We aimed to describe the serum levels of 25-hydroxyvitamin D (25OHD) in juvenile idiopathic arthritis (JIA) patients living in a low-latitude (3°43'S) region. Fifty JIA patients, 31 (62 %) female, seen between May 2012 and April 2013 in the northeast of Brazil had clinical data and serum collected for determination of 25OHD and parathyroid hormone (PTH) using a chemiluminescent ELISA; 20 age- and sex-matched controls were used for comparison. Mean age was 13.4 ± 4 years. Twenty-five (50 %), 15 (30 %), 4 (8 %), 4 (8 %), and 2 (4 %) patients were of the polyarticular, oligoarticular, systemic, enthesitis-related, and undifferentiated categories, respectively. Mean 25OHD was 31.6 ± 10 and 30.4 ± 5.7 ng/mL in patients and controls (P > 0.05), respectively; PTH was normal in JIA and controls; 25OHD was similar regardless of JIA category, disease activity, or severity measured by JADAS-27, CHAQ, or presence of joint deformities. Twenty-six (52 %), 20 (40 %), and 4 (8 %) patients were considered to have optimal, sufficient, and deficient 25OHD levels, respectively, whereas 11 (52 %) and 10 (48 %) controls had optimal and sufficient 25OHD. Ethnicity, body mass index, seasonal variation, and use of steroids did not influence 25OHD levels. This is the first study on 25OHD levels in JIA patients living in a low-latitude region, showing the lowest prevalence of vitamin D deficiency ever reported. Serum 25OHD was similar in JIA and controls and did not vary regardless of JIA category or severity.

Determine disease activity in a low income juvenile idiopathic arthritis (JIA) cohort. 164 JIA patients from families with less than US$ 4500.00/capita mean annual income followed in Fortaleza-CE, Brazil, were cross-sectionally evaluated between May 2015-April 2016. Mean age was 14 ± 5.1 years (95 female) with 10.31 ± 3.7 years disease duration. Polyarticular category predominated, with 63 (38.4%) patients, followed by 40 (24%) enthesitis-related (ERA), and 36 (22%) oligoarticular. All but 1 out of 84 parents declared less than US$ 10,000.00 annual family income. Eighty-eight (60.7%) were receiving methotrexate and 19 (13%) leflunomide including 12 (63%) using both; 46 (28%) were on biologic DMARD including 20 (43.5%) adalimumab, 17 (41.5) etanercept, 5 (10.8%) tocilizumab, 2 (4.2%) abatacept, and 1 (2.1%) each on infliximab and canakinumab. Mean CHAQ and JADAS27 were 0.36 ± 0.55 and 5.31 ± 8.5, respectively. Thirty-two (20%) out of 159 patients had deformities. A bivariate analysis revealed that polyarticular had more deformities than oligoarticular patients (p = 0.002; OR = 2.389; 95% CI 1.37-4.14). Logistic regression showed no association between high JADAS and family income (p = 0.339; OR = 1.45; 95% CI 0.67-3.31). A general linear model showed significantly lower CHAQ score in patients from families earning more as compared to those earning less than 300.00 US$ monthly (p = 0.002). This study reports JIA disease activity in a low income population. Low income apparently did not influence prognosis given the low mean JADAS27 and CHAQ scores vis-à-vis data from other cohorts.

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RESUMOEssa revisão integrativa tem como objetivo sintetizar o conhecimento atual referente à influência da composição corporal na saúde óssea de crianças e adolescentes, períodos importantes na aquisição da massa óssea. A busca na literatura ocorreu nas bases de dados Sciencedirect e Biblioteca Virtual em Saúde (BVS), sem recorte temporal, incluindo artigos publicados até outubro de 2019. Os termos "bone density" AND "body composition" AND child AND adolescent foram utilizados como descritores. Os critérios de inclusão usados na seleção dos estudos consistiram na presença de artigos disponíveis eletronicamente na íntegra, nos idiomas português, inglês e espanhol. Foram considerados critérios de exclusão, artigos não relacionados ao tema do estudo ou incompletos, revisões de literatura e relatos de casos. Os estudos que integram essa revisão foram realizados em vários continentes, envolveram várias etnias e demonstraram um maior risco de fraturas em crianças e adolescentes com alterações na massa corporal, seja por obesidade ou emagrecimento, ocorrendo mesmo com modestas reduções na densidade óssea. A massa magra foi um preditor da densidade mineral óssea em ambos os sexos e independentemente de etnia, enquanto a massa gorda teve resultados conflitantes. Recentemente, verificou-se que a massa gorda influencia positivamente a massa óssea até atingir um limiar, quando a partir de então ocorre um impacto negativo nos ossos. Esse trabalho demonstra a importância da composição corporal na massa óssea, o que prediz a necessidade de manter um índice de massa corporal dentro da faixa normal em crianças e adolescentes para prevenir a osteoporose.