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Juvenile Arthritis
June 2015
Questions and Answers about Juvenile Arthritis
This publication contains general information about juvenile arthritis (JA). It describes what juvenile arthritis is and how it may develop. It also explains how juvenile arthritis is diagnosed and treated. At the end is a list of key words to help you understand the terms used in this publication. If you have further questions after reading this publication, you may wish to discuss them with your doctor.
What Is Juvenile Arthritis?
"Arthritis" means joint inflammation. This term refers to a group of diseases that cause pain, swelling, stiffness, and loss of motion in the joints. Arthritis is also used more generally to describe the more than 100 rheumatic diseases that may affect the joints but can also cause pain, swelling, and stiffness in other supporting structures of the body such as muscles, tendons, ligaments, and bones. Some rheumatic diseases can affect other parts of the body, including various internal organs. Juvenile arthritis (JA) is a term often used to describe arthritis in children. Children can develop almost all types of arthritis that affect adults, but the most common type that affects children is juvenile idiopathic arthritis.
- What Is Juvenile Idiopathic Arthritis?
- What Causes Juvenile Arthritis?
- What Are Its Symptoms and Signs?
- How Is It Diagnosed?
- Who Treats It?
- How Is It Treated?
- How Can the Family Help a Child Live Well With Juvenile Arthritis?
- Do These Children Have to Limit Activities?
- What Research Is Being Conducted on Juvenile Arthritis?
- Where Can People Find More Information About Juvenile Arthritis?
- Key Words
Both juvenile idiopathic arthritis (JIA) and juvenile rheumatoid arthritis (JRA) are classification systems for chronic arthritis in children. The juvenile rheumatoid arthritis classification system was developed decades ago and had three different subtypes: polyarticular, pauciarticular, and systemic-onset. More recently, pediatric rheumatologists throughout the world developed the juvenile idiopathic arthritis classification system, which includes more types of chronic arthritis that affect children. This classification system also provides a more accurate separation of the three juvenile rheumatoid arthritis subtypes.
Prevalence statistics for juvenile arthritis vary, but according to a 2008 report from the National Arthritis Data Workgroup, about 294,000 children age 0 to 17 are affected with arthritis or other rheumatic conditions.1
1According to the National Arthritis Data Workgroup, the actual number of new cases of JA is higher than previously reported because the statistic includes conditions not previously captured, as cited in Helmick CG, Felson DT, Lawrence RC, Gabriel S, Hirsch R, Kwoh CK, et al.; National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis Rheum. 2008 Jan;58(1):15-25.
What Is Juvenile Idiopathic Arthritis?
Juvenile idiopathic arthritis is currently the most widely accepted term to describe various types of chronic arthritis in children.
In general, the symptoms of juvenile idiopathic arthritis include joint pain, swelling, tenderness, warmth, and stiffness that last for more than 6 continuous weeks. It is divided into seven separate subtypes, each with characteristic symptoms:
- Systemic juvenile idiopathic arthritis (formerly known as systemic juvenile rheumatoid arthritis). A patient has arthritis with, or that was preceded by, a fever that has lasted for at least 2 weeks. It must be documented as an intermittent fever, spiking for at least 3 days, and it must be accompanied by at least one or more of the following:
- Generalized enlargement of the lymph nodes.
- Enlargement of the liver or spleen.
- Inflammation of the lining of the heart or the lungs (pericarditis or pleuritis).
- The characteristic rheumatoid rash, which is flat, pale, pink, and generally not itchy. The individual spots of the rash are usually the size of a quarter or smaller. They are present for a few minutes to a few hours, and then disappear without any changes in the skin. The rash may move from one part of the body to another.
- Oligoarticular juvenile idiopathic arthritis (formerly known as pauciarticular juvenile rheumatoid arthritis). A patient has arthritis affecting one to four joints during the first 6 months of disease. Two subcategories are recognized:
- Persistent oligoarthritis, which means the child never has more than four joints involved throughout the disease course.
- Extended oligoarthritis, which means that more than four joints are involved after the first 6 months of the disease.
- Polyarticular juvenile idiopathic arthritis—rheumatoid factor negative (formerly known as polyarticular juvenile rheumatoid arthritis—rheumatoid factor negative). A patient has arthritis in five or more joints during the first 6 months of disease, and all tests for rheumatoid factor (proteins produced by the immune system that can attack healthy tissue, which are commonly found in rheumatoid arthritis and juvenile arthritis) are negative.
- Polyarticular juvenile idiopathic arthritis—rheumatoid factor positive (formerly known as polyarticular rheumatoid arthritis—rheumatoid factor positive). A patient has arthritis in five or more joints during the first 6 months of the disease. Also, at least two tests for rheumatoid factor, at least 3 months apart, are positive.
- Psoriatic juvenile idiopathic arthritis. Patients have both arthritis and psoriasis (a skin disease), or they have arthritis and at least two of the following:
- inflammation and swelling of an entire finger or toe (this is called dactylitis)
- nail pitting or splitting
- a first-degree relative with psoriasis.
- Enthesitis-related juvenile idiopathic arthritis. The enthesis is the point at which a ligament, tendon, or joint capsule attaches to the bone. If this point becomes inflamed, it can be tender, swollen, and painful with use. The most common locations are around the knee and at the Achilles tendon on the back of the ankle. Patients are diagnosed with this juvenile idiopathic arthritis subtype if they have both arthritis and inflammation of an enthesitis site, or if they have either arthritis or enthesitis with at least two of the following:
- inflammation of the sacroiliac joints (at the bottom of the back) or pain and stiffness in the lumbosacral area (in the lower back)
- a positive blood test for the human leukocyte antigen (HLA) B27 gene
- onset of arthritis in males after age 6 years
- a first-degree relative diagnosed with ankylosing spondylitis, enthesitis-related arthritis, or inflammation of the sacroiliac joint in association with inflammatory bowel disease or acute inflammation of the eye.
- Undifferentiated arthritis. A child is said to have this subtype of juvenile idiopathic arthritis if the arthritis manifestations do not fulfill the criteria for one of the other six categories or if they fulfill the criteria for more than one category.
What Causes Juvenile Arthritis?
Most forms of juvenile arthritis are autoimmune disorders, which means that the body's immune system—which normally helps to fight off bacteria or viruses—mistakenly attacks some of its own healthy cells and tissues. The result is inflammation, marked by redness, heat, pain, and swelling. Inflammation can cause joint damage. Doctors do not know why the immune system attacks healthy tissues in children who develop juvenile arthritis. Scientists suspect that it is a two-step process. First, something in a child's genetic makeup gives him or her a tendency to develop juvenile arthritis; then an environmental factor, such as a virus, triggers the development of the disease.
Not all cases of juvenile arthritis are autoimmune, however. Recent research has demonstrated that some people, such as many with systemic arthritis, have what is more accurately called an autoinflammatory condition. Although the two terms sound somewhat similar, the disease processes behind autoimmune and autoinflammatory disorders are different.
When the immune system is working properly, foreign invaders such as bacteria and viruses provoke the body to produce proteins called antibodies. Antibodies attach to these invaders so that they can be recognized and destroyed. In an autoimmune reaction, the antibodies attach to the body's own healthy tissues by mistake, signaling the body to attack them. Because they target the self, these proteins are called autoantibodies.
Like autoimmune disorders, autoinflammatory conditions also cause inflammation. And like autoimmune disorders, they also involve an overactive immune system. However, autoinflammation is not caused by autoantibodies. Instead, autoinflammation involves a more primitive part of the immune system that in healthy people causes white blood cells to destroy harmful substances. When this system goes awry, it causes inflammation for unknown reasons. In addition to inflammation, autoinflammatory diseases often cause fever and rashes.
What Are Its Symptoms and Signs?
The most common symptom of all types of juvenile arthritis is persistent joint swelling, pain, and stiffness that is typically worse in the morning or after a nap. The pain may limit movement of the affected joint, although many children, especially younger ones, will not complain of pain. Juvenile arthritis commonly affects the knees and the joints in the hands and feet. One of the earliest signs of juvenile arthritis may be limping in the morning because of an affected knee. Besides joint symptoms, children with systemic juvenile arthritis have a high fever and a skin rash. The rash and fever may appear and disappear very quickly. Systemic arthritis also may cause the lymph nodes located in the neck and other parts of the body to swell. In some cases (fewer than half), internal organs including the heart and (very rarely) the lungs, may be involved.
Eye inflammation is a potentially severe complication that commonly occurs in children with oligoarthritis but can also be seen in other types of juvenile arthritis. All children with juvenile arthritis need to have regular eye exams, including a special exam called a slit lamp exam. Eye diseases such as iritis or uveitis can be present at the beginning of arthritis but often develop some time after a child first develops juvenile arthritis. Very commonly, juvenile arthritis-associated eye inflammation does not cause any symptoms and is found only by performing eye exams.
Typically, there are periods when the symptoms of juvenile arthritis are better or disappear (remissions) and times when symptoms "flare," or get worse. Juvenile arthritis is different in each child; some may have just one or two flares and never have symptoms again, while others may experience many flares or even have symptoms that never go away.
Some children with juvenile arthritis have growth problems. Depending on the severity of the disease and the joints involved, bone growth at the affected joints may be too fast or too slow, causing one leg or arm to be longer than the other, for example, or resulting in a small or misshapen chin. Overall growth also may be slowed. Doctors are exploring the use of growth hormone to treat this problem. Juvenile arthritis may also cause joints to grow unevenly.
How Is It Diagnosed?
To be classified as juvenile arthritis, symptoms must have started before age 16. Doctors usually suspect juvenile arthritis, along with several other possible conditions, when they see children with persistent joint pain or swelling, unexplained skin rashes, and fever associated with swelling of lymph nodes or inflammation of internal organs. A diagnosis of juvenile arthritis also is considered in children with an unexplained limp or excessive clumsiness.
No single test can be used to diagnose juvenile arthritis. A doctor diagnoses juvenile arthritis by carefully examining the patient and considering his or her medical history and the results of tests that help confirm juvenile arthritis or rule out other conditions. Specific findings or problems that relate to the joints are the main factors that go into making a juvenile arthritis diagnosis.
When diagnosing juvenile arthritis, a doctor must consider not only the symptoms a child has but also the length of time these symptoms have been present. Joint swelling or other objective changes in the joint with arthritis must be present continuously for at least 6 weeks for the doctor to establish a diagnosis of juvenile arthritis. Because this factor is so important, it may be useful to keep a record of the symptoms and changes in the joints, noting when they first appeared and when they are worse or better.
Family History
It is very rare for more than one member of a family to have juvenile arthritis. But children with a family member who has juvenile arthritis are at a slightly increased risk of developing it. Research shows that juvenile arthritis is also more likely in families with a history of any autoimmune disease. One study showed that families of children with juvenile arthritis are more likely to have a member with an autoimmune disease such as rheumatoid arthritis, multiple sclerosis, or thyroid inflammation (Hashimoto's thyroiditis) than are families of children without juvenile arthritis. For that reason, having an autoimmune disease in the family may raise the doctor's suspicions that a child's joint symptoms are caused by juvenile arthritis or some other autoimmune disease.
Laboratory Tests
Laboratory tests, usually blood tests, cannot alone provide the doctor with a clear diagnosis. But these tests can be used to help rule out other conditions and classify the type of juvenile arthritis that a patient has. Blood samples may be taken to test for anti-CCP antibodies, rheumatoid factor, and antinuclear antibodies, and to determine the erythrocyte sedimentation rate (ESR), described below.
