Background Immunosuppressive drugs, incomplete vaccine coverage, immune system dysregulation might be factors of a low level of anti-vaccine antibodies in JIA patients. The study aimed to evaluate vaccine coverage, post-vaccine immunity, and risk factors of non-protective levels of antibodies against measles, mumps, rubella, hepatitis B, and diphtheria in JIA patients. Methods A cross-sectional study included 170 children diagnosed with JIA aged 2 to 17 years who received routine vaccinations against measles, rubella, mumps (MMR), diphtheria, and hepatitis B national vaccine schedule. In all patients, the levels of post-vaccination antibodies (IgG) for measles, rubella, mumps, hepatitis B, and diphtheria were measured with ELISA. Results Protective level of antibodies were 50% against hepatitis B, 52% - diphtheria, 58% - measles, 80% - mumps, 98% rubella. MMR’s best coverage had patients with enthesitis-related arthritis-85%, compared to oligoarthritis-70%, polyarthritis-69%, systemic arthritis-63%. Diphtheria coverage was 50, 51, 46, 63%, respectively. Incomplete MMR vaccination had 39% patients, treated with biologics, 22% with methotrexate and 14% with NSAID (p = 0.025), and 61, 46, 36% for diphtheria (p = 0.021). Incomplete vaccination was a risk factor of non-protective level of antibodies against measles (HR = 2.03 [95%CI: 1.02; 4.0], p = 0.042), mumps (HR = 6.25 [95%CI: 2.13; 17.9], p = 0.0008) and diphtheria (HR = 2.39 [95%CI: 1.18; 4.85], p = 0.016) vaccines, as well as JIA category, biologics, corticosteroids and long-term methotrexate treatment for distinct vaccines. One-third part of JIA patients continued vaccination against MMR and diphtheria without serious adverse events and JIA flare. There were no differences between patients who continued MMR vaccination or denied in the means of JIA category and treatment options. Patients, continued diphtheria vaccination rare received methotrexate (p = 0.02), biologics (p = 0.004), but had higher levels of anti-diphtheria antibodies (p = 0.024) compare who omitted vaccination. Methotrexate (OR = 9.5 [95%CI: 1.004; 90.3]) and biologics (OR = 4.4 [95%CI: 1.6; 12.1]) were predictors of omitted diphtheria revaccination. Conclusion Children with JIA may have lower anti-vaccine antibody levels and required routine checks, especially in children with incomplete vaccination, biologics, systemic arthritis, and long-term methotrexate treatment. Revaccination of JIA patients was safe and effective.

Objectives: To describe the clinical characteristics of hip involvement in juvenile idiopathic arthritis (JIA) from arthritis to hip osteoarthritis (HOA) and total hip arthroplasty (THA).Study Design: Seven hundred fifty-three patients aged 2–17 years with JIA were included in the study. The comparison analysis was performed between the following subgroups: (i) JIA without hip involvement (n = 600; 79.7%) vs. JIA with hip involvement without HOA (n = 105; 13.9%), (ii) JIA with hip involvement with HOA, but without THA (n = 32; 4.3%) and JIA with hip involvement with HOA and with THA (n = 16; 2.1%). Clinical, laboratory characteristics and treatment regimens compared.Results: Hip involvement was present in 20.3% of patients. HOA was present in 6.4% (12*1,000 patient-years) of the entire JIA group and 31.4% of patients with hip involvement. Sixteen patients (2.1%; 4.0*1,000 patient-years) required THA. The following factors were associated with HOA: sJIA (OR = 3.6, p = 0.008; HR = 3.0, p = 0.002), delayed remission (OR = 4.2, p = 0.004; HR = 1.4, p = 0.538), delay in biologic therapy initiation (OR = 7.5, p = 0.00001; HR = 6.7, p = 0.002), alkaline phosphatase <165 U\l (OR = 4.1, p = 0.0003; HR = 5.2, p = 0.000004), treatment with corticosteroids (CS) (OR = 2.6, p = 0.008; HR = 1.2, p = 0.670), cumulative corticosteroids >2,700 mg (OR = 4.3, p = 0.032; HR = 1.4, p = 0.527). The following factors were associated with THA: delay in biologic treatment initiation (OR = 1.04, p = 0.0001; HR = 9.1, p = 0.034), delayed hip involvement (OR = 5.2, p = 0.002; HR = 3.0, p = 0.044), and methylprednisolone pulse therapy (OR = 10.8, p = 0.0000001; HR = 5.6, p = 0.002).Conclusion: Both sJIA and systemic CS, impaired calcium-phosphorus metabolism, and delayed hip arthritis are associated with HOA development in JIA. HOA is considered to be a severe adverse event of CS treatment, especially delayed hip involvement.

