No abstract

Background: Fluoxetine, one kind of selective serotonin reuptake inhibitors (SSRI), has rarely been reported to be related to vasculitis in adults. Methods: Herein we present a boy who developed Henoch-Schönlein purpura (HSP) during treatment with fluoxetine. Results: This 8-year-old boy suffered from depression about 3 months after he entered a new school. He visited a psychiatric clinic and fluoxetine was prescribed. The response was good and he went back to school smoothly. Sixth weeks later, he developed purpuric rash over bilateral lower extremities which extended to buttock and hands in two days. Mild painful swelling over left ankle was also noted when he was admitted. The investigations were normal including complete blood cell & platelet count, blood biochemistry, liver function tests, prothrombin time, partial thromboplastin time, serum immunoglobulin A and fibrinogen level. Yet D-dimer level was elevated to 8927 μg/dl (normal＜500), consistent with vasculitis. The diagnosis of HSP was made and fluoxetine ceased. Treatment was given with Prednisolone and Ranitidine, after which the purpura resolved in one week. Conclusions: HSP related to fluoxetine medication has rarely been reported in the young adults. Our case may attribute to be the youngest one who receives fluoxetine therapy and give us an example of the potential adverse effect of fluoxetine to the children.

Background: Musculoskeletal ultrasound (MSUS) has been used worldwide in adult patients with rheumatoid arthritis (RA) but is beginning to play an increasing role in patients with juvenile idiopathic arthritis (JIA). The aim of this study was to investigate the application of MSUS findings of a single indicator joint in JIA to assess the disease activity and classify disease subtype.Methods: Thirty-five non-systemic JIA patients with a total of 62 visits were retrospectively recruited in this study. Among the involved joints, the joint with highest value of grey-scale (GS) plus power Doppler (PD) (=GSPD) was selected as the indicator joint at each visit. The correlations between each MSUS parameter (GS, PD, GSPD) of indicator joints and the Physician Global Assessment (PGA) score, the Childhood Health Assessment Questionnaire‐disability index (CHAQ-DI), and laboratory data were analyzed. The ultrasound features in different subtypes of JIA were also compared.Results: PD was weakly correlated with the PGA score (rho=0.323, p=0.010), while both GS and GSPD were moderately correlated with the PGA score (rho=0.405, p=0.001; rho=0.434, p=0.000). On the other hand, GS, PD, and GSPD were weakly correlated with CHAQ-DI. Although erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) had a weak correlation with PGA, they were not statistically correlated with GS, PD, or GSPD. The proportions of effusion, synovial hypertrophy, and enthesopathy in three different subtypes, showed significant differences (Fisher’s exact test, p=0.037; p=0.004; p=0.019). Enthesopathy was only seen in joints of enthesitis-related arthritis (ERA), but not in joints of polyarthritis and oligoarthritis.Conclusions: MSUS is an acceptable non-invasive tool for the patients with JIA, particularly for those with non-systemic JIA, that might assist disease classification, and whose parameters of the indicator joints may potentially contribute to the evaluation of disease activity.

Abstract Background: Musculoskeletal ultrasound (MSUS) has been used worldwide in adult patients with rheumatoid arthritis (RA) but not in juvenile idiopathic arthritis (JIA). The aim of this study was to investigate the application of MSUS findings of a single indicator joint in JIA to assess the disease activity and classify disease subtype.Methods: Thirty-five non-systemic JIA patients with a total of 62 visits were retrospectively recruited in this study. Among involved joints, the one with highest value of grey scale (GS) plus power Doppler (PD) (=GSPD) was selected as the indicator joint of each visit. The correlations between MSUS parameters of indicator joints and the Physician Global Assessment (PGA) score, The Childhood Health Assessment Questionnaire‐disability index (CHAQ-DI), and laboratory data were analyzed. The ultrasound features in different subtypes of JIA were also compared.Results: PD was weakly correlated with the PGA score (rho=0.323, p=0.010), while both GS and GSPD were moderately correlated with the PGA score (rho=0.405, p=0.001; rho=0.434, p=0.000). On the other hand, GS, PD, and GSPD were weakly correlated with CHAQ-DI. Although erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) had a weak correlation with PGA, they were not statistically correlated with GS, PD, or GSPD. The proportions of effusion, synovial hypertrophy, and enthesopathy in 3 different subtypes, showed significant differences (Fisher’s exact test, p=0.037; p=0.004; p=0.019). Enthesopathy was only seen in joints of enthesitis-related arthritis (ERA) but not in joints of polyarthritis and oligoarthritis.Conclusions: MSUS seems to be an acceptable non-invasive tool for JIA, particularly for non-systemic JIA patients, that could assist disease classification, and whose parameters of the indicator joints may potentially contribute to the disease activity evaluation.