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Background. Despite the sufficient amount of data characterizings quality of life in adult patients with arterial hypertension and high-normal blood pressure, there is little information concerning the pediatric population. Objectives. The aim of the presented study was to investigate the association between health-related quality of life (HRQoL) parameters and the amount of increasing arterial blood pressure in children with primary arterial hypertension (PH) and high-normal blood pressure. Material and methods. We performed a case-control study with an assessment of the impact of BP elevation on HRQoL scores obtained in children 9-17 years old. BP was measured by ambulatory blood pressure monitoring (ABPM). HRQoL was assessed with the PedsQL survey. Results. The study included 179 participants. Analysis of the impact of high-normal BP or PH on HRQoL parameters found non-linear associations between BP and HRQoL. We found decreased quality of life indicators in children with high-normal BP and first stage PH. The HRQoL parameters of children with stable PH did not differ from those of the control group, with the exception of children with daytime systolic BP higher than 160 mm Hg, according to the ABPM data. Conclusions. BP elevation affects quality of life in children with high-normal BP and PH. This relationship is non-linear and consists of the fact that at the beginning of PH formation (systolic BP less than 130 mm Hg), HRQoL parameters are reduced. As BP becomes constantly elevated (systolic BP of 130-160 mm Hg), the HRQoL parameters improve. In children with severe grades of BP elevation, quality of life is low due to adaptation failure.

Relevance. It is known that the poly-articular variant of JIA is associated with significant articular and extra-articular damages with predominant lesions of small and medium joints with limitation of their function and the development of ankylosis, requiring surgical intervention in these patients. Objective. The aim of the study was to evaluate the risk factors of articular and extra-articular damages in adults with the poly-articular variant of the JIA and to work out a prognostic model for their development. Materials and methods. The study included 45 adult patients with poly-articular (RF+ and RF-) variant of the JIA. Retrospective analysis of medical records of patients with poly-articular variant of JIA was made, taking into account clinical manifestations in the onset of the disease, laboratory parameters and response to therapy. In adulthood, the integral index of articular (JADI-A) and extra-articular (JADI-E) damages was used to assess the long-term effects of JIA. Results. Unfavorable prognostic factors were revealed by method of binary logistic regression. Mathematical model for predicting the probability of long-term negative articular and extra-articular damages of poly-articular JIA was developed. Conclusions 1. The risk factors for the development of articular and extra-articular damages in adulthood in patients with a poly-articular variant of the JIA are female sex, the presence of lymphadenopathy and/or splenomegaly in childhood, the level of ESR during treatment in childhood, the activity of JADAS in childhood, the presence of symmetric arthritis in childhood, the RF positivity in the debut of the disease, the treatment with glucocorticoids, the cumulative dose of the DMARDs, and lack of therapy by DMARDs. 2. A prognostic model for the development of articular and extra-articular damages in adult patients with a poly-articular variant of the JIA is developed. This model is effective and allows determine the adverse course of the disease and can be the basis for personalized treatment for the prevention of the development of significant articular and extra-articular damages of JIA.

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BackgroundEvaluation of inflammatory activity is an important element in the management of patients with juvenile idiopathic arthritis (JIA), for which C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are traditionally used. However, they might be uninformative in case of subclinical inflammation. The serum level of calprotectin MRP-8/MRP-14 (sCal) correlates well with arthritis activity, as it is produced by activated cells directly in synovia.ObjectivesWe evaluate the level of sCal in patients with JIA depending on the type of therapy in order to assess comprehensively the disease activity for further treatment correction.Methods74 patients with JIA were examined, 18 of them had oligoarticular disease subtype, 39 – polyarticular, 17 – systemic. The mean age was 11.3 ± 0.4 years; the disease duration was 5.2 ± 0.4 years. Among them, there were 49 (66%) females and 25 (34%) males. All patients were divided into 2 groups depending on the therapy type. Group I consisted of 33 children treated with methotrexate, while 11 of them were in a state of clinical remission. Group II included 41 children treated with biologic DMARDs (adalimumab, etanercept, tocilizumab), while 14 of them achieved clinical remission. All children had normal levels of CRP and ESR. Quantitative indicators distribution is given as a median [5th; 95th percentile], the calculations were carried out using the Mann-Whitney U test.ResultsLevel of sCal in the active disease stage in children of Group I was 8,750 ng/ml [3,700; 17,100], while sCal level in Group II was 2,900 ng/ml [1,200; 24,900]; sCal level in children of Group I which achieved clinical remission – 3,400 ng/ml [1,200; 6,000], and the same indicator in Group II – 1,000 ng/ml [100; 2,800]. sCal level was significantly higher in the group of patients who did not receive biologic DMARDs, both in the active stage of disease (p = 0.000006, U = 71.5) and in the stage of clinical remission (p = 0.00034, U = 11). sCal level is 5,800 ng/ml less in patients with active stage of disease and 2,400 ng/ml less in patients with clinical remission, both treated with biologic DMARDs. In addition, the level of sCal is 5.5 times higher in our patients (3,300 ng/ml) compared with healthy children (600 ng/ml) (p = 0.015). The moderate positive correlation of sCal and JADAS-27 activity index (r-Spearman’s = 0.58) was credibly established.ConclusionThe level of sCal can reflects the degree of inflammatory activity in JIA, it is significantly higher in the group of patients who did not receive biologic DMARDs in the treatment regimen, both in the active disease stage (p = 0.000006, U = 71.5) and in the stage of clinical remission (p = 0.00034, U = 11), which indicates the effectiveness of biologic DMARDs in the treatment of JIA. We assume that it would be appropriate to estimate the serum calprotectin level in the comprehensive analysis of clinical status in JIA patients for the further correction of therapy.Disclosure of InterestsNone declared