BackgroundPatients with juvenile idiopathic arthritis (JIA) may have lower protective levels of anti-vaccine antibodies (AVA) due to high inflammatory activity, interrupted or incomplete vaccination schedule, using of immune-modulating drugs, e.g. systemic corticosteroids (CS), methotrexate (MTX) and biologics [1].ObjectivesThe aim of our study was to evaluate levels of AVA in the patients with JIA.MethodsWe included data about 90 JIA (26 M and 64 F) aged from 2 to 17 years, who received scheduled vaccination before the age of 2 years and before JIA onset. In all patients the Ig G anti-measles (AM), anti-parotitis (AP), anti-hepatitis B (AHB), anti-diphtheria (AD) and anti-rubella (AR) AVA levels were detected with ELISA. In each patient we evaluate the type of the JIA (oligoarthritis – OA (n=38), polyarthritis – PA (n=36), systemic-SA (n=7) and enthesitis-related arthritis – ERA (n=10), routine disease activity and treatment. In healthy controls were measured anti-measles (n=40) and anti-parotitis (n=30) antibodies (AB) for comparison with JIA.ResultsThe main demographic characteristics: age of inclusion in the study 11 (8-15) years, disease onset–6 (4-8) years, JIA duration–4 (2-7) years. The AM AB in JIA patients were 0.2 (0.0-0.5) IU/ml and in HC 0.3 (0.2-1.1) IU/ml (p=0.00002), despite the higher age of JIA patients than HC (p=0.0000001); AP AB were 2.6 (1.0-5.1) IU/ml vs 1.1 (0.0-4.9) IU/ml in JIA and HC, respectively (p=0.08). Protective levels of AM AB was detected in 50% of all JIA population, vs. HC – 87.5% (p=0.00005), AP–67.7% vs. 60% in HC (p=0.076), AHB – 54.4%, AD–50%, AR–97.8%. The main data related to vaccination status in the table. We have found correlation between JIA duration and levels AM AB (r=-0.27, p=0.015), AP AB (r=-0.22, p=0.039), AD AB (r=-0.27, p=0.015); MTX treatment with AM AB (r=-0.37, p=0.001), and AD AB (r=-0.29, p=0.007); treatment with biologics and AM AB (r=-0.25, p=0.018), and using more than one biologics with AR AB (r=-0.27, p=0.047). In the regression model only MTX had a negative impact on AM (r=-0.001) and AD AB level (p=0.01). ParameterOAPASAERAPOnset age, y5 (4-7)6 (4-8)8 (4-11)9 (7-12)0.01JIA duration, y3 (2-5)5.4 (2-9)4 (1-6)6 (5-10)0.006# AM vaccinations2 (1-2)2 (1-2)1 (1-2)2 (2-2)0.005# of patients with AM revaccination,%5160431000.06AM IgG, IU/ml0.2 (0-0.6)0 (0-0.4)0.2 (0; 1.6)0.2 (0.1-0.3)0.2Protective AM IgG level,%583957500.42# of patients with AP revaccination,%5061431000.05# AP vaccinations1.5 (1-2)2 (1-2)1 (1-2)2 (2-2)0.004AP IgG, IU/ml3 (1.5-5)2.3 (0-5)1.3 (0; 5)2.6 (1.1-3.3)0.67Protective AP IgG level,%827271750.8# AD vaccinations4 (4-5)5 (4-5)4 (4-5)5 (4-6)0.09AD IgG, IU/ml0.1 (0.03-0.3)0.1 (0.03-0.2)0.04 (0.0; 0.2)0.16 (0.05-0.4)0.64Protective AD IgG level,%535029500.71# AHB vaccinations3 (3-3)3 (3-3)3 (3-3)3 (3-3)0.87AHB IgG, IU/ml5 (0-20)17 (2-45)1 (0; 10)19 (4-228)0.09Protective AHB IgG level,%456729)630.13# AR vaccinations1 (1-2)1 (1-2)1 (1-1)2 (2-2)0.57AR IgG, IU/ml72 (35-145)54 (27-96)200 (18; 200)67 (42-2000)0.52Protective AR IgG level,%1009710010...

Background: Immunosuppressive drugs, decreased vaccine coverage, aberrant immunity might be factors of low anti-vaccine antibodies in JIA patients. The study aimed to evaluate vaccine coverage, post-vaccine immunity and risk factors of non-protective levels of antibodies against measles, mumps, rubella, hepatitis B and diphtheria in JIA patients. Methods: A prospective study included 170 children diagnosed with JIA aged 2 to 17 years, who received routine vaccinations against measles, rubella, mumps (MMR) diphtheria and hepatitis B. In all patients, the levels of post-vaccination antibodies (IgG) for measles, rubella, mumps, hepatitis B and diphtheria measured with ELISA.Results: Protective level of antibodies were 50% against hepatitis B, 52% - diphtheria, 58% - measles, 80% - mumps, 98% rubella. The best coverage for MMR had patients with enthesytis-related arthritis-85%, compare to oligoarthritis-70%, polyarthritis-69%, systemic arthritis-63%. Diphtheria coverage was 50%, 51%, 46%, 63%, respectively. Incomplete MMR vaccination had 39% patients, treated with biologics, 22% with methotrexate and 14% with NSAID (p=0.025), and 61%, 46%, 36% for diphtheria (p=0.021). Incomplete vaccination was a risk factor of non-protective level of antibodies against measles (HR=2.03 [95%CI: 1.02; 4.0], p=0.042), parotitis (HR=6.25 [95%CI: 2.13; 17.9], p=0.0008) and diphtheria (HR=2.39 [95%CI: 1.18; 4.85], p=0.016) vaccines, as well as JIA category, biologics, corticosteroids and long-term methotrexate treatment for distinct vaccines.Conclusion: Children with JIA may have lower anti-vaccine antibodies levels and required routine check, especially in children with incomplete vaccination, biologics, systemic arthritis and long-term methotrexate treatment.