title: Patterns of pain over time among children with juvenile idiopathic arthritis Anti-tumor necrosis factor therapy improves insulin resistance, beta cell function and insulin signaling in active rheumatoid arthritis patients with high insulin resistance Presenting features of inflammatory bowel disease in Great Britain and Ireland Incidence and Prevalence of Juvenile Idiopathic Arthritis Among Children in a Managed Care Population, 1996–2009 Lean body mass, physical activity and quality of life in paediatric patients with inflammatory bowel disease and in healthy controls. The Relationship Between Physical Activity Levels and Pain in Children with Juvenile Idiopathic Arthritis
abstract: Objectives Pain is a very common symptom of juvenile idiopathic arthritis ( JIA ) . Disease activity alone can not explain symptoms of pain in all children , suggesting other factors may be relevant . The objectives of this study were to describe the different patterns of pain experienced over time in children with JIA and to identify predictors of which children are likely to experience ongoing pain . Methods This study used  longitudinal- data from patients ( aged 1–16 years ) with new-onset JIA .  Baseline and up to 5-year follow-up pain data from the Childhood Arthritis Prospect i ve Study ( CAPS ) were used . A two-step approach was adopted . First ,  pain trajectories  were modelled using a discrete mixture model . Second , multinomial logistic regression was used to determine the association between variables and trajectories . Results Data from 851 individuals were included ( 4 years , median follow-up ) . A three-group trajectory model was identified : consistently low pain ( n=453 ) , improved pain ( n=254 ) and consistently high pain ( n=144 ) . Children with improved pain or consistently high pain differed on average at baseline from consistently low pain . Older age at onset , poor function/disability and longer disease duration at baseline were associated with consistently high pain compared with consistently low pain . Early increases in pain and poor function/disability were also associated with consistently high pain compared with consistently low pain . Conclusions This study has identified routinely collected clinical factors , which may indicate those individuals with JIA at risk of poor pain outcomes earlier in disease . Identifying those at highest risk of poor pain outcomes at disease onset may enable targeted pain management strategies to be implemented early in disease thus reducing the risk of poor pain outcomes Introduction Prevalence of insulin resistance and the metabolic syndrome has been reported to be high in rheumatoid arthritis ( RA ) patients .  Tumor necrosis factor ( TNF ) , a pro-inflammatory cytokine with a major pathogenetic role in RA , may promote insulin resistance by inducing Ser312 phosphorylation ( p-Ser312 ) of insulin receptor substrate (IRS)-1 and downregulating phosphorylated (p-)AKT . We examined whether anti-TNF therapy improves insulin resistance in RA patients and assessed changes in the insulin signaling cascade . Methods Prospect i ve study of RA patients receiving anti-TNF agents ( infliximab , n = 49 , adalimumab , n = 11 , or etanercept , n = 1 ) due to high disease activity score in 28 joints ( DAS28 > 5.1 ) . A complete biochemical profile was obtained at weeks 0 and 12 of treatment . Insulin resistance , insulin sensitivity and pancreatic beta cell function were measured by the Homeostasis Model Assessment ( HOMA-IR ) , the Quantitative Insulin Sensitivity Check Index ( QUICKI ) and the HOMA-B respectively . Protein extracts from peripheral blood mononuclear cells were assayed by western blot for p-Ser312 IRS-1 and p-AKT . RA patients treated with abatacept ( CTLA4.Ig ) were used as a control group for insulin signaling studies . Results At study entry , RA patients with high insulin resistance ( HOMA-IR above median ) had significantly higher mean DAS28 ( P = 0.011 ) , serum triglycerides ( P = 0.015 ) , and systolic blood pressure levels ( P = 0.024 ) than patients with low insulin resistance . After 12 weeks of anti-TNF therapy , patients with high insulin resistance demonstrated significant reduction in HOMA-IR ( P < 0.001 ) , HOMA-B ( P = 0.001 ) , serum triglycerides ( P = 0.039 ) , and increase in QUICKI ( P < 0.001 ) and serum HDL-C ( P = 0.022 ) . Western blot analysis in seven active RA patients with high insulin resistance showed reduction in p-Ser312 IRS-1 ( P = 0.043 ) and increase in p-AKT ( P = 0.001 ) over the study period . In contrast , the effect of CTLA4.Ig on p-Ser312 IRS-1 and p-AKT levels was variable . Conclusions Anti-TNF therapy improved insulin sensitivity and reversed defects in the insulin signaling cascade in RA patients with active disease and high insulin resistance . The impact of these biochemical changes in modifying cardiovascular disease burden in active RA patients remains to be seen Background : Reports from individual referral centres suggest that a significant proportion of children with inflammatory bowel disease ( IBD ) present after prolonged delays and with impaired growth . Aims : To prospect ively document the presenting features , delay in presentation , disease localisation , and growth in newly diagnosed cases of IBD . Methods : For 13 months , between June 1998 and June 1999 , 3247 paediatricians , adult gastroenterologists , and surgeons across the UK and Irel and were prospect ively surveyed each month and asked to report every newly diagnosed case of childhood IBD . Results : A total of 739 new IBD cases aged less than 16 years were identified . Only one quarter of Crohn ’s disease ( CD ) cases presented with the “ classic triad ” of diarrhoea , weight loss , and abdominal pain ; nearly half did not report diarrhoea . The median delay from onset of symptoms to diagnosis was 5 months ( mean 11 months ) , with one fifth having symptoms of more than one year . Delays were most common in CD and in younger children .  