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Paediatric rheumatological disorders: All you need to know

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From Dr. Anju Singh

Rheumatological diseases in children arise from dysregulations in theirs immune system. As a result, there is a state of exaggerated immune response in the form of hyperinflammation that attacks its own cells and organs such as joints, eyes, skin, lungs, heart, intestines and brain; and produces a spectrum of different diseases known as autoimmune rheumatic diseases. Most of them are idiopathic in nature, meaning the underlying cause is unknown. Generally these can be called juvenile idiopathic arthritis (JIA), connective tissue disorders (CTDs), and primary vasculitis. be categorized autoinflammatory syndromes.

Juvenile idiopathic arthritis is the most common rheumatic disease in children, affecting 1 in 1,000 children. It includes several subtypes classified according to the number of joints, the presence of fever, rash, RF, anti-CCP autoantibodies, and HLA B27 antigen. Mostly these are children occur with pain, swelling, and stiffness in the joints or limping. Most of them are first seen by orthopedic surgeons. Some of them may appear with just a fever for more than two weeks, sometimes with an unfixed rash and joint pain. Others may occur during routine eye exams with symptoms in the eyes such as poor eyesight, reddening of the eyes, whitening of the eyes (cataract), or the incidental finding of uveitis (inflammation of the middle layer of the eye, uvea).

Children with juvenile idiopathic arthritis may experience pain, swelling, and stiffness in their joints or limping. (Source: Getty Images)

Children with connective tissue Disruptions may have persistent fever with mouth ulcers, photosensitive skin rash, diffuse hair loss and weight loss (as in systemic lupus erythematosus). Another group of children with juvenile dermatomyositis may present with a fever, rash over the eyelids, easily fatigued knuckles and toes, inability to climb stairs, raise hands above their head, or lift their head off the pillow. Children with scleroderma or juvenile systemic sclerosis may present with episodes of reflux with thickening of the skin of the face (which creates an expressionless and wrinkle-free face), arms and legs, and difficulty swallowing food.

Some children may have inflammation of the blood vessels called vasculitis and have had it for a long time fever with weight loss, body aches, altered sensory properties or a shock-like state or simply with urinary problems from blood in the urine with a rash. For example, children with Kawasaki disease may present with a fever, redness of their eyes and mouth, a rash all over their body, and swelling of their hands and feet.

Another group of children who become autoinflammatory syndrome may have recurring attacks of fever with rash, joint pain, persistent loose stools, sore throat, chest and stomach. However, between these episodes, the child will remain healthy with normal growth and development.

Broad knowledge of the different types of children’s rheumatism Diseases is essential in order to recognize the clinical picture and to offer the child an early diagnosis and the best possible treatment in order to guarantee an optimal result.

In the current Covid pandemic, although children are asymptomatic to slightly ill, an increase in autoimmune and autoinflammatory complications after Covid-19 has been observed in children, such as MIS-C (Multisystem Inflammatory Syndrome).Covid related) and chilblains skin lesions. MIS-C usually mimics Kawasaki disease or just presents as a persistent fever. Recently, another entity identified following Covid disease is steroid-induced avascular necrosis (AVN) of the bones, particularly the hips and knees. Because children with MIS-C and severe Covid disease need a high dose of steroids as primary therapy, they make them prone to AVN. These children can be looked after by a team of pediatric rheumatologists and orthopedists. Most of these children respond well to medical therapy, and some may require surgery depending on the severity.

Tips and care for autoimmune diseases:

  • Most of these diseases have no known cause. But children have to be full vaccinated against various diseases, as autoimmune diseases are sometimes triggered by infections.

  • Healthy, nutritious diet and hygiene play critical roles in preventing various infections and autoimmune diseases such as enthesitis-associated arthritis and inflammatory bowel disease-associated arthritis.

  • Children with juvenile idiopathic arthritis should avoid prolonged inactivity as it aggravates arthritis and should do so regularly physical therapy Exercises for the range of motion of different joints.