- Anticyclic citrullinated peptide (anti-CCP) antibodies. Anti-CCP antibodies may be detected in healthy individuals years before onset of clinical rheumatoid arthritis. They may predict the eventual development of undifferentiated arthritis into rheumatoid arthritis.
- Rheumatoid factor (RF). Rheumatoid factor, an autoantibody that is produced in large amounts in adults with rheumatoid arthritis, also may be detected in children with juvenile arthritis, although it is rare. The RF test helps the doctor differentiate among the different types of juvenile arthritis.
- Antinuclear antibody (ANA). An autoantibody directed against substances in the cells' nuclei, ANA is found in some juvenile arthritis patients. However, the presence of ANA in children generally points to some type of connective tissue disease, helping the doctor to narrow down the diagnosis. A positive test in a child with oligoarthritis markedly increases his or her risk of developing eye disease.
- Erythrocyte sedimentation rate (ESR or sed rate). This blood test, which measures how fast red blood cells fall to the bottom of a test tube, can tell the doctor if inflammation is present. Inflammation is a hallmark of juvenile arthritis and a number of other conditions.
X Rays
X rays are needed if the doctor suspects injury to the bone or unusual bone development. Early in the disease, some x rays can show changes in soft tissue. In general, x rays are more useful later in the disease, when bones may be affected.
Other Tests
Because there are many causes of joint pain and swelling, the doctor must rule out other conditions before diagnosing juvenile arthritis. These include physical injury, bacterial or viral infection, Lyme disease, inflammatory bowel disease, lupus, dermatomyositis, and some forms of cancer. The doctor may use additional laboratory tests to help rule out these and other possible conditions.
Who Treats It?
Treating juvenile arthritis often requires a team approach, encompassing the child and his or her family and a number of different health professionals. Ideally, the child's care should be managed by a pediatric rheumatologist, who is a doctor who has been specially trained to treat the rheumatic diseases in children. However, many pediatricians and "adult" rheumatologists also treat children with juvenile arthritis. Because there are relatively few pediatric rheumatologists and they are mainly concentrated at major medical centers in metropolitan areas, children who live in smaller towns and rural areas may benefit from having a doctor in their town coordinate care through a pediatric rheumatologist. Many large centers now conduct outreach clinics, in which doctors and a supporting team travel from large cities to smaller towns for 1 or 2 days to treat local patients.
Other members of your child's health care team may include:
- Physical therapist. This health professional can work with your child to develop a plan of exercises that will improve joint function and strengthen muscles without causing further harm to affected joints.
- Occupational therapist. This health professional can teach ways to protect joints, minimize pain, conserve energy, and exercise. Occupational therapists specialize in the upper extremities (hands, wrists, elbows, arms, shoulders, and neck).
- Counselor or psychologist. Being a child or adolescent with a chronic disease isn't easy, for the child or his or her family. Some children may benefit from sorting out their feelings with a psychologist or counselor trained to help children in this situation. Members of the child's family may benefit from counseling as well.
- Ophthalmologist. If your child's medications or form of arthritis can affect the eyes, catching problems early can help keep them from becoming serious. All children with juvenile arthritis need to have regular exams by an ophthalmologist (eye doctor) to detect eye inflammation.
- Dentist and orthodontist. Dental care can be difficult if a child's hands are so affected by arthritis that thorough brushing and flossing of the teeth becomes difficult. In addition, children with involvement of the jaw may have difficulty opening the mouth for proper brushing. Therefore, regular dental exams are important. Because juvenile arthritis can affect the alignment of the jaw, it is important for children with this disease to be evaluated by an orthodontist.
- Orthopaedic surgeon. For some children, surgery is necessary to help minimize or repair the effects of their disease. Orthopaedic surgeons are doctors who perform surgery on the joints and bones.
- Dietitian. For children with chronic diseases, good nutrition is particularly important. A dietitian can help design a nutritious diet that will benefit the whole family.
- Pharmacist. A pharmacist is a good source of information about medications, including possible side effects and drugs that have the potential to interact with one another. If a child has trouble swallowing large pills or taking other medication, the pharmacist may have suggestions for different ways to take the medication or may be able to formulate or help you get kid-friendly versions of some medications.
- Social worker. A social worker can help a child and his or her family deal with life and lifestyle changes caused by arthritis. A social worker also can help you identify helpful resources for your child.
- Rheumatology nurse. A rheumatology nurse likely will be intimately involved in a child's care, serving as the main point of contact with the doctor's office concerning appointments, tests, medications, and instructions.
- School nurse. For a school-age child, the school nurse also may be considered a member of the treatment team, particularly if the child is required to take medications regularly during school hours.
How Is It Treated?
The main goals of treatment are to preserve a high level of physical and social functioning and maintain a good quality of life. To achieve these goals, doctors recommend treatments to reduce swelling, maintain full movement in the affected joints, relieve pain, and prevent, identify, and treat complications. Most children with juvenile arthritis need a combination of medication and nonmedication treatments to reach these goals.
Following are some of the most commonly used treatments.
Medication Treatments2
Nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin, ibuprofen, naproxen, and naproxen sodium are examples of NSAIDs. They are often the first type of medication used. All NSAIDs work similarly by blocking substances called prostaglandins that contribute to inflammation and pain. However, each NSAID is a different chemical, and each has a slightly different effect on the body.
2All medicines can have side effects. Some medicines and side effects are mentioned in this publication. Some side effects may be more severe than others. You should review the package insert that comes with your medicine and ask your health care provider or pharmacist if you have any questions about the possible side effects.
Some NSAIDs are available over the counter, while several others, including a subclass called COX-2 inhibitors, are available only with a prescription.
All NSAIDs can have significant side effects, so consult a doctor before taking any of these medications.3 For unknown reasons, some children seem to respond better to one NSAID than another. A doctor should monitor any child taking NSAIDs regularly to control juvenile arthritis symptoms as effectively as possible, at the optimal dose.
3 Warning: Side effects of NSAIDs include stomach problems; skin rashes; high blood pressure; fluid retention; and liver, kidney, and heart problems. The longer a person uses NSAIDs, the more likely he or she is to have side effects, ranging from mild to serious. Many other drugs cannot be taken when a patient is being treated with NSAIDs, because NSAIDs alter the way the body uses or eliminates these other drugs. Check with your health care provider or pharmacist before you take NSAIDs. NSAIDs should only be used at the lowest dose possible for the shortest time needed.
Disease-modifying antirheumatic drugs (DMARDs). If NSAIDs do not relieve symptoms of juvenile arthritis, the doctor may prescribe this type of medication. DMARDs slow the progression of juvenile arthritis, but because they may take weeks or months to relieve symptoms, they often are taken with an NSAID. Although many different types of DMARDs are available, doctors are most likely to use one particular DMARD, methotrexate, for children with juvenile arthritis.
Researchers have learned that methotrexate is safe and effective for some children with juvenile arthritis whose symptoms are not relieved by other medications. Because only small doses of methotrexate are needed to relieve arthritis symptoms, potentially dangerous side effects rarely occur. The most serious complication is liver damage, but it can be avoided with regular blood screening tests and doctor follow-up. Careful monitoring for side effects is important for people taking methotrexate. When side effects are noticed early, the doctor can reduce the dose and eliminate the side effects.
Corticosteroids. In children with very severe juvenile arthritis, stronger medicines may be needed to stop serious symptoms such as inflammation of the sac around the heart (pericarditis). Corticosteroids such as prednisone may be added to the treatment plan to control severe symptoms. This medication can be given either intravenously (directly into the vein) or by mouth. Corticosteroids can interfere with a child's normal growth and can cause other side effects, such as a round face, weakened bones, and increased susceptibility to infections. Once the medication controls severe symptoms, the doctor will reduce the dose gradually and eventually stop it completely. Because it can be dangerous to stop taking corticosteroids suddenly, it is important to carefully follow the doctor's instructions about how to take or reduce the dose. For inflammation in one or just a few joints, injecting a corticosteroid compound into the affected joint or joints can often bring quick relief without the systemic side effects of oral or intravenous medication.
Biologic agents. Children with juvenile arthritis who have received little relief from other drugs may be given one of a newer class of drug treatments called biologic response modifiers, or biologic agents. Tumor necrosis factor (TNF) inhibitors work by blocking the actions of TNF, a naturally occurring protein in the body that helps cause inflammation. Other biologic agents block other inflammatory proteins such as interleukin-1 or immune cells called T cells. Different biologics tend to work better for different subtypes of the disease.
Treatments Without Medication
- Physical therapy. A regular, general exercise program is an important part of a child's treatment plan. It can help to maintain muscle tone and preserve and recover the range of motion of the joints. A physiatrist (rehabilitation specialist) or a physical therapist can design an appropriate exercise program for a person with juvenile arthritis. The specialist also may recommend using splints and other devices to help maintain normal bone and joint growth.
Complementary and alternative therapies. Many adults seek alternative ways of treating arthritis, such as special diets, supplements, acupuncture, massage, or even magnetic jewelry or mattress pads. Research shows that increasing numbers of children are using alternative and complementary therapies as well.
Although there is little research to support many alternative treatments, some people seem to benefit from them. If a child's doctor feels the approach has value and is not harmful, it can be incorporated into the treatment plan. However, it is important not to neglect regular health care or treatment of serious symptoms.
How Can the Family Help a Child Live Well With Juvenile Arthritis?
Juvenile arthritis affects the entire family, all of whom must cope with the special challenges of this disease. Juvenile arthritis can strain a child's participation in social and after-school activities and make schoolwork more difficult. Family members can do several things to help the child physically and emotionally.
- Get the best care possible. Ensure that the child receives appropriate medical care and follows the doctor's instructions. If possible, have a pediatric rheumatologist manage your child's care. If such a specialist is not close by, consider having your child see one yearly or twice a year. A pediatric rheumatologist can devise a treatment plan and consult with your child's doctor, who will help you carry it out and monitor your child's progress.
- Learn as much as you can about your child's disease and its treatment. (The resources listed at the end of this publication can help.) Many treatment options are available, and because juvenile arthritis is different in each child, what works for one may not work for another. If the medications that the doctor prescribes do not relieve symptoms or if they cause unpleasant side effects, you and your child should discuss other choices with the doctor. A person with juvenile arthritis can be more active when symptoms are controlled.
- Consider joining a support group. Try to find other parents and kids who face similar experiences. It can help you—and your child—to know you're not alone. Some organizations have support groups for people with juvenile arthritis and their families.
- Treat the child as normally as possible. Try not to cut your child too much slack just because he or she has arthritis. Too much coddling can keep your child from being responsible and independent and can cause resentment in siblings.
