We organized the largest international pediatric rheumatology congress with 940 participants from 69 countries in Cankarjev dom, Ljubljana, Slovenia. President of the organising committee was research project leader Prof. Tadej Avčin.
B.01 Organiser of a scientific meeting
Background: Influenza vaccination in children with juvenile idiopathic arthritis is often recommended, but not frequently performed. The aim of the study was to assess the efficacy of annual influenza vaccination and adverse events after vaccination. Influence of influenza vaccination on diseases activity was evaluated. According to results of the study on induction of autoantibodies in apparently healthy adults after influenza vaccination, the second aim was also to asses the induction of autoantibodies after influenza vaccination in children with juvenile idiopathic arthritis. Methods: Thirtyone children with stable juvenile idiopathic arthritis (10 boys, 21 girls, mean age 11.0 years) receiving various therapies and 14 children in a control group (10 boys, 4 girls, mean age 11.9 years), followed at Cardiology outpatient service at University children’s hospital Ljubljana for congenital cardiac disease or investigated for suspected cardiac disease, were vaccinated with the annual influenza vaccine Begrivac® 2008/2009. The efficacy of influenza vaccination was evaluated by determination of the number of infectious episodes with influenza during the 6 month period after the vaccination and by the immunogenicity of the influenza vaccine. Viral infections were followed by oral and nasal swabs analysis. In a case of infectious episode swabs were taken by parents according to precise instructions. Protective antibodies against three vaccine viruses were determined in serial samples taken before, 1 month and 6 months after vaccination. Children in both groups were followed for adverse events 6 months after vaccination. ANA, anti-ENA, ANCA, IgG/IgM aCL, IgG/IgM/IgA antiβ2GPI autoantibodies and LA production was determined in serial samples taken before, 1 month and 6 months after vaccination. The activity of juvenile idiopathic arthritis was followed in an observational time of 6 months after vaccination. To better asses the impact of influenza vaccination on disease activity, group of 31 unvaccinated children with juvenile idiopathic arthritis (13 boys, 18 girls, mean age 8.0 years) was included in the study. Results: There was no statistically significant difference in the rate of influenza infection between the children with juvenile idiopathic arthritis and children in the control group. Three children got influenza infection in the observational period of 6 months after vaccination. The response to vaccination after one month was significant for all three influenza vaccine viruses in the control group and in the group of children with JIA as a whole, but not in a subgroup of 4 children receiving antiTNFα therapy. After six months, no significant differences in the protective titers against vaccine viruses among the patient and control groups were observed. Eleven (35%) children with juvenile idiopathic arthritis and five (36%) children in the control group reported shortterm adverse events. Changes in the mean values of autoantibodies after vaccination were found only for IgG anticardiolipin antibodies in the study group of children with juvenile idiopathic arthrtitis but the difference was not statistically significant (p=0.05). A juvenile idiopathic arthritis flare was observed one month after vaccination in 4 (13%) patients, and in the following five months in 7 (23%) patients. Conclusion: Vaccination against influenza was effective in a study group of children with juvenile idiopathic arthritis. Protective antibodies against at least two vaccine viruses 6 months after vaccination were detected in all patients. Protective antibodies against three vaccine viruses 6 months after vaccination were detected in 24 (77%) children with juvenile idiopathic arthritis. Thirty five percent of children with juvenile idiopathic arthritis experienced flare of the disease in an observational time of 6 months after vaccination.
D.09 Tutoring for postgraduate students
COBISS.SI-ID: 265013248In the described study we analyzed the antiinfliximab antibody response in pediatric patients with JIA treated with infliximab. Similarly to other studies in adults we found that antibodies to infliximab (ATI) developed in 43% of the patients. We also observed that the formation of ATI is associated with decreased infliximab serum trough levels, which is the most likely cause of the and a loss of infliximab efficacy. The majority of our efforts were focused on elucidating where on the infliximab molecule the ATI bind. As predicted, we observed that the majority of ATI bind the variable regions of infliximab, which are the regions where the amino acid residues of murine origin can still be found. To define the binding sites, or epitopes, of these ATI more precisely, we tried a number of different methods for epitope mapping. However, none of the methods that we used in our study proved to be successful. We attributed our shortcomings to the finding that all of the antibody epitopes were composed of discontinuous segments of infliximab only coming into proximity to one another in the folded conformation. Discontinuous epitopes are much more difficult to map, as there are few methods to do so and those methods that exist do not always yield reliable results.
D.09 Tutoring for postgraduate students
COBISS.SI-ID: 255788032Objective To propose a common nomenclature to refer to individuals who fulfillthe American College of Rheumatology classification criteria for systemic lupus erythematosus (SLE) during childhood or adolescence. Methods The medical literature was reviewed for studies conducted in the target population between 1960 and December 2011 to obtain information about the terms used to refer to such children and adolescents. We reviewed the threshold ages used and disease features considered to discriminate these individuals from patients with onset of SLE during adulthood. Furthermore, thenomenclature used in other chronic diseases with onset during both childhood and adulthood was assessed. Results There was an astonishing variability in the age cutoffs used to define SLE onset prior to adulthood, ranging from 14-21 years, but most studies used age 18 years. The principal synonyms in the medical literature were SLE without reference to the age at onset of disease, childhood-onset SLE, juvenile SLE, and pediatric (or paediatric) SLE. Conclusion Based on the definition of childhood, in analogy with other complex chronic diseases commencing prior to adulthood, and given the current absence of definite genetic variations that discriminate adults from children, the term childhood-onset SLE is proposed when referring to individuals with onset of SLE prior to age 18 years.
F.21 Development of new health/diagnostic methods/procedures
COBISS.SI-ID: 657836OBJECTIVE: To obtain international consensus around processes that support the delivery of high quality care to patients with childhoodonset systemic lupus erythematosus (SLE) based on current recommendations and scientific evidence. METHODS: To identify process quality indicators (QIs) for the medical care of children and adolescents with childhood-onset SLE, we sent 2 Delphi questionnaires internationally to 340 physicians who treat these patients. We set consensus at 80% of completed responses. RESULTS: Two hundred ninetyseven physicians (87%) responded to the first Delphi questionnaire and 265 physicians (76%) responded to the second questionnaire. The group achieved consensus for 26 QIs addressing laboratory testing at diagnosis, health maintenance measures, diagnosis and therapy of lupus nephritis, general preventive strategies, surveillance for medication safety, counseling and evaluation of cardiovascular risk factors, as well as transition planning. Of the 26 process QIs for use in childhood-onset SLE, 11 matched those established for adults with SLE, 9 required modification, and consensus was reached for an additional 6 QIs specific to children. CONCLUSION: An international consensus for a set of process QIs for childhood-onset SLE was reached that considers unique aspects of children with childhood-onset SLE. The presented set of QIs for children and adolescents with childhood-onset SLE defines agreed-upon standards of medical care.
F.21 Development of new health/diagnostic methods/procedures