  • Children with connective tissue diseases such as systemic lupus erythematosus and juvenile dermatomyositis should use sun protection measures, e.g. B. Sun protection creams on exposed areas with at least SPF 30.

  • Children with Raynaud’s phenomenon (fingers, toes, ears and tip of the nose become numb, blue and icy in cold or stressful conditions) should keep their extremities warm by wearing gloves and socks, especially in the winter season.

  • Any child with a fever that has persisted for more than a month and does not respond to antibiotics without an infection should be seen by a pediatric rheumatologist, as rheumatic diseases are the second most common cause in such a situation Infections.

  • Any child who has been diagnosed with a type of uveitis called chronic (initially asymptomatic) anterior uveitis (inflammation of the middle layer of the eye, called uvea) should see a pediatric rheumatologist, as idiopathic (unknown cause) uveitis, or uveitis associated with juvenile idiopathic arthritis, forms the most common types that are autoimmune in nature.

(The author is a pediatric rheumatologist, senior consultant, Madhukar Rainbow Hospital.)

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Two-hour glucose tolerance test helps identify patients at heightened risk of cognitive decline

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Diabetes is a risk factor for cognitive decline. In a study by the University of Turku and the Finnish Institute for Health and Welfare, researchers observed that even a higher two-hour glucose level in the glucose tolerance test predicts poorer performance in a test measuring episodic memory after ten years. Episodic memory decline is one of the first symptoms of Alzheimer’s disease.

Diabetes is known to be an independent risk factor for memory impairment. Previous studies have shown that risk factors for diabetes such as obesity, metabolic syndrome, and decreased insulin sensitivity are linked to a decrease in cognitive function and an increased risk of developing memory disorders. Fasting blood sugar is not as good a risk measurement tool as this, and according to an earlier report from the Finnish Health 2000 study, it did not predict a decline in memory functions.

The two-hour glucose test in a glucose tolerance test is a commonly used test in healthcare that assesses whether the person being tested has diabetes or impaired glucose tolerance. By definition, a person has impaired glucose tolerance when glucose levels are elevated on the two-hour glucose tolerance test but the diagnostic criteria for diabetes are not met.

In the new study, the researchers investigated whether the glucose levels of the two-hour glucose tolerance test after a ten-year follow-up period are related to cognitive functions. The surveys were carried out in the years 2000-2002 and 2011 with a total of 961 participants. Memory and other cognitive functions were measured using three tests commonly used in the diagnosis and follow-up of patients with memory impairment.

The study suggested that higher blood sugar levels measured in a glucose tolerance test in 2001-2002 was linked to weaker performance in a 2011 memory test, in which participants had a delay in retrieving a previously learned word list.

The glucose level measured in the two-hour glucose tolerance test was also associated with a greater decrease in test results during the follow-up period. The analyzes took into account the most important known risk factors for memory disorders such as age, educational background, elevated blood pressure, elevated cholesterol levels, obesity, type 2 diabetes and smoking. “

Sini Toppala, first author, Turku PhD University

The study is based on the population-based survey “Health 2000” of the Finnish Institute for Health and Social Affairs and its supplementary data, which were collected in 2001-2002, as well as on its follow-up study, the study “Health 2011”. In the first survey, the participants were 45-74 years old (mean 55.6 years).

The study shows that the glucose tolerance test helps identify patients with impaired glucose tolerance who are at increased risk of cognitive decline. This is important for targeted interventions, explains Toppala.

The research article was published as an online ahead-of-print version on August 15, 2021. The study will be published in a future issue of Diabetes Care.

Source:

Journal reference:

Toppala, S., et al. (2021) Oral Glucose Tolerance Test Predicts Episodic Memory Loss: A 10-Year Population-Based Follow-Up Study. Diabetes treatment. doi.org/10.2337/dc21-0042.