Short stature was noted only in those with CD and not with ulcerative colitis . One fifth of CD cases had disease activity in the jejunum and this group had significantly reduced stature . Ileo-colonic involvement was documented in most CD cases , with only a small minority having isolated ileal or isolated colonic disease . Pan-colitis was reported in most UC cases , with very few having only an isolated proctitis . Conclusions : Many children are diagnosed after prolonged delays and have growth failure . Improved knowledge of the presenting features of IBD , and earlier investigation of suspected cases , may help reduce the delays noted Objective . Few studies based in well-defined North American population s have examined the occurrence of juvenile idiopathic arthritis ( JIA ) , and none has been based in an ethnically diverse population . We used computerized healthcare information from the Kaiser Permanente Northern California membership to vali date JIA diagnoses and estimate the incidence and prevalence of the disease in this well-characterized population . Methods . We identified children aged ≤ 15 years with ≥ 1 relevant International Classification of Diseases , 9th edition , diagnosis code of 696.0 , 714 , or 720 in computerized clinical encounter data during 1996–2009 . In a r and om sample , we then review ed the medical records to confirm the diagnosis and diagnosis date and to identify the best-performing case-finding algorithms . Finally , we used the case-finding algorithms to estimate the incidence rate and point prevalence of JIA . Results . A diagnosis of JIA was confirmed in 69 % of individuals with at least 1 relevant code . Forty-five percent were newly diagnosed during the study period . The age- and sex-st and ardized incidence rate of JIA per 100,000 person-years was 11.9 ( 95 % CI 10.9–12.9 ) . It was 16.4 ( 95 % CI 14.6–18.1 ) in girls and 7.7 ( 95 % CI 6.5–8.9 ) in boys . The peak incidence rate occurred in children aged 11–15 years . The prevalence of JIA per 100,000 persons was 44.7 ( 95 % CI 39.1–50.2 ) on December 31 , 2009 . Conclusion . The incidence rate of JIA observed in the Kaiser Permanente population , 1996–2009 , was similar to that reported in Rochester , Minnesota , USA , but 2 to 3 times higher than Canadian estimates BACKGROUND AND AIMS Physical activity is important for muscle and bone strength in the growing child and may be impaired in paediatric patients with inflammatory bowel disease ( IBD ) even during quiescent disease . The SenseWearPro(2 ) armb and allows to measure physical activity under everyday life conditions . METHODS Thirty-nine IBD patients ( 27 Crohn 's disease , 12 ulcerative colitis , 24 boys ) in remission ( n=26 ) or with only mild disease activity ( n=13 ) were compared to 39 healthy age and sex-matched controls .  Body weight , height , body mass index ( BMI ) , lean body mass as phase angle α ( determined by bioelectrical impedance analysis ) , and dynamometric grip force were expressed as age- and sex-related Z-scores . SenseWearPro(2 ) armb and s were applied for three consecutive days to record number of steps , duration of physical activity and sleeping time . Quality of life was assessed with the German KINDL and IMPACT III question naires , energy intake with prospect i ve food protocol s. Differences between patients and pair-matched controls were analysed by paired t-test . RESULTS Patients showed lower Z-scores for phase angle α ( difference -0.72 ; 95 % CI [ -1.10 ; -0.34 ] ) and lower grip strength ( -1.02 [ -1.58 ; -0.47 ] ) than controls . They tended towards lesser number of steps per day ( -1339 [ -2760 ; 83 ] ) and shorter duration of physical activity ( -0.44 h [ -0.94 ; 0.06 ] ) , particularly in females and patients with mild disease . Quality of life and energy intake did not differ between patients and controls . CONCLUSION In spite of quiescent disease lean body mass and physical activity were reduced . Interventions to encourage physical activity may be beneficial in this lifelong disease Objective . Pain and reduced physical activity levels are common in children with juvenile idiopathic arthritis ( JIA ) . Currently , there is no consensus about the role of physical activity in managing pain in JIA . The purpose of our study was to assess the relationship between physical activity level and pain in children ages 11 to 18 years with JIA . Methods . A r and om sample of 50 patients with JIA were approached by mailed question naires . Physical activity was determined using the Physical Activity Question naire ( PAQ ) .  Pain measures included the Numerical Rating Scale ( pain severity ) , SUPER-KIDZ body diagram ( number of painful areas ) , and the Child Activities Limitations Inventory-21 ( pain interference ) . Generalized linear models were used to assess the relationship between physical activity and pain , as well as the roles of sex and age . Results . The response rate was 84 % . Thirty-four respondents completed the question naire package . The median age was 15 years . The mean PAQ score was 2.16/5 . Physical activity declines with increasing age in youth with JIA ( r = 0.53 , p = 0.0014 ) . Lower physical activity is associated with greater pain interference ( r = 0.39 , p = 0.0217 ) and more severe pain ( r = 0.35 , p = 0.0422 ) . Conclusion . Children with JIA report significantly less activity than healthy children based on PAQ scores , with physical activity declining throughout adolescence . Physical activity is inversely related to pain interference and severity in children with JIA . Our findings suggest that physical activity interventions may play an important role in the management of pain in JIA
target: Results The literature review and meta- analysis identified decreased PA and increased time spent in SB in these population s , which may exacerbate both their lower physical fitness and the symptoms of their health disorders .
background: Background Physical activity ( PA ) is essential for children throughout their growth and maturation .
  It improves physiological and psychological health and limits the risk of developing metabolic disorders .
  However , some chronic physiological and metabolic diseases may lead to decreased PA .
  The diversity of outcomes in the literature offers no consensus for physical activity and sedentary levels in children with juvenile idiopathic arthritis ( JIA ) or inflammatory bowel disease ( IBD ) .
  The aim was to examine  PA and SB  in children with JIA or IBD compared to their healthy peers .