- Encourage exercise and physical therapy for the child. For many young people, exercise and physical therapy play important roles in managing juvenile arthritis. Parents can arrange for children to participate in activities that the doctor recommends. During symptom-free periods, many doctors suggest playing team sports or doing other activities. The goal is to help keep the joints strong and flexible, to provide play time with other children, and to encourage appropriate social development.
- Work closely with your child's school. Help your child's school to develop a suitable lesson plan, and educate your child's teacher and classmates about juvenile arthritis. Some children with juvenile arthritis may be absent from school for prolonged periods and need to have the teacher send assignments home. Some minor changes—such as having an extra set of books or leaving class a few minutes early to get to the next class on time—can be a great help. With proper attention, most children progress normally through school.
- Talk with your child. Explain that getting juvenile arthritis is nobody's fault. Some children believe that juvenile arthritis is a punishment for something they did. Let your child know you are always available to listen, and help him or her in any way you can.
- Work with therapists or social workers. They can help you and your child adapt more easily to the lifestyle changes juvenile arthritis may bring.
Do These Children Have to Limit Activities?
Although pain sometimes limits physical activity, exercise is important for reducing the symptoms of juvenile arthritis and maintaining function and range of motion of the joints. Most children with juvenile arthritis can take part fully in physical activities and selected sports when their symptoms are under control. During a disease flare, however, the doctor may advise limiting certain activities, depending on the joints involved. Once the flare is over, the child can start regular activities again.
Swimming is particularly useful because it uses many joints and muscles without putting weight on the joints. A doctor or physical therapist can recommend exercises and activities.
What Research Is Being Conducted on Juvenile Arthritis?
Researchers keep trying to improve existing treatments for children and find new medicines that will work better with fewer side effects. That effort received a major boost with the passage of the Pediatric Research Equity Act of 2003, which requires drugs that might be used in children to be tested in children. As a result of the act, increasing numbers of medications are being tested for safety and effectiveness in children. Consequently, doctors will have more information on appropriate medications and doses to prescribe for their pediatric patients.
Scientists supported by the National Institutes of Health (NIH) are investigating the possible causes of juvenile arthritis. Researchers suspect that both genetic and environmental factors are involved in development of the disease, and they are studying these factors in detail. To help explore the role of genetics, the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) has a research registry for families in which two or more siblings have juvenile arthritis.
Eventually, gene therapy, or therapy based on the functioning of genes, may be used to treat pediatric rheumatic disorders by monitoring children's response to treatment or by predicting who is most likely to respond to a particular treatment regimen.
One recent NIAMS-supported study—the largest collaborative study of juvenile idiopathic arthritis to date—identified 14 genes linked to juvenile idiopathic arthritis and confirmed three previously discovered genes. The study also suggested that another 11 genetic regions might be involved in the disease.
Other areas of research supported by the NIH are widely varied and include studies of the following:
- Improved understanding of the biology and use of tumor necrosis factor inhibition in juvenile arthritis.
- Biomarkers of macrophage activation syndrome (MAS) a potentially life-threatening complication in systemic juvenile arthritis.
- The determinants of health-related quality of life in children with juvenile arthritis.
- The causes and consequences of sleep-disordered breathing in children with juvenile arthritis.
- The effectiveness of daily calcium supplementation for increasing bone mineral density in children with juvenile arthritis. A randomized, controlled trial of calcium supplementation was conducted among children with juvenile arthritis. The trial found that supplementation resulted in a small, but statistically significant, increase in total body bone mineral density, compared with a placebo in children with juvenile arthritis.
- The impact of chronic and recurrent pain on children.
- Ways to limit the impact of pain on children's functioning.
- The role of the innate immune system in juvenile arthritis and the environmental triggers that might initiate the disease.
- A randomized, controlled trial of the effectiveness of a combination of methotrexate, corticosteroids, and etanercept compared to the standard therapy of methotrexate in keeping disease inactive in children with new onset polyarthritis.
- A study of juvenile arthritis patients to see if genetic analysis can predict which patients will experience a flare of the disease after stopping TNF treatment.
- A study of the expression of thousands of genes in the blood cells of children with juvenile arthritis to learn how these genes are affected by specific treatments or if their expression can predict how a patient will respond to certain medications.
Information on research is available from the following resources:
- National Institutes of Health (NIH) Clinical Research Trials and You was designed to help people learn more about clinical trials, why they matter, and how to participate. Visitors to the website will find information about the basics of participating in a clinical trial, first-hand stories from clinical trial volunteers, explanations from researchers, and links on how to search for a trial or enroll in a research-matching program.
- ClinicalTrials.gov offers up-to-date information for locating federally and privately supported clinical trials for a wide range of diseases and conditions.
- NIH RePORTER is an electronic tool that allows users to search a repository of both intramural and extramural NIH-funded research projects from the past 25 years and access publications (since 1985) and patents resulting from NIH funding.
- PubMed is a free service of the U.S. National Library of Medicine that lets you search millions of journal citations and abstracts in the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and preclinical sciences.
Where Can People Find More Information About Juvenile Arthritis?
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Information Clearinghouse
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
Phone: 301-495-4484
Toll free: 877-22-NIAMS (877-226-4267)
Fax: 301-718-6366
Email: firstname.lastname@example.com
Website: https://www.niams.nih.gov
If you need more information about available resources in your language or another language, please visit our website or contact the NIAMS Information Clearinghouse at email@example.com.
Other Resources
NIH Osteoporosis and Related Bone Diseases ~ National Resource Center
2 AMS Circle
Bethesda, MD 20892-3676
Phone: 202-223-0344
Toll free: 800-624-BONE (2663)
Fax: 202-293-2356
Email: email@example.com
Website: http://www.bones.nih.gov
American Academy of Orthopaedic Surgeons
Website: https://www.aaos.org (con información en español)
Arthritis Foundation
Website: https://www.arthritis.org
Juvenile Arthritis Association
Website: http://www.juvenilearthritis.org
Anti-CCP antibodies. A type of antibody that may be detected in healthy individuals years before the onset of clinical rheumatoid arthritis. Anti-CCP antibodies are also prevalent in children with polyarticular juvenile arthritis and may correlate with disease severity.
Antinuclear antibody (ANA). A type of antibody directed against the nuclei of the body's cells. Because these antibodies can be found in the blood of children with lupus and some other rheumatic disorders, testing for them can be useful in diagnosis.
Corticosteroids. Powerful anti-inflammatory hormones made naturally in the body or synthetically for use as medicine. Corticosteroids may be taken by mouth or intravenously, or they may be injected into the affected joints to temporarily suppress the inflammation that causes arthritis-related swelling, warmth, loss of motion, and pain.
Disease-modifying antirheumatic drugs. A class of medication that can slow or potentially stop the activity of rheumatic disorders, such as rheumatoid arthritis, often by suppressing the overactive immune system.
Erythrocyte sedimentation rate (ESR or sed rate). A test that measures how quickly red blood cells fall to the bottom of a test tube of unclotted blood. Rapidly descending cells (an elevated sed rate) indicate inflammation in the body.
Flare. A period in the course of disease in which symptoms become worse. In most children, juvenile arthritis is characterized by periods of remission punctuated by flares.
Immune-response modifiers. A relatively new class of medications used in arthritis treatment that are based on compounds made by living cells. These compounds modify the action of the immune system by blocking chemicals that fuel inflammation and tissue destruction.
Juvenile arthritis (JA). A term often used to describe arthritis in children.
Juvenile idiopathic arthritis (JIA). A term for various types of chronic arthritis in children. Arthritis is an inflammation of the tissues lining the joints of the body. Juvenile idiopathic arthritis can cause swelling, pain, damage to the joints, and, in some cases, damage to other parts of the body. Juvenile idiopathic arthritis has replaced juvenile rheumatoid arthritis as the preferred term for the same condition.
Juvenile rheumatoid arthritis (JRA). A term used to describe the most common types of arthritis in children. It is characterized by joint pain, swelling, tenderness, warmth, and stiffness that lasts for more than 6 weeks and cannot be explained by other causes. Previously, juvenile rheumatoid arthritis was the preferred term, but recently it has been replaced by juvenile idiopathic arthritis.
Nonsteroidal anti-inflammatory drugs (NSAIDs). A class of medications that work to reduce pain, fever, and inflammation by blocking substances called prostaglandins. Some NSAIDs, such as ibuprofen and naproxen sodium, are available over the counter, while many are available only with a doctor's prescription.
Oligoarticular juvenile idiopathic arthritis (formerly known as pauciarticular juvenile rheumatoid arthritis). Refers to a form of juvenile idiopathic arthritis that affects four or fewer joints.
Pericarditis. Inflammation of the pericardium, the membrane that surrounds the heart. Pericarditis is a feature of some rheumatic disorders, including systemic arthritis.
Pleuritis. Inflammation of the pleura, the membrane that covers the lungs and lines the inner chest wall. Pleuritis is a feature of some rheumatic disorders, including systemic arthritis.
Polyarticluar juvenile idiopathic arthritis (formerly known as polyarticular juvenile rheumatoid arthritis). Refers to a form of juvenile idiopathic arthritis that affects five or more joints.
Remission. A period when the symptoms of juvenile arthritis improve or disappear completely. Sometimes remission is permanent, but more often it is punctuated by flares of the disease.
Rheumatic disorders. Disorders that affect the joints and soft tissues, causing pain, and sometimes inflammation, tissue damage, or disability.
Rheumatoid factor. An antibody that is found often in the blood of adults with rheumatoid arthritis and once in a while in children with juvenile arthritis. For these children, testing for the antibody may be useful as a diagnostic tool.
Systemic. Refers to a disease that can affect the whole body, rather than just a specific organ or joints. For example, the juvenile idiopathic arthritis subtype systemic arthritis (formerly known as systemic juvenile rheumatoid arthritis) can affect the skin, blood vessels, bones, and membranes lining the chest wall, as well as the joints.
Tendinitis. The inflammation of tendons, which are strong bands of connective tissue that attach muscles to bones.
Vasculitis. Inflammation of the blood vessels. Vasculitis is a feature of a number of rheumatic disorders.
The NIAMS gratefully acknowledges the assistance of the following individuals in the preparation and review of the original version of this publication: Susana Serrate-Sztein, M.D., James Witter, M.D., Ph.D., FACR, and Daniel L. Kastner, M.D., Ph.D., NIAMS/NIH; Laurie Ebner-Lyon, R.N., APN-C, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, NJ; Edward H. Giannini, M.Sc., Dr.P.H., David Glass, M.D., and Daniel J. Lovell, M.D., M.P.H., Cincinnati Children's Hospital Medical Center, Cincinnati, OH; J. Roger Hollister, M.D., Children's Hospital, Denver, CO; and Carol B. Lindsley, M.D., University of Kansas City Medical Center, Kansas City, KS.
The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the U.S. Department of Health and Human Services' National Institutes of Health (NIH), is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. The NIAMS Information Clearinghouse is a public service sponsored by the NIAMS that provides health information and information sources. Additional information can be found on the NIAMS website at www.niams.nih.gov.
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NIH Publication No. 15–4942


