The American College of Rheumatology recommends early and aggressive treatment for juvenile idiopathic arthritis, and disease-modifying therapies are recommended over NSAIDs and glucocorticoids.

“If a child has damage from untreated or undertreated arthritis, that will follow them forever,” said Dr. Onel. "We know that some children with get off medication over time as the arthritis regresses. However, if damage has already happened that cannot be fixed.”

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JIA is the term doctors use to refer to chronic arthritis that affects kids before the age of 16. It is an autoimmune disease, or a condition in which the body attacks its own tissues—in this case, the joints.

Kids with oligoarticular JIA have swelling, pain, and stiffness in large joints like their knees, ankles, and elbows. They may have trouble walking, and one leg could be longer than the other because bones near inflamed joints grow too quickly or slowly, per NIAMS.

Keep in mind that your child might not tell you their joint hurts. It’s not that they don’t feel pain, but that they react to it differently than adults might, said Dr. Onel. “I think it happens slowly and they get used to it. And because they have limited memory and life experience, they just don’t remember the way it used to feel.”

Read the full article at healthcentral.com. 

Karen Brandt Onel, MD, chief of Pediatric Rheumatology at HSS, and the principle investigator for 2021 American College of Rheumatology's (ACR) guidelines for sJIA noted the EULAR recommendations are congruent. One main difference is that the EULAR recommendations included timelines for treatment targets, while the ACR's did not, she continued. 

"It's great to have these timelines in there," cited Dr. Onel though there are still some unknowns. "We don't actually know what the tapering frequency should be," she said, "but these are definitely goals that we need to explore and see how they evolve."

The EULAR recommendations also touched on two concerning complications, particularly in children: macrophage activation syndrome (MAS) and lung disease. According to the document, MAS should be considered in patients with Still's disease with these symptoms: fever, splenomegaly, elevated serum ferritin, low cell counts, abnormal liver function tests, elevated serum triglycerides, and intravascular activation of coagulation.

The recommendations for lung disease are "broad," as there is still much to learn about the risk for lung disease in a small portion of sJIA patients, Dr. Onel said.

Read the full article at Medscape.com. 

Research highlights include the success of a lupus peer support and education group that transitioned to a virtual format during the COVID-19 pandemic,  a community-based participatory research approach to assess musculoskeletal health needs, the way in which ultraviolet (UV) exposure triggers immune activation and disease flares in lupus, trends in the use of total knee arthroplasty (TKA) in patients under the age of 21 in the United States (U.S.), and insights that may help future research explore why women with knee osteoarthritis report worse pain than men.

HSS Rheumatologists, Social Worker Honored by American College of Rheumatology
The ACR and ARP have honored HSS rheumatologists Michael D. Lockshin, MD, Melanie H. Smith, MD, PhD and social worker Adena Batterman, LCSW, MSW, with prestigious awards at the ACR Convergence meeting on November 12. Each year, the ACR and ARP recognize members who have made outstanding contributions to the field of rheumatology.

Participation Doubles After Lupus Support Group at HSS Transitions to Virtual Format During Pandemic
An HSS study presented by Giselle Rodriguez, LCSW, social work program coordinator for Charla de Lupus (Lupus Chat)®, highlighted the success of a lupus peer support and education group that transitioned to a virtual format during the COVID-19 pandemic. In addition to receiving high marks from group members, participation more than doubled after the meetings went remote. 

Study Finds Chronic-Pain Management, Falls and Limited Access to Care Are Critical Issues Among Medically Underserved
Titilayo Adeniran, MPH, director of outcomes & data analytics at the HSS Education Institute and colleagues implemented a community-based participatory research approach to assess musculoskeletal health needs, identify health disparities and support the development of initiatives to address unmet needs. Critical issues included a lack of health education and awareness in managing arthritis and other painful conditions; a high incidence of falls in the community; and limited access to care among underserved populations. Findings will help to raise awareness about disparities that continue to affect diverse and underserved populations and the development of community-based initiatives to promote health equity.

HSS Research Uncovers How UV Light Triggers Immune Activation and Disease Flares in Lupus
A study by HSS scientist Theresa T. Lu, MD, PhD and former fellow William Ambler, MD, examined the way in which UV exposure triggers immune activation and disease flares in lupus. Results found an underlying mechanism that explains this association: decreased lymphatic drainage, which contributes to both photosensitivity and an immune response in the lymph nodes. The research also suggests that boosting lymphatic drainage may be an effective treatment for lupus photosensitivity and autoimmunity.

Study Examines Total Knee Replacement in Patients Under 21
HSS rheumatologist Bella Mehta, MBBS, MS, hip and knee surgeon Cynthia A. Kahlenberg, MD, MPH, and colleagues evaluated trends in the use of TKA in patients under 21 years old in the U.S. The researchers retrospectively analyzed the Kids’ Inpatient Database (KID), a national weighted sample of all inpatient hospital admissions of patients under 21 years of age in approximately 4,200 hospitals in 46 states. They also used International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 codes to identify patients undergoing TKA from 2000-2016 and determine primary diagnosis. 70.3% of TKAs were performed for a primary diagnosis of a tumor; and the number of TKAs for malignant tumors increased slightly over the study period. In contrast, use of TKA for inflammatory arthritis / juvenile idiopathic arthritis (JIA) decreased by more than 70% over the study period, likely due to improvements in medical management of inflammatory arthritis /JIA patients.

Mast Cell Levels May Explain Sex Differences in Osteoarthritis Pain
A study by HSS rheumatologists Dana Orange, MD, MS, Bella Mehta, MBBS, MS, and colleagues discovered that at the time of total knee replacement, women have significantly increased levels of immune cells called mast cells in synovial tissue surrounding the knee joint than men. The findings may help future research explore why women with knee osteoarthritis report worse pain than men.

Additional coverage: 

• Hcplive.com
• Ajmc.com
• Rheumatologynetwork.com
• Healthday.com
• Everydayhealth.com

“The strength of those recommendations is largely conditional,” explained Dr. Onel. “The quality of supporting evidence is largely very low,” she added. “Similar to the RA [rheumatoid arthritis] guidelines, although we know that corticosteroids are important, especially for children as regards growth stunting and weakened bones, we really try to avoid their use whenever possible so that was a critical part of what we presented,” noted Dr. Onel. “Secondly, strong recommendations for immunizations. Thirdly, early use of biologics, especially for children with systemic juvenile arthritis. And our first toe into the water of recommending stopping medications when children [exhibited inactive disease]. These were crucially important and I think really represent an advance forward,” she said.

Read the full article at Healio.com/news/rheumatology.

Additional coverage:

• MDedge.com/rheumatology
• Juvenilearthritisnews.com
• AJMC.com 
• Consultant360.com