence and expert opinion.

Quality of 'glottal' stops in tracheoesophageal speakers

Glottal stops are conveyed by an abrupt constriction at the level of the glottis. Tracheoesophageal (TE) speakers are known to have poor control over the new voice source (neoglottis), and this might influence the production of 'glottal' stops. This study investigated how TE speakers realized 'glottal' stops in abutting words that end and begin with the same vowel. Ten phoneticians rated seven TE speakers' attempts to convey 'glottal' stops less favourably than two laryngeal control speakers' 'glottal' stops. Acoustic analyses showed that TE speakers relied on more gradual changes, but in 25% of realizations, a constriction at the neoglottis, similar to the constriction found in normal speakers, was produced. It was concluded that control over the neoglottis might be greater than is generally assumed. It might be possible to improve TE speakers' awareness and control over the neoglottis through training, using such tools as digital high-speed imaging.

Prosodic boundaries in alaryngeal speech

Alaryngeal speakers (speakers in whom the larynx has been removed) have inconsistent control over acoustic parameters such as F(0) and duration. This study investigated whether proficient tracheoesophageal and oesophageal speakers consistently convey phrase boundaries. It was further investigated if these alaryngeal speakers used the same hierarchy of acoustic boundary cues that is found in normal speakers. A perception experiment revealed that listeners identified prosodic boundaries less accurately in oesophageal speakers. Acoustic analyses showed that laryngeal speakers used pre-boundary lengthening and pitch movements at phrase boundaries, as expected. Tracheoesophageal speakers used pre-boundary-lengthening and pauses and oesophageal speakers used pauses to convey phrase boundaries. Two oesophageal speakers also paused inappropriately, within phrases. Although these two speakers differentiated between air-injection and prosodic pauses, listeners were unable to tell the two types of pauses apart. Alaryngeal speakers might benefit from therapy that specifically teaches them how to optimize their prosodic abilities.

"Pitch" accent in alaryngeal speech

Highly proficient alaryngeal speakers are known to convey prosody successfully. The present study investigated whether alaryngeal speakers not selected on grounds of proficiency were able to convey pitch accent (a pitch accent is realized on the word that is in focus, cf. Bolinger, 1958). The participating speakers (10 tracheoesophageal, 9 esophageal, and 10 laryngeal [control] speakers) produced sentences in which accent was cued by the preceding context. For each utterance, a group of listeners identified which word conveyed accent. All speakers were able to convey accent. Acoustic analyses showed that some alaryngeal speakers had little or no control over fundamental frequency. Contrary to expectation, these speakers did not compensate by using nonmelodic cues, whereas speakers using F0 did use nonmelodic cues. Thus, temporal and intensity cues are concomitant with the use of F0; if F0 is affected, these nonmelodic cues will be as well. A pitch perception experiment confirmed that alaryngeal speakers who had no control over F0 and who did not use nonmelodic cues were nevertheless able to produce pitch movements. Speakers with no control over F0 apparently relied on an alternative pitch system to convey accents and other pitch movements.

Effects of sulfasalazine treatment on serum immunoglobulin levels in children with juvenile chronic arthritis

This article describes the effects of sulfasalazine (SSZ) treatment on serum immunoglobulin (Ig) levels in 6 children with oligoarticular- or polyarticular onset juvenile chronic arthritis (JCA). None of the children who developed dysimmunoglobulinemia during treatment showed clinical symptoms of this adverse event, in particular none developed severe infections. All patients regained normal immunoglobulin levels after discontinuing SSZ treatment. One patient with a partial IgA deficiency at the start of SSZ treatment showed a slow increase in the IgA level during treatment. During follow-up (4-6 years), one patient spontaneously developed a dysimmunoglobulinemia and one patient developed diabetes mellitus. Based on these case reports and review of the literature we advocate monitoring of serum immunoglobulin levels while on SSZ treatment.

Sulfasalazine in the treatment of juvenile chronic arthritis: a randomized, double-blind, placebo-controlled, multicenter study. Dutch Juvenile Chronic Arthritis Study Group

OBJECTIVE

To assess the efficacy, tolerability, and safety of sulfasalazine (SSZ) in the treatment of juvenile chronic arthritis (JCA).

METHODS

We conducted a 24-week randomized, placebo-controlled, double-blind, multicenter study of patients with active JCA of both oligoarticular and polyarticular onset. Patients were treated with a dosage of 50 mg/kg/day of SSZ (maximum 2,000 mg/day) or placebo. The efficacy variables were joint scores, physician's, parents', and patient's overall assessments, and laboratory parameters of inflammation.

RESULTS

Of the 69 patients enrolled, 52 (75%) completed the trial. Six patients (18%) withdrew from the placebo group, and 11 (31%) withdrew from the SSZ group (P = 0.18). In the intention-to-treat analysis of end point efficacy, between-group differences were significant for the overall articular severity score (P = 0.02), all global assessments (P = 0.01), and the laboratory parameters (P < 0.001). Adverse events occurred more frequently in the SSZ group and were the main reason for withdrawal (P < 0.001), but in all instances, these events were transient or reversible upon cessation of treatment.

CONCLUSION

The results of this first placebo-controlled study show that SSZ is effective and safe in the treatment of children with oligoarticular- and polyarticular-onset JCA, although it was not well tolerated in one-third of the patients.

A new surgical complication related to corticosteroids in a patient with Henoch-Schönlein purpura

In this case presentation of a 4-year-old boy with histopathologically proven Henoch-Schönlein purpura the authors report a surgical complication that occurred under corticosteroids; this had not been described previously. Relief of abdominal pain was dramatic and the hematemesis disappeared, but an entero-enteral fistula and abscess developed without any sign of peritonitis. Therefore, when corticosteroids are used for symptomatic relief, and intermittent bowel obstruction persists during their use, surgical complications should be suspected. In such cases, intermittent small bowel obstruction might be the only sign of a grave surgical complication.