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Assassin's Creed 4: Black Flag's Season Pass Plans Revealed
Ubisoft's plans for Assassin's Creed 4: Black Flag's Season Pass content have been revealed.
It seems that Black Flag will be an adventure in piracy that just keeps on going. A press release reveals the content to included with the Season Pass. According to the release, the following downloadable add-on content will be available with the Season Pass (some SPOILERS ahead):
- Freedom Cry: Single-player DLC featuring Adewale, Kenway's first mate. Set 15 years after Kenway's adventures, Adewale has become a trained assassin. After being shipwrecked in Saint-Domingue, he must undertake his own adventure in survival.
- Exclusive Kraken Ship Pack – A slew of customization options for the Jackdaw, exclusive only to Season Pass owners.
- More missions, weapons, skins and collectibles for the single-player experience.
- New character unlocks for the multiplayer mode.

subset: commoncrawl


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BP Comment Quick Links
April 15, 2013
Minor League Update
Games of April 12-14
Games of Friday, April 12
Pitching Prospect of the Day: Jameson Taillon, RHP, Pirates (Double-A Altoona): 6.0 IP, 5 H, 2 ER, 3 BB, 10 K; Here's a conversation I had with a scout. Scout: "Have you seen Taillon?" Me: "Yes." Scout: "That curveball could be a (expletive expletive)!"
Position Prospect of the Day: Rosell Herrera, SS, Rockies (Low-A Asheville): 3-3, 2 2B, HR, 2 R, HR, 3 RBI, BB; Herrera is a switch-hitter with an uncanny ability to barrel balls and plus power from the left side of the plate. Since he's already 6-foot-3, a move off of shortstop to the hot corner is imminent.
"The Good"
"The Bad"
"The Disappointing"
Matthew Hobgood, RHP, Orioles (Low-A Delmarva): 3.0 IP, 1 H, 0 ER, 0 BB, 3 K; It's good to see that the 2009 first-round selection was at least able to get back on the mound.
Games of Saturday, April 13
Pitching Prospect of the Day: Yordano Ventura, RHP, Royals (Double-A Northwest Arkansas): 5.0 IP, 3 H, 0 ER, 2 BB, 7 K; Ventura has a lightning-fast arm with the best fastball in the minors (according to Baseball Prospectus), a power curveball that is an easy plus pitch, and a changeup that is improving. If everything comes together, Ventura will be able to pitch at the front of a rotation, and if the changeup never comes, he still has the stuff to be a top-notch closer.
Position Prospect of the Day: Dilson Herrera, 2B, Pirates (Low-A West Virginia): 4-4, 2B, HR, 4 R, 3 RBI, 2 BB; Herrera has a good stroke with plenty of punch. He has a small frame and plus speed, and has made the move to the right side of the infield full time in 2013.
"The Good"
"The Bad"
"The Dry Air of the Pacific Coast League"
Tyler Skaggs, LHP, Diamondbacks (Triple-A Reno): 2.1 IP, 8 H, 9 ER, 3 BB, 3 K; Skaggs is looked upon as one of the best pitchers in the minors, but of nights in the unfriendly environments of the PCL can yield lines like this one.
Games of Sunday, April 14
Pitching Prospect of the Day: Zack Wheeler, RHP, Mets (Triple-A Las Vegas): 5.1 IP, 6 H, 3 ER, 0 BB, 8 K; plus-plus fastball, easy plus curveball, and a usable slider and changeup. The combination of Wheeler and Harvey will put smiles on Mets fans' faces for a long time.
Position Prospect of the Day: Michael Choice, OF, Athletics (Triple-A Sacramento): 4-5, 2 2B, 2 HR, 5 R, 3 RBI; Built like a middle linebacker, Choice offers plus-plus power with an average hit tool.
"The Good"
"The Bad"
"The Ugly"
Mike Olt, 3B, Rangers (Triple-A Round Rock): 0-4, 4 K; Not a good trend for Olt, who has scuffled since returning to Triple-A.
Zach Mortimer is an author of Baseball Prospectus.
11 comments have been left for this article.
BP Comment Quick Links
" Baez wears his chain out"
Apr 15, 2013 05:49 AM
Syndergaard is on the Mets. No take backsies!
Apr 15, 2013 06:21 AM
Why is Matt Hobgood's performance "disappointing"? Because he gave up a hit? He only struck out three? I would bet the Orioles are pleased so far. He hasn't given up a run in three appearances. Mychal Givens, a converted shortstop now pitching, is also worth noting.
Apr 15, 2013 06:52 AM
Nothing about Matt Hobgood's performance was disappointing. Matt Hobgood is disappointing. The fact that he is still in Low-A won't put a smile on Orioles' fans faces.
Apr 15, 2013 07:30 AM
I realize he's being mentioned because he had a couple good games, but is Stetson Allie a real 1B prospect, or is he here only because he is a name that people know?
Apr 15, 2013 08:10 AM
Is what Michael Taylor is putting up at home (in a pitchers park for the PCL) mean something, or is it just SSS at this point?
Apr 15, 2013 20:39 PM
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OAKLAND -- Warriors point guard Stephen Curry insists that his confident court demeanor should not be mistaken for swagger.
However you want to define his new aura -- the celebrations, the clapping on defense, the speeches in the huddles -- Golden State will gladly take it from its fourth-year player. Curry's emotional presence has sparked his own game, and the play of his teammates.
"I love his energy, his enthusiasm, his passion," coach Mark Jackson said. "It takes us to another level, because guys are looking for that."
Curry, 24, says his vocal demeanor is no coincidence. Management made it clear that he was the unquestioned leader in the Warriors' post-Monta Ellis world, a fact the team backed up by signing him to a four-year, $44 million extension.
The team's 8-6 start, highlighted by a grittiness previous Warriors teams have not displayed, has provided the perfect backdrop for Curry's growth.
"I don't think you can be successful in sports or pretty much anything if you're not confident in what you're doing," Curry said. "I've always been this way. But when you're losing every game, it's frustrating. When you're competitive, it gives it meaning. We're winning and playing well, and we're competitive in each game. There are more moments when it means something."
Step one for Curry was to resist all bad body language. He'd been known to sulk on the court, especially after turnovers or when he got into foul trouble. But this season, as the newly anointed face of the franchise, Curry sought to flip the script.
He assumed the task of keeping the team's spirits up, making sure he displayed positive energy even when he was in a personal slump (a difficult task with his shooting woes to start the season).
Then, in a road win at Dallas on Nov. 19, he tweaked the right ankle that has caused him two seasons of pain and frustration. Previous ankle sprains prompted displays of frustration -- depressed expressions, thrown mouth guards, punched chairs.
This time, he was determined to react differently.
He was able to return to the floor after the ankle sprain, and did so with a certain bounce to his step, a smile on his face, a presence that shined on the court. He clapped to encourage his teammates on defense. And when he set up David Lee's game-winning layup in overtime, he screamed as he headed to the bench.
"I think that something on the inside told him he had to muster it," Jackson said. "He was rah-rah, high-fiving, demanding the basketball."
That Dallas game seems to have stuck with Curry. Two nights later in a win over visiting Brooklyn, he drilled a 3-pointer and got the foul, flashing four fingers to celebrate his four-point play even before he attempted the free throw.
In Friday's loss to Denver, he regressed a bit. Coaches pointed out his uninspiring body language as the Nuggets went on a big run. But by Saturday against Minnesota, he was back at it, prepping his team for a fourth-quarter surge with a pep talk and egging on the crowd after he nailed a big 3-pointer.
"My body language has to be positive at all times," Curry said. "You've got to have somebody that's always up and positive when things are looking bad. I try to make a conscious effort to do that. Make sure everybody knows it's all right, we'll get it on the next one. So nobody's sulking."
Jackson challenged him early to take over the team, be the leader. A legendary point guard in his own right, Jackson has put the ball in Curry's hands when it matters most.
Curry's moxie is especially evident down the stretch of close games. He said his confidence is at an all-time high not just because of his own ability but because of the players surrounding him and the energy of the team.
You can see the belief in his strut, in his facial expression. Even mistakes don't seem to bother him as much anymore.
"The energy we've kind of established over the course of 12 games is entirely different than what we've had in the past," point guard Jarrett Jack said. "So it may be you're seeing him in a way you haven't seen him before. But we're playing the type of ball you haven't seen: grind-it-out wins. It's gone unsaid. Nobody has talked to him. But of course we see it."
Curry said, by his estimation, he's been pretty subdued. His emphasis is on the little things. Encouraging his teammates. Talking on defense. Bringing energy. And, yes, even flashing three fingers after he drains a 3-pointer.
"There is a difference between confidence and trying to let everybody know that you're good," Curry said. "But you have to some kind of ... I hate that word, but ... 'swag.'?"


