Glucocorticoid treatment in juvenile idiopathic arthritis

Batu, Ezgi Deniz

doi:10.1007/s00296-018-4168-0

Cited by 25 publications

(12 citation statements)

References 99 publications

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“…The Australian and New Zealand JIA‐Uveitis Working Group agreed that oral prednisolone may be useful as a systemic immunomodulatory drug for JIA‐like uveitis, particularly for rapid control of inflammation. As highlighted in a recent rheumatological review, there is no medical evidence to direct the use of systemic glucocorticoid drugs in children with JIA 21 . The Working Group recommended limiting the dose of prednisolone to a maximum of 1 mg/kg/d, and limiting the duration of treatment with prednisolone at any dose to a maximum of 16 weeks.…”

Section: Resultsmentioning

confidence: 99%

Recommendations for the management of childhood juvenile idiopathic arthritis‐type chronic anterior uveitis

Smith

Matthews

Conrad

et al. 2021

Clinical Exper Ophthalmology

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Importance Australian‐ and New Zealand‐based, uveitis‐specialized ophthalmologists have produced recommendations for the management of juvenile idiopathic arthritis (JIA)‐type chronic anterior uveitis. Background Historically, the visual prognosis of JIA‐type chronic anterior uveitis has been poor. New medical advances are likely to improve outcomes, but recently published guidelines are tailored for ophthalmic care in Europe and the United States. Design This work involved a consensus survey and a panel meeting. Participants The Australian and New Zealand JIA‐Uveitis Working Group (29 ophthalmologists) participated in the work. Methods The Delphi technique was used to achieve consensus. Main Outcome Measures This work yielded consensus statements. Results The Working Group achieved consensus around 18 statements related to clinical evaluation, use of topical and regional corticosteroids, use of systemic corticosteroid and non‐corticosteroid immunomodulatory drugs, and management of secondary cataract and glaucoma in childhood JIA‐type uveitis. Conclusions and Relevance Recommendations of the Australian and New Zealand JIA‐Uveitis Working Group provide current and regionally applicable advice for managing chronic anterior uveitis in children with JIA.

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Section: Resultsmentioning

confidence: 99%

Recommendations for the management of childhood juvenile idiopathic arthritis‐type chronic anterior uveitis

Smith

Matthews

Conrad

et al. 2021

Clinical Exper Ophthalmology

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“…Depending on continued disease activity, further treatment modalities could be added: canakinumab, tocilizumab, tumor necrosis factor‐α (TNF‐α) inhibitor, methotrexate or leflunomide. The long‐term usage of corticosteroids should be avoided due to many potential adverse effects . Methotrexate is the most frequently used disease‐modifying anti‐rheumatic drug (DMARD), followed by cyclosporine A, leflunomide and so on .…”

Section: Introductionmentioning

confidence: 99%

“…The long-term usage of corticosteroids should be avoided due to many potential adverse effects. 2,5,6 Methotrexate is the most frequently used disease-modifying anti-rheumatic drug (DMARD), followed by cyclosporine A, leflunomide and so on. 7 Proinflammatory cytokines including interleukin (IL)-1, IL-6 and IL-18 play an important role in the pathogenesis of the disease.…”

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confidence: 99%

Prognosis, complications and treatment response in systemic juvenile idiopathic arthritis patients: A single‐center experience

et al. 2019

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Aim Systemic juvenile idiopathic arthritis (sJIA) is a distinctive subtype of JIA characterized by systemic features and poor outcome. We aimed to investigate demographic and clinical features, long‐term treatment response and disease complications in a large sJIA cohort. Methods Patients diagnosed with sJIA followed up at a pediatric rheumatology outpatient department from January 2003 to December 2017 were included. Demographic and clinical features, long‐term treatment response and disease complications were retrospectively collected. Results A total of 168 sJIA patients (51.8% female, 48.2% male) were included: 31.5% with monocyclic, 13.7% polycyclic and 54.8% with persistent clinical course. Corticosteroids were initially used in all patients. Methotrexate was used in 75% and cyclosporine A was used in 17.3% patients. Biological drugs were used in 42.8% patients; etanercept in 29.7%, anakinra in 16%, canakinumab in 16%, tocilizumab in 10% patients. Remission off medication was achieved in 82 (48.8%). Macrophage activation syndrome (MAS) was present in 11.9%, growth retardation in 11.3% patients. Eight percent (4/50) of patients had low bone mineral density. Three patients (1.78%) died due to MAS secondary multiorgan insufficiency and infection. Conclusion The disease is characterized with diverse clinical presentation and possibly severe complications. MAS complicated with multiorgan insufficiency is the major mortality factor. Corticosteroids represent the mainstay of the initial treatment. In patients resistant to classic treatment, biological drugs should be timely introduced.

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“…ynthetic glucocorticoids (GCs) are one of the most effective treatments for a wide range of chronic inflammatory, autoimmune, and neoplastic diseases. Approximately 10% of children receive GC treatment at some point during childhood 1 , and long-term GC treatment is common in the management of many chronic childhood illnesses [2][3][4][5][6][7] . The use of GCs has improved outcomes and survival rates for children with these disorders; however, the adverse effects of GCs on bone can be severe.…”

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confidence: 99%

Osteoclasts protect bone blood vessels against senescence through the angiogenin/plexin-B2 axis

et al. 2021

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Synthetic glucocorticoids (GCs), one of the most effective treatments for chronic inflammatory and autoimmune conditions in children, have adverse effects on the growing skeleton. GCs inhibit angiogenesis in growing bone, but the underlying mechanisms remain unclear. Here, we show that GC treatment in young mice induces vascular endothelial cell senescence in metaphysis of long bone, and that inhibition of endothelial cell senescence improves GC-impaired bone angiogenesis with coupled osteogenesis. We identify angiogenin (ANG), a ribonuclease with pro-angiogenic activity, secreted by osteoclasts as a key factor for protecting the neighboring vascular cells against senescence. ANG maintains the proliferative activity of endothelial cells through plexin-B2 (PLXNB2)-mediated transcription of ribosomal RNA (rRNA). GC treatment inhibits ANG production by suppressing osteoclast formation in metaphysis, resulting in impaired endothelial cell rRNA transcription and subsequent cellular senescence. These findings reveal the role of metaphyseal blood vessel senescence in mediating the action of GCs on growing skeleton and establish the ANG/PLXNB2 axis as a molecular basis for the osteoclast-vascular interplay in skeletal angiogenesis.

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Glucocorticoid treatment in juvenile idiopathic arthritis

Cited by 25 publications

References 99 publications

Recommendations for the management of childhood juvenile idiopathic arthritis‐type chronic anterior uveitis

Recommendations for the management of childhood juvenile idiopathic arthritis‐type chronic anterior uveitis

Prognosis, complications and treatment response in systemic juvenile idiopathic arthritis patients: A single‐center experience

Osteoclasts protect bone blood vessels against senescence through the angiogenin/plexin-B2 axis

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