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John Whaite health: Bake Off star’s eating disorder has been ‘very difficult to overcome’

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The star baker, who became the 2012 Bake Off Champion, stunned Paul Hollywood and then judged Mary Berry on his culinary skills, but behind closed doors the star has struggled with his body image since he was a teenager. The star previously discussed his “serious” mental battle with depression, but when he appeared on Steph’s Packed Lunch on Channel 4, he wanted to raise awareness about eating disorders too.

The 32-year-old spoke openly about his struggles with bulimia in the hope that others would also speak out.

He said, “My body image growing up was very difficult … I was so aware that I was fat. But one thing that I was aware of as problematic for 12, 14 years was overeating and then cleaning. The painful pressing down on food and then the immediate need to get that out of me.

“If I bake a lot of muffins and something went wrong that day or time in my life, I would sit and eat all 12 muffins and then run to the bathroom and I would get sick.”

It is estimated that around one million people in the UK have an eating disorder, one in four of whom are men.

CONTINUE READING: Dementia Diet: 3 Foods To Remove From Your Diet To Stop The Risk

Bulimia nervosa is an eating disorder that is characterized by binge eating followed by purification, which may include vomiting, taking laxatives, fasting, or excessive exercise.

The chef, who is still struggling with his condition, said, “One of the things that I find myself very embarrassed about is that … my food every now and then makes me feel very guilty. But it’s not something that I can control.

“I’ve only really accepted it as an eating disorder for the past 18 months, two years, and it has been very, very raw.”

The feelings of guilt that the cook feels unnecessarily about his condition are underlined by his chosen career path.

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“It was very, very difficult to overcome and I think that’s because of the stigma of an eating disorder,” added John.

“Especially as a chef, I didn’t really want to talk about it because I felt like it undermined my entire career.

“How can a chef who writes recipe books and cooks on TV, how can he realistically have bulimia?”

When John first noticed the symptoms, he didn’t realize it was a major problem. Instead, I thought it was a way to deal with overeating. However, if people have the condition for a long time, it can become life-threatening.

The NHS lists several health risks that can arise from persistent vomiting or excessive laxative use.

Possible complications are:

  • feeling tired and weak
  • Dental problems – caused by stomach acid when vomiting persists, can damage tooth enamel
  • Bad breath, sore throat or even tears in the lining of the throat – also caused by stomach acid
  • Irregular or absent periods
  • Dry skin and hair
  • Brittle fingernails
  • Swollen glands
  • Seizures and muscle cramps
  • Heart, kidney, or bowel problems, including permanent constipation
  • Bone Problems – You are more likely to develop problems like osteoporosis, especially if you’ve had symptoms of both bulimia and anorexia.

Before an eating disorder turns into a life-threatening condition, there are general warning signs to look out for in yourself, as well as close friends and relatives.

These can be emotional and behavioral as well as physical in nature.

Emotional and behavioral warning signs include things like unusual swelling of the cheeks or jaw area, hiding or stealing food, excessive use of mouthwash, mints, or chewing gum, extreme mood swings.

Physical symptoms include fainting, muscle weakness, noticeable fluctuations in weight, and difficulty concentrating.

Treatment of the condition is often offered in the form of a guided self-help program. It involves working with a healthcare professional such as a therapist who will enable you to overcome the condition and understand why you are having this behavior.

You can trust an eating disorders charity advisor by calling the adult hotline 0808 801 0677 or the youth hotline 0808 801 0711.

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University of Utah study examines link between suicide risk, genetics | News, Sports, Jobs

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KERA WILLIAMS, special about the standard examiner

A candle is held during the candlelight vigil for World Suicide Prevention Day at Mount Ogden Park in Ogden on Thursday, September 10, 2015.

SALT LAKE CITY – People who suffer from bipolar disorder and are genetically predisposed to post-traumatic stress disorder may have a higher risk of dying of suicide, according to a study conducted by researchers at the University of Utah.