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Twins say Guerrier progressing as planned
FORT MYERS, Fla. -- Right-hander Matt Guerrier threw his first live bullpen session on Tuesday without any issues, and he remains on track to make his Grapefruit League debut on Tuesday against the Rays.
Guerrier, who had surgery in mid-August to repair the flexor mass in his right elbow, is scheduled to throw another live bullpen session Friday.
"He's throwing all his pitches now, so he's getting close," Twins assistant general manager Rob Antony said. "He's probably a bullpen or two away from getting in a game next week. I think he should be on schedule. Every report has been positive for him. No issues. No soreness."
Antony added that Guerrier, who is a non-roster invitee as a Minor League signing, should still have ample time to get ready for the regular season. The Twins open the season against the White Sox in Chicago on March 31.
"If he starts in on the 11th, he'll have 17 or 18 days," Antony said. "It'll probably be a lot like [Anthony] Swarzak last year, who came in with a rib injury but still had plenty of time to get ready. So he should have plenty of opportunity to get in games."
Rhett Bollinger is a reporter for MLB.com. Read his blog, Bollinger Beat, and follow him on Twitter @RhettBollinger. This story was not subject to the approval of Major League Baseball or its clubs.


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College Football Top 25, Rankings, Predictions, NCAA Football Schedules, and News
Here's a look at our favorite college cheerleaders from week 4 of the 2017 football season.
Here's a look at our favorite college cheerleaders from week 1 of the 2017 football season. , Here's a look at our favorite college cheerleaders from week 1 of the 2017 football season.
Update: See the latest AP Poll Top 25 Rankings. Ranking all 130 college football teams is no easy task, but with the first Saturday of action on Aug. 26 days away, it is time to see...
Spring practice is a busy time for all 130 college football teams, and it's no secret most of the attention in offseason workouts starts with the quarterback position. The 2017 crop of...
A look back at our 30 favorite cheerleaders from the first seven weeks of the 2016 college football season. They can cheer for us anytime!
Weekly rankings are a big part of every college football season, and Athlon Sports will update its top 25 following the games each weekend. The final weekend of the 2016 regular season produced a...
See who's No. 1 on our list of the 25 best college football uniforms for the 2016 season.
Be it a savory brat haze floating over State Street, towering Georgia pines surrounding the 40 Watt Club or 1.5 million bats emerging nightly from slumber, the uniqueness of college football is...
The offseason is over and after several long and excruciating months, college football is back in our lives. Normally any kind of football in late August and early September should be celebrated but...
Each season of college football comes with its share of changes and 2016 is no exception. Here's a rundown of the new uniforms for the upcoming year.
Quarterback play is always under the microscope for every college football team. Finding and developing a reliable starter isn't easy for some programs, but for other schools, the...
It's not easy getting college football coaches to honestly comment on another coach, player or team. Most coaches don't want to give opposing teams billboard material, which is why...


text:
Pharmacokinetic and Pharmacodynamic Effects of MTR107 in End-Stage Renal Disease (ESRD) Patients
The recruitment status of this study is unknown. The completion date has passed and the status has not been verified in more than two years.
Verified December 2006 by Wolfson Medical Center.
Recruitment status was: Recruiting
Recruitment status was: Recruiting
Wolfson Medical Center
Meditor Pharmaceuticals Ltd.
Information provided by:
Wolfson Medical Center
ClinicalTrials.gov Identifier:
First received: March 14, 2007
Last updated: NA
Last verified: December 2006
History: No changes posted
- Full Text View
- Tabular View
- No Study Results Posted
- Disclaimer
- How to Read a Study Record
Detailed Description:
MTR107 effect on blood pressure throught the dialysis procedure and its ability to prevent Intra dialytic Hypotension
|Hypotension End Stage Renal Disease Intra Dialytic Hypotension
|Drug: MTR107
|Phase 2
|Study Type:
|Study Design:
|Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double
Primary Purpose: Treatment
|Official Title:
|A Phase II, Randomized Double Blind Placebo-Controlled, Dose Escalating Study to Determine Pharmacokinetic and Pharmacodynamic Effects of MTR107 in End-Stage Renal Disease (ESRD) Patients
Resource links provided by NLM:
MedlinePlus related topics: Kidney Diseases Kidney Failure Low Blood PressureU.S. FDA Resources
Further study details as provided by Wolfson Medical Center:
Primary Outcome Measures:
- A descriptive pharmacokinetic / pharmacodynamic study. No primary end-points apply.
Secondary Outcome Measures:
- Exploratory Efficacy Parameters:
- Number and type of medical interventions required for treatment of hypotension.
- Alleviation of symptoms associated with intradialytic hypotension.
- Efficiency of dialysis as reflected by Kt/V
|Estimated Enrollment:
|Study Start Date:
|May 2006
|Estimated Study Completion Date:
|March 2007
The present clinical trial aims to investigate and provide a more precise characterization of the pharmacokinetic and pharmacodynamic profile of MTR107 in a population of ESRD patients predisposed to developing intradialytic hypotension. The study is also designed as a dose esclating study aiming to assess MTR107 safety.
|Ages Eligible for Study:
|20 Years to 75 Years (Adult, Senior)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
Inclusion Criteria:
- Age 20-75 years, inclusive.
- Presence of frequent bouts of hypotension defined as 3 or more intradialytic hypotensive events per month for the last six months prior to baseline, despite standard adjustments in dry weight.
- ECG performed up to one month before study start.
Well-preserved hepatic function (within normal laboratory ranges) at study entry as judged by:
- Serum Bilirubin (Total Bilirubin (direct and indirect) 0.3-1.0 mg/dL, and Direct Bilirubin 0.1-0.5 mg/dL)
- Serum Albumin (>3.6 g/dL),
- Serum aminotransferases (AST (0-37 U/L) and ALT (0-40 U/L)),
- GGT (Gamma Glutamine Trans Peptidase)
- Normal coagulation status at study entry as judged by PT-INR, PTT, fibrinogen and platelet count.
- Willingness to participate in the study and adhere to the study design.
- Willingness to sign an informed consent form.
Exclusion Criteria:
- Uncontrolled hypertension >140/90 mmHg.
- Unstable angina.
- Abnormal ECG which may indicate acute disease
- Variable weight gains.
- Mental retardation.
- Pregnancy.
- Malignancy or other concomitant serious diseases.
- Current participation in another clinical trial involving an investigational drug/device, or participation in such a trial within the last 30 days.
Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00448071
Please refer to this study by its ClinicalTrials.gov identifier: NCT00448071
|Contact: Zeev Katzir, MD
|Wolfson Medical Center
|Holon, Israel, 58100
|Contact: Zeev Katzir, MD 972-3-5028291 firstname.lastname@example.com
|Principal Investigator: Zeev Katzir, MD
|Asaf Harofeh Medical Center
|Rishon Le Zion, Israel, 70300
|Contact: Shay Efrati, MD 972-8-9778061
|Principal Investigator: Shay Efrati, MD
Sponsors and Collaborators
Wolfson Medical Center
Meditor Pharmaceuticals Ltd.
|Principal Investigator:
|Zeev Katzir, MD
|Wolfson Medical Center
|Principal Investigator:
|Shay Efrati, MD
|Asaf Harofeh Medical Center
More Information
Keywords provided by Wolfson Medical Center:
Additional relevant MeSH terms:
ClinicalTrials.gov processed this record on September 21, 2017
|ClinicalTrials.gov Identifier:
|NCT00448071 History of Changes
|Other Study ID Numbers:
|Study First Received:
|March 14, 2007
|Last Updated:
|March 14, 2007
Keywords provided by Wolfson Medical Center:
End Stage Renal Disease
Intra Dialytic Hypotension
Blood Pressure
Additional relevant MeSH terms:
Kidney Diseases
Kidney Failure, Chronic
Renal Insufficiency, Chronic
Urologic Diseases
Renal Insufficiency
Vascular Diseases
Cardiovascular Diseases
ClinicalTrials.gov processed this record on September 21, 2017


