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In our study, IL1RN was the only candidate locus associated with systemic JIA. The implicated SNPs are among the strongest known determinants of IL1RN and interleukin-1 receptor antagonist levels, linking low expression with increased systemic JIA risk. Homozygous high expression alleles predicted nonresponsiveness to anakinra therapy, making them ideal candidate biomarkers to guide systemic JIA treatment. This study is an important first step toward the personalized treatment of systemic JIA.

We studied the school attendance of 113 children and adolescents (mean age 11 yr, S.D. 3.8, range 3-18 yr) with juvenile chronic arthritis (73 with pauci- and 40 with polyarthritis). The mean attendance rate for the group was 92% (equivalent to 15 absent days a year) with a median of 97%. Attendance was significantly lower in the more severely affected poly group (90% vs 98% in the pauci group; P = 0.03). We found associations of school absence (i) with decreased compliance with physical treatments (r = -0.35, P < 0.05 for compliance with physiotherapy) in the poly group and (ii) with child psychological deviance (r = 0.36 for parentally rated and r = 0.42 for teacher-rated psychological deviance; both P < 0.05) in the pauci group. We conclude that school attendance can be good in severely affected children. Severity of illness, treatment compliance and psychological problems in the child may affect school attendance.

Twelve children are described with an essentially benign vasculitic illness in association with streptococcal infection. They demonstrated characteristic clinical features of nodular cutaneous polyarteritis with fever. Laboratory findings showed an acute phase response associated with raised antistreptolysin and antihyaluronidase titres in all patients and a positive throat culture for 1B haemolytic streptococcus in three patients. Ten required corticosteroids. Two patients had systemic involvement with abnormal arteriography; both had appreciably raised white cell counts (>40X 109/1). They may represent a subset of poststreptococcal vasculitis, requiring cytotoxic treatment for effective disease control.

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