The study looked at risk factors for completing suicide, not just attempting suicide, said Dr. Eric Monson, lead study author and co-chief physician in the Department of Psychiatry at the University of Utah, who suggested the results could lead to better screening measures to identify and identify those with previous trauma in people diagnosed with bipolar disorder the highest risk of suicide.

“Death rates from suicide are 10 to 30 times higher in people with bipolar disorder than in the general population. The suicide rate in Utah is about 22 per 100,000, or about 660 a year, “Monson said. “We found in this study that a combination of previous trauma, a genetic predisposition to PTSD, and a diagnosis of bipolar disorder can increase a higher risk of death from suicide.”

Monson said the results showed that 50% of those studied with bipolar disorder died of suicide without ever trying.

“The focus group was bipolar, but within that disorder we wanted to see if there were other factors like PTSD and severe anxiety,” said Monson. “Those with past trauma and great anxiety were much more likely to die of suicide than the other groups we studied. This is not entirely surprising, as anxiety is pretty closely linked to PTSD. “

The research team, which included Monson, U of U psychiatry professor Hilary Coon, and Virginia Willour, a University of Iowa psychiatry professor, used several thousand DNA samples from Utahners who died from suicide, along with electronic medical records. They also used data from the National Institute of Mental Health Genetics Initiative. Hundreds of people who died were diagnosed with bipolar disorder and had a higher rate of PTSD diagnoses.

According to brainline.org, PTSD is a mental illness that some people develop after experiencing or experiencing a traumatic event such as an accident, sexual assault, fight, or natural disaster. These events can cause flashbacks, nightmares, or triggers. Anyone can develop PTSD, but a number of factors play a role, such as whether the traumatic event was long-lasting. In the United States, it is estimated that about seven or eight in 100 people will develop PTSD at some point in their life. Approximately 8 million adults have PTSD during any given year. About 10% of women and 4% of men develop the disorder.

“People with PTSD tend to have more severe illnesses than other people and are harder to treat with medication,” said Monson.

The study showed some promising results, Monson said, but the problem still exists of helping people who are suicidal. His own sister took her own life when she was 15 and Monson was only 7. He also lost three coworkers to suicide.

“That was an important aspect of my life that drove me to keep digging. Suicide is very complex and there are undoubtedly other characteristics such as environmental factors, toxins and chronic stress, ”he said. “There’s also decent evidence that altitude can play a role. If you look at a map, you can see that the suicide belt is in the Rocky Mountains. These include Utah, Nevada, Wyoming, Colorado, and Idaho. When you are at a higher altitude, your oxygen levels are lower and this can affect the neurotransmitters in the brain. “

Monson also said that while the study is important, it doesn’t mean that a person will definitely commit suicide – and he added that suicide is preventable.

“We have limited mental health resources, but suicide is inherently preventable and we should take all measures to help those at risk,” Monson said. “I think it’s important now that we in the medical field ask people more about serious traumatic experiences in their lives, but it’s also important that people be direct when they suspect someone might be trying to commit suicide . There is a difference between saying, “Do you feel like you might be hurt” and “Do you have the thought of killing yourself”. Please be as straightforward as possible. “

But when all you’re doing to help someone fails, the important thing is not to blame yourself, Monson said.

“It’s not your fault. It’s never so easy to think that you said something or couldn’t have said something,” he said. “Please don’t get caught up in self-blame.”

What to look out for

September is Suicide Awareness Month. Here are the warning signs when someone thinks of suicide:

  • Increased isolation from the world.
  • Bringing matters in order.
  • Give things away.
  • Anxious, tired, or depressed behavior.
  • Talk about being a burden on others.
  • Feeling hopeless or feeling like they are no use.
  • Speaking of wanting to die.
  • Display of extreme mood swings.
  • Increase in the consumption of alcohol or drugs.
  • Anger or recklessness.

Other resources:

  • National Lifeline for Suicide Prevention, 1-800-273-8255
  • https://intermountainhealthcare.org/blogs/topics/live-well/2018/04/suicide-prevention-resources-in-utah/

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