text:
On the surface, it seems as if former slugger Jack Clark has been trying to draw attention for his new radio show with his inflammatory on-air comments accusing Albert Pujols of using steroids.
Clark, who hit 340 home runs in his 18-year career with the Giants, Cardinals, Yankees, Padres and Red Sox, recently started his show on WGNU 920 AM in St. Louis as a partner with Kevin Slaten, the long-time sports talk personality who has a well-earned reputation in the city for delivering inflammatory comments on top of inflammatory comments.
MORE: Rios traded to Rangers | Lohse staying with Brewers
As first reported in the St. Louis Post-Dispatch, last week Clark responded to Slaten's on-air claim that he always thought Pujols "was a juicer" by adding this to the conversation: "I know for a fact he was. The trainer that worked with him, threw him batting practice from Kansas City, that worked him out every day, basically told me that's what he did."
The athletic trainer in question, Chris Mihlfeld, has worked with Pujols since his he was Pujols' baseball coach at Maple Woods Community College in the Kansas City area.
Clark was the Dodgers' hitting coach in the early 2000s, when Mihlfeld worked as an athletic trainer with the organization. Clark says that's when the conversation took place.
NBCSports.com contacted Mihlfeld soon after the Post-Dispatch's story broke Friday morning and he vehemently denied Clark's accusations in an email: "I haven't even talked to Jack Clark in close to 10 years. His statements are simply not true. I have known Albert Pujols since he was 18 years old and he would never use illegal drugs in any way. I would bet my life on it and probably drop dead on the spot if I found out he has. As before once again both Albert and myself have been accused of doing something we didn't do."
For good measure, Clark also accused Tigers ace Justin Verlander and former major league outfielder Shawn Green of "juicing," too.
The question, of course (well, one of many questions), is why Clark would bring this up now if he's had this information for more than a decade. The timing—his new radio show—seems suspicious at best and an outright attention grab at worst.
UPDATE: Pujols released a statement to St. Louis television station KSDK on Friday night. In it, he denied using steroids and said he has begun legal action against Clark and WGNU. The full statement:
"I've said time and time again that I would never take, or even consider taking, anything illegal. I've been tested hundreds of times throughout my career and never once have I tested positive. It is irresponsible and reckless for Jack Clark to have falsely accused me of using PED's. My faith in Jesus Christ, and my respect for this game are too important to me. I would never be able to look my wife or kids in the eye if I had done what this man is accusing me of.
"I know people are tired of athletes saying they are innocent, asking for the public to believe in them, only to have their sins exposed later down the road. But I am not one of those athletes, and I will not stand to have my name and my family's name, dragged through the mud.
"I am currently in the process of taking legal action against Jack Clark and his employers at WGNU 920AM. I am going to send a message that you cannot act in a reckless manner, like they have, and get away with it. If I have to be the athlete to carry the torch and pave the way for other innocent players to see that you can do something about it, I am proud to be that person. I have five young children and I take being a role model very seriously. The last thing I want is for the fans, and especially the kids out there, to question my reputation and character."
UPDATE 2: Per the Post-Dispatch, the company that employed Clark and Slaten for WGNU announced early Saturday that it told the two men not to return to work.
The company, insideSTL Enterprises, said it "has terminated its relationship with Jack Clark and Kevin Slaten."
"As independent contractors, we want to make it clear that the opinions expressed do not necessarily reflect the opinions of insideSTL. Also as independent contractors, insideSTL did not have editorial control over the show's content,'' the company said in its statement.


text: Adventure among the most dangerous seas, steal treasures overflowing with gems and make your disloyal subjects walk the plank when you wear our pirate costume accessories. Make your pirate costume official with a funky eye patch or a skull and crossbones captain's hat. Fighting enemy ships is easier when you use a curved sword or antique musket. Parade your pirate style with these pirate accessories, and you'll surely strike gold.


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- Hours: Monday through Friday, 8:30 am until 5:00 pm CT
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- If you have any questions about a product, an order you placed, or our company policies, please do not hesitate to contact us. Scojo New York is a brand of Ogi Eyewear, an independent eyewear design company.
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- Scojo New York guarantees a high quality product and will repair or replace products with factory defects at no charge for a period of 12 months from the purchase date. This warranty does not apply to products purchased at special sales or discounted pricing. The Scojo New York Warranty does not cover frames that have been broken by personal wear and tear or abuse, or other conditions not associated with a factory defect. Any and all warranties are null and void if factory lenses are removed and/or replaced. Frames that have been discontinued during the 12-month warranty period may be exchanged for frames of a similar value.
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All prices are FOB Minneapolis, MN and are subject to change without notice. All shipments are carefully checked. Discrepancies should be reported immediately to Scojo New York Customer Service for assistance. All orders are billed from Ogi Eyewear—the independent eyewear company that designs Scojo New York product. To view Ogi Eyewear's other frame lines, please visit www.ogieyewear.com
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text:
Acquired for on-campus installation and access during the Summer of 2002, the Blackboard product provides a Course Management Software (CMS) environment to the academic community. Consistent with the 01/02 Blackboard Users Group proposal, the following services and responsibility summation is provided. The proposal is available at http://www.muskingum.edu/home/cns/downloads/BbRollout.pdf. Complete documentation of the Blackboard system is kept on local files at http://muskingum.blackboard.com/local/Learn_R91_Documentation.html
System availability
The server and software is made available on a 22 hour, 7 days a week basis. Starting at 3:00 a.m., system backups are taken on a nightly basis and the backup media is stored in a secure and safe manner. For clarity purposes, these system backups are not individual course backups, rather, they are backups taken for disaster, system and/or hardware recovery purposes. Reactive attention to system errors and problems are given high priority. The hardware is under a maintenance contract which guarantees a 4 hour response time.
User account management (NOTE: See separate Account Services section.)
Through the enrollment process, student Blackboard accounts are flagged for generation as soon as an applicant becomes a student or if a student registers for a course without going through the enrollment process. Faculty/instructor accounts are flagged for generation when the Registrar's office assigns a course to that employee. All Blackboard account names are the same as the person's email account name. The default password uses the first four letters (lower case) of the last name and either the last 4 digits of the Social Security Number or the last 4 digits of the Colleague/faculty/student ID Number, in that priority. Blackboard accounts are removed at the same time as email accounts are removed, either through graduation, withdrawal, or termination of employment.
Course creation (See Course Export and Removal below) Need more info, read the course creation
Through the online form, faculty submit requests for course creation prior to the beginning of the term needed. As long as the course is available in the institutional data base and has the instructor properly assigned, the online form will generate the course automatically. It is the instructor's responsibility to notify CNS if the automatic process fails to generate the desired course. The course creation process does not load instructional content, it is recommended that course requests occur no later than the final exam period of the preceding term. Unless requested (by you) and approved (by the VPAA or VP-GCS), all courses will retain the existing naming and numbering conventions as used by the Muskingum University Registrar. All variances to the standard procedure must be approved by the appropriate VP in advance. When courses are created, the person making the request is granted instructor status which enables the addition of content as well as the management of student enrollment into that course.
Should a previously developed course exist in the exported course list, it may be selected for use in the online form. The link to the online course request form is: http://www.muskingum.edu/cns/BbForm.html
Course enrollment responsibility
The instructor of each course is responsible for enrolling the student participants. The Blackboard system provides several easy to use methods to accomplish this task. Please refer to Pages 276 and 291 of the Blackboard Instructor Manual. Most faculty prefer to enable and use the student self enrollment option available under the instructor control panel. The version of Blackboard that the university utilizes does not provide a facility for mass course enrollment or integration with our student enrollment database.
Internet Browser, Plug-ins, and Lab Preparation
As of January 2012, Blackboard is supported on Internet Explorer version 8 or higher, Firefox version 3.6 or higher, Google Chrome 10 or higher, and Safari version 4 or higher. [Note: The following are NO longer supported: Internet Explorer 6 and 7, Firefox 1.x 2.x 3.x up to 3.5, Safari 2 and 3, Mac OSX 10.3 10.4 and "Tiger", and Java 5.] The following standard player/plug-ins are supported: Acrobat Reader, Flash, JRE, Shockwave, Media Player, Real Player and QuickTime. All of these are currently installed on all the public laboratory computers. Should you need a unique configuration or installation it is your responsibility to submit a request to CNS at least 30 days in advance.
Instructor training
Per the Blackboard Implementation Proposal, instructor training is accomplished on a peer basis. Members of the original Blackboard User Group are available to assist new instructors in developing the basic skill set associated with Blackboard utilization. A new instructor may wish to start by reviewing the instructor's manual. CNS will be glad to identify appropriate assistance, whether on-campus, on-line, or from an external source.
Student training
The level of student web and on-line knowledge is left to the instructor to determine. Should it be needed, each faculty is responsible for student training. The original proposal suggested that students would receive an introduction to basic Blackboard features in their First Year Seminar class. CNS and computer lab staff will assist with account, access, and basic feature mentoring, however anything in Blackboard that is course specific shall remain the instructor's responsibility.
Preserving the "Academic Record"
See page 285 for a full description of the archive/export process.
Short guide for archiving/exporting courses.
While CNS does utilize the export process to facilitate content re-use, it should be clearly understood that faculty are responsible for the archiving of academic materials, including but not limited to gradebooks, syllabi, course notes, and instructional content. Instructional content is considered to be the intellectual property and responsibility of the course creator. Due to a system limitation, content consisting of large media files may need to be managed separate from the integrated archive/restore process if the combined archive size exceeds 2.5GB.
Course Export and Removal
In order to maintain stability and performance of the server, each term we purge old courses. Faculty receive an advance email that reminds them to archive their courses in order to preserve their "Academic Record". Six weeks into the successive term, we export all previous term's courses that use the standard naming convention and then remove them from the active system. Courses that have been created for other purposes, as approved by the appropriate VP, do not follow the standard naming convention and thus remain active until no longer needed.
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text: Whatever method you opt for, it is going to take a great deal of work. Also, I have no idea what is meant by the "suttanta" method. It really does not exist. What exists are various ways of putting the sutta teachings into practice as we find with the Goenka and Mahasi Sayadaw methods and others.danieLion wrote: but I am also interested in the "suttanta" method and ways of deepening practice at home to at least approximate retreat like conditions


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Hello everyone. I have found a great deal of peace through the Dhamma, and it has had a remarkable impact on my ability to deal with the stresses of daily life.
My girlfriend, unfortunately, has quite a bit of difficulty with stress. Setbacks during the day (traffic, interruptions of routine, events beyond our control) have a huge effect on her, sometimes driving her to tears. She recently mentioned that she admired my ability to take these things in stride, and I asked if she would be willing to listen to a Dhamma talk or read something that might explain my perspective on these things.
Does anyone have a favorite Dhamma talk or some relatively short piece of writing that takes on this subject? She comes from a fairly strict Christian background, and while she doesn't practice any longer and is very open-minded, I don't think she is in a place where she'd be willing to practice meditation. Listening to a talk or two is about as close as I can get to sharing the Dhamma with her, which is fine. If anyone has an recommendations I'd love to hear them.


text:
#1: Am I the Only One?
Am I the only one who doesn't care about shrinkage? My hair is below bra strap length, but it shrinks up to around chin length or even shorter, depending upon what I do to it. Yet, this doesn't really bother me, I think it's kinda neat. I wear twistouts most of the time, so it usually ends up looking like a short, curly bob from the 20's.
Anyone else?
Anyone else?
Truqueen01, ricotdorothy, RMonzie and 1 others like this.


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A specialised load transporter carrying an Airbus A321 aircraft fuselage, will be escorted by Wiltshire Police through part of the county on Sunday afternoon and delays to traffic are expected.
The journey will begin in Wiltshire at about 1pm from M4 Junction 18, depending on the weather, where the load will be transported in convoy.
It departs from M4 junction 18 to junction 15 before travelling north on the A419 towards Cirencester, then onto the A429 to arrive at Kemble.
The transporter and its load will measure 6.10 metres (20ft) wide, 4.93 m (16ft-01ins) high with an overall length of 46.00 m (151 ft) and gross weight of 58 tonnes.
While on the A419 it will take up both northbound carriageways and motorists are being aske to be patient and to allow extra time for important journeys.
The load is due to travel from MoD St Athan, near Barry, South Wales, to Cotswold Airport, Kemble, near Cirencester, Gloucestershire.
Regular updates and travel information in respect of this abnormal load will be passed from the Wiltshire Police control room at Devizes to help motorists plan their journey.
The police escort is being provided by volunteer officers on rest days, paid for by the haulier at no cost to the public.


text:
Allergy Fatigue Syndrome
What is the deal with decreased alertness and a general sense of fatigue during allergy season? What is it about allergy symptoms that are frequently associated with just plain feeling tired? Do I need to reach for an extra cup of joe to keep going throughout the day?
Okay, here is the sleep and allergy connection. It is something that I have termed "allergy fatigue syndrome." First, we know that about one third of allergy sufferers have some sleep difficulties as a result of "nasal blockage and congestion."
Allergies are not commonly recognized as a cause of sleep problems. However, those with allergies, especially when their symptoms are not well controlled, are more likely to have sleep problems. There is also a known link between allergies and the condition sleep apnea.
Many allergy sufferers reach for over the counter medications for their seasonal allergy symptoms, and some of these can cause drowsiness. Alternatively, those who use oral decongestants may experience a negative impact on staying asleep due to "insomnia-like" effects.
We also know that snoring can worsen the effects of poor quality sleep and compound the problem. This can be due to pronounced nasal and sinus obstruction – from allergy symptoms as well as structural problems like deviated septum.
Inadequate sleep contributes significantly to a reduction in the quality of life. Did you know that snoring, as well as sleep disordered breathing, can lead to decreased learning in the classroom and even lower IQ?
What's the solution? Get the right treatment to control your seasonal and indoor allergies, so you can breathe better at night and have better quality rest. Break the cycle, get treated successfully, and sleep better – eventually you won't even need that extra latte!
Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine. He is the chair for public education committee of the American Academy of Allergy, Asthma and Immunology and a fellow of the American College of Allergy, Asthma and Immunology. No information in this blog is intended as medical advice to any reader or intended to diagnose or treat any medical condition. For more allergy and asthma tips you can visit his website: www.nyc-allergist.com.


text:
ADVERSE weather has once again severely hit the county and disrupted the Pembrokeshire Football League programme on Saturday.
The whole of the Pembrokeshire junior league was postponed and there were only three matches completed in the senior league.
Two of the games were played at the same ground, where Camrose first and second teams hosted Hubberston and Narberth thirds respectively at the Martin Mathias Memorial Ground.
The only other game to take place was at Hillcroft where a mid-table division two clash was played between Johnston seconds and Milford Athletic.
The Tigers' second string narrowly won 3-2, with Joe John, Ben Phillips and Ryan Doyle netting for the victors as Shane Walsh and an own goal was credited with the goals for the losing visitors.
With another bad weather forecast for this week, this Saturday's league programme is possibly in danger of seeing another washout.


text:
Last.fm: http://lastfm.com.br/user/leandromoraes88
Facebook: https://www.facebook.com/leandromoraes88
Twitter: https://twitter.com/#!/leandromoraes88
YouTube Channel: http://www.youtube.com/leandromoraes88
Offspring shows that I went to:
2004, October 24 - Recife, Brazil
2013, September 14 - Rock In Rio, Brazil
2013, September 15 - Credicard Hall - Sao Paulo, Brazil
2014, February 05 - Chevrolet Hall - Belo Horizonte, Brazil
2016, September 01 - Espaço das Américas - São Paulo, Brazil
Come to Brazil ... you are the best !!!!!
Fico impressionado com meu "ingrês" !!!
I never been in a Offspring show...in the first and second time they came I was to young.And in the Third i was working too hard with my Dad in our new restaurant... and I didnt have much time to go... BUT KNOW if they come I'll let all behind and goo rock with them!
Thumbs UP FOR THE OFFSPRING GUYS!!
Facebook | XBOX 360 | Twitter
Sep 01, 2016. São Paulo, Brazil - Espaço das Américas.
Aug 27, 2014. Las Vegas, United States - The Joint.
Feb 05, 2014. Belo Horizonte, Brazil - Chevrolet Hall.
Sep 15, 2013. Sao Paulo, Brazil - Credicard Hall.
Nov 08, 2008. Sao Paulo, Brazil - Vila dos Galpões.
Nov 06, 2008. Rio de Janeiro, Brazil - HSBC Arena.
Oct 21, 2004. Sao Paulo, Brazil - Credicard Hall.
Oct 20, 2004. Sao Paulo, Brazil. - Credicard Hall.
New Bootleg: Offspring Live - GUTÃO RESTAURANT
huauhahuahu morri.
Hi guys! Offspring also do great tours, amazing shows here in Brazil and we cant wait to see you again crossing the country just like last time! I saw the band here in Rio de Janeiro and also went to Curitiba to enjoy another show there! Both were amazing!
Come on Offspring. Brazil is waiting for another south american tour so big and amazing just like last one!!! Come on soon! WE ARE HERE...WE ARE WAITING!!!!!
Offspring Rocks!!!
We're extremely horny for The Offspring in Brazil. Please come back soon!
"Noodles, the man who put the O in Obrigado." - Dexter Holland
"You're a sexy fucking audience!" - Noodles
"It is the power of music, to carry one directly into the mental state of the composer. The listener has no choice, it is like hypnotism." -Beethoven
Vou usar o google tradutor. Ele traduz direitinho
Haaa, brinquei


text: 'Library Pete' spreads love of reading By Bill Lynch November 14, 2012 Story Share Courtesy photo In his job at the Nashville Public Library, Pete Carden goes by the moniker "Library Pete." The Hurricane native has a CD of children's songs that he's raising money to produce. CHARLESTON, W.Va. -- Pete Carden, the Nashville Public Library's "Library Pete," wants to help get kids excited about reading. The Hurricane native recently launched a Kickstarter site to fund the production of a children's music CD meant to inspire.Kickstarter is a funding platform for creative projects, where artists and innovators seek out financial resources through the direct support of the public. Carden hopes to raise $8,000 by Nov. 25. He has about $1,550 right now.Hurricane is a long way from Nashville, but it's where Carden got his start, learned to read and discovered a love of theater and music.He said, "I got into drama class in high school and ended up going to Ringling Bros. and Barnum & Bailey Clown College."We had an artist in residence at the high school who was from the circus, and he sort of urged me in that direction. He thought I might be a good candidate for that."Carden didn't run off to join the circus, though. Instead, he came back to West Virginia and worked at the short-lived Mountaineer Dinner Theater in Charleston, which opened in 1989 and closed about nine months later."I did props and stage management," he said. "I even started getting up on the stage a little bit toward the end."When the end came, Carden went to a conference in Florida where he auditioned for jobs where he could use his theater and clowning background."I ended up with a whole bunch of different jobs," he said, but they took him from West Virginia.Carden said he bounced from place to place for a couple of years before deciding that he really needed a place that was sort of central to the path his different entertainment jobs took him. "Nashville seemed like it was in the middle of the path, and there were theater opportunities," he said. "But once I moved here, I got a lot of work and just never left."For the past 12 years, Carden has been a puppeteer and performer at the downtown branch of the Nashville library."It's a real job," Carden said and laughed. "Forty hours a week."You think puppet show, and you imagine some little something off in a corner somewhere, but we have a real theater, with sets and a carpentry show where we build things. It's really kind of a big deal."On the weekends, Carden helps put on marionette shows in the children's theater. "We do everything from 'Mother Goose' to 'Hamlet,'" he said. During the week, Carden is part of a trio that read books, plays music, juggles and entertains mostly younger children during the library's story time, which is how Carden got the name Library Pete.He said, "I guess I'd been there for four or five months, and there was this one time when I was absent. I don't know why, but one of the little girls who usually came to the show kept asking, 'Where's Library Pete?' Well, that got around and sort of stuck."Carden liked it, too. "So I just ran with it."He built a character around the name. He took his own friendly, fun-loving persona and built on it. He put together a costume and eventually began writing songs encouraging kids to go to the library and read."I played music when I lived in West Virginia, but it was really just for fun," he said. "I was never in a band or anything. It was just a couple of us goofing off in the basement." A little more than a year ago, he found David Adkins, an old friend from home, through Facebook."We were in the Cub Scouts together," Carden said, "and now he was living in Murfreesboro, which is like 45 minutes from Nashville."Carden invited Adkins to Nashville for lunch and to bring his kids to see the puppet show. At lunch, Carden told his old friend he really wanted to record those library songs and maybe try to distribute them, but he had no idea where to start, and it sounded expensive.Carden's old friend turned out to be an audio engineer."He told me, 'Why don't you come down, and we'll put down some tracks.'"After a year of going back and forth and getting friends to help out, he finished recording. But to professionally master the recording, pay for artwork and duplicate the CD, he needed money.Another friend told Carden about Kickstarter."I've done everything else I know how to do," he said. "I've posted things on Facebook, put flyers in coffee shops, and I'm still trying things, but maybe this will help."If Carden reaches his goal, his plans are modest. He's not looking to get rich from the CD, just encourage a few more kids to read and check out what their local library offers."I'd love to do a CD release here in Nashville," he said, "and maybe a concert."Reach Bill Lynch at firstname.lastname@example.com or 304-348-5195. Story Share Story Share Trending Now 1 Innerviews: Dual-identity surgeon riding high in horse racing world 2 Huggins, WVU tap South Florida hoops talent 3 WVU seeking improvements during off week 4 Former State Police captain now chief in Winfield 5 Rod Run and Doo Wop brings classic cars, music to Boulevard for 12th year Frost on the leaves (photo) Previous Story Sushi, hibachi restaurant to open soon on East End Next Story


text:
Brule Donates $250,000 Gift to SBE
March 17, 2006—
Dave Brule '72 has donated $250,000 to support the new master's program in business administration. Additional donors have given or pledged $453,000.
"This is an extremely generous gift, which reflects Mr. Brule's awareness of the critical need for business education in a technological university and his strong commitment to the graduate program," said Christa Walck, dean of the School of Business and Economics.
Over the coming months, the School will be developing a plan to invest the gift in students, faculty and programs.
"I am particularly interested in providing more opportunities for graduate students to engage in hands-on activities and research projects, to participate in competitions, and to travel to site visits and conferences," Walck said. "Funding for graduate course development is also needed. Plus, keeping up with information technology is very important and comes at a significant cost: As our numbers grow, more students will need access to the latest and best technologies."
"Mr. Brule, through his challenge grant, has challenged not only our supporters to match his generous gift, but also the SBE to develop a graduate program that will draw the best and brightest to MTU for a program of rigorous study that truly bridges business and technology," she said.
Brule earned a BS in Electrical Engineering from Michigan Tech in 1972 and is now president and CEO of Northern Star Industries, Inc., in Iron Mountain. He has been a member of the university's Board of Trustees since 2001 and is a lifetime member of the MTU Alumni Association. In 1996, he was elected to the university's Electrical and Computer Engineering Academy.
Michigan Technological University (www.mtu.edu) is a leading public research university developing new technologies and preparing students to create the future for a prosperous and sustainable world. Michigan Tech offers more than 120 undergraduate and graduate degree programs in engineering; forest resources; computing; technology; business; economics; natural, physical and environmental sciences; arts; humanities; and social sciences.


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L'Oréal Paris Colour Riche Lipcolour Reviews
LipstickI like to think of Loreal as the higher end of drug store products. I thought this lipstick was very rich and creamy, and had a very nice vibrant color to it. I performs well and stays put on your lips. I like it. — 4 years, 7 months agoLittleBunny | 545 reviews
This review is: Helpful | Not helpful | Inappropriate | 1 of 2 people said helpful
My favorite!My most favorite lipstick in the WORLD is this one in the limited edition "Color of Hope." The formula is perfect and the color looks great on literally anyone. Keep an eye out for it in drugstores in October. — 9 years, 7 months agotallredamanda | 433 reviews
This review is: Helpful | Not helpful | Inappropriate | 7 of 8 people said helpful
One of my staplesThis is one of my go to lipsticks. The shades are well pigmented and stay put. The lipstick does not feather, nor does it have an overwhelming scent. I have found the product has a great shelf life. — 6 years, 2 months agoTheLacqueredLady | 751 reviews
This review is: Helpful | Not helpful | Inappropriate | 3 of 4 people said helpful
Incredibly perfumeyI love this lipstick in Fairest Nude but I would not by again. I couldn't get past the smell! It is awful; very artificial and strong smelling. There is also a taste to it that is not pleasant. If you can get past those two things, it is a good quality lipstick. — 5 years, 2 months agopixie_dust | 492 reviews
This review is: Helpful | Not helpful | Inappropriate | 1 of 1 people said helpful
Review subjectMy favorite lipstick is in the L'Oreal Color Riche line. I wear 102 'Pucker Up Pink', and I'd say it's the only lipstick shade I have ever found that compliments my skin whether I am winter pale, or tanned and wearing bronzer. If you have lighter skin with an olive undertone (I wear W3 in True Match if that helps any), and you are looking for a shade in the pink family that is not too ma...read moreuve, brown, or fuchsia, I would definitely recommend it. I once accidently purchased 103 'Seductive Pink' and found it too violent of a pink. If you peel back the barcode label it reads, "This product may cause a light, temporary tingling sensation", which I do experience when I apply it to clean lips. It feels very similar to the tingle you get from a plumping gloss, and I do feel like this lipstick plumps a little bit, just not a dramatically. It also feels nice on my lips, very moisturizing. Others have mentioned the scent, and my shade certainly has one: It actually smells like it has some rose fragrance added. I can smell it when I first open the cap to apply it, but I can't smell it after it's on, (not like the BonneBell glosses that you can always smell after application. For the price point I think this is a great product, but there are a few cons: First it doesn't stay on too long, after two hours of sitting in class, it's gone. Also, it ends up on my teeth much more easily than other lipsticks I've had, perhaps because it is so moisturizing it moves back on my lips easily. I always remove it from behind my lips after application to avoid lipstick teeth. I would absolutely LOVE to find a stain true to this color- It would be the product I could not start my day without, but until then I'll just have to make do. I recommend this product to someone looking for a lipstick, with the understanding that they will have to re-apply. — 5 years, 6 months agoElphieGranger | 80 reviews
This review is: Helpful | Not helpful | Inappropriate | 4 of 5 people said helpful
Strong scentAs soon as I opened the case, I was put off by this strong perfumy, nauseating, sweet scent. When I put this on, the thick cushiony layer felt uncomfortable and too heavy on my lips. It wasn't as highly pigmented, but didn't want to layer more since it's uncomfortably greasy feeling. I will never buy another tube of this. — 8 years, 4 months agoMakeupGuru | 444 reviews
This review is: Helpful | Not helpful | Inappropriate | 5 of 7 people said helpful
excellent all - aroundThis lipstick has been my new found favorite. I bought the shade in nude, and since it has become my favorite drug store brand. I love the colors and the variety. I think that it does tend to have a thick texture, but I tend to like that since thicker lipsticks last longer to me. It's nice and compact, the square shape is cute, and I nearly own almost every color. Nude is my favorite though! They are so creamy and affordable too! — 6 years, 8 months agoeatinglipstick | 145 reviews
This review is: Helpful | Not helpful | Inappropriate | 3 of 3 people said helpful
I chose YOU!After reading Allure's top beauty picks, I purchased this in Fairest Nude. In the past I haven't had much luck if any with lipsticks. They either dry my lips out or just don't look or feel right on me. I have used L'Oreal in the past and wasn't swayed either way, but this formulation is awesome! I've finally found the perfect shade of "Nude" for a nude lip AND it doesn't dry my lips out, or ma...read moreke my face look washed out. When it wears off, it's gradual and doesn't leave a color residue. Now I'm sitting back patiently waiting for Ulta to have buy 1 get 1 50% off and I'm stocking up! — 6 years, 8 months agoSwoldierGirl72 | 342 reviews
This review is: Helpful | Not helpful | Inappropriate | 3 of 5 people said helpful
ChicThis is good quality lipstick that is rich in pigment so you get every bit of color you see in the chic fancy like tube for a good price. The only fault of this lipstick is that it will dry over time so keeping it stored in an enclosed space with the cap tightly on is highly recommended. These lipsticks are better for the dramatic looks because they are thicker in formula and create more matte looks. — 9 years, 7 months agoVLA | 336 reviews
This review is: Helpful | Not helpful | Inappropriate | 5 of 5 people said helpful
Super Rich In Color, Texture...I only own two Colour Riche lipsticks ~ one in Nature's Blush and another one in Sunwash. This lipstick goes on smoothly and is very rich with a huge color payoff. The scent, while annoying to some, is lovely to me ~ almost flowery. It's fairly long lasting ~ I applied at the beginning of my commute and it still looked fresh when I reached Grand Central, two hours, three phone calls and a medium...read more coffee later! Very creamy in texture and comfortable to wear, I may just have to start using this more... it's definitely a lot less than my usual Clinique lipstick. — 6 years, 7 months agonycmuse | 136 reviews
This review is: Helpful | Not helpful | Inappropriate | 1 of 1 people said helpful
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text: Was it a white truck? He cut the mini van off and all I could do is shake my head at the guy. Washington St was not in good condition and I was not going to go over 20 either. Sure I was late to work, but at least I was in one piece.This quote is hidden because you are ignoring this member. Show Quote