Sensing the Simmering Inflammation: Clues for Diagnosis of Underlying Rheumatic Disorder.

Diagnosing pediatric rheumatic diseases can be challenging, as they often mimic common conditions such as infections and, less commonly, malignancies. Characteristic pattern recognition, guided by a detailed history and clinical examination, often helps in making the correct diagnosis. A delay in diagnosing these disorders can lead to disease-related damage, such as joint disabilities in juvenile idiopathic arthritis, and life-threatening organ involvement in conditions like childhood vasculitis and lupus.

Disease Damage in Juvenile Idiopathic Arthritis.

Objectives: To estimate the prevalence and predictors of disease-related damage in children with juvenile idiopathic arthritis (JIA) in a resource-limited setting.

Methods: A single-centre study was conducted from January 2021 - December 2022. Children (≤ 18 y) diagnosed with JIA as per International League of Associations for Rheumatology (ILAR) criteria, with a disease duration of more than one year, were enrolled for this study.

CAR T-Cell Therapy: A Promising Modality for Autoimmune Diseases.

Chimeric Antigen Receptor (CAR) T-cells have emerged as a promising immune effector cell-based therapy. With promising results and approval for the treatment of hematological malignancies, we discuss the scope of this novel therapeutic modality in systemic autoimmune diseases and immune-mediated inflammatory disorders refractory to conventional and biological disease-modifying agents.

Secukinumab for children and adolescents with enthesitis-related arthritis and psoriatic arthritis: .

Introduction: Targeting IL-17A using Secukinumab, a humanized monoclonal immunoglobulin G1 (IgG1)/κ against IL-17A is a therapeutic option for immune-mediated disorders such as psoriasis and ankylosing spondylitis. The US Food and Drug Administration and the European Medicines Agency have approved it for the treatment of moderate to severe plaque psoriasis, active psoriatic arthritis, ankylosing spondylitis, and non-radiographic axial spondylarthritis. Recently it has also been approved for use in children with severe plaque psoriasis, active psoriatic arthritis, and enthesitis-related arthritis.

Scope of JAK Inhibitors in Children: Recent Evidence and Way Forward.

Over the last decade, there has been an increase in the use of targeted therapy using small molecules such as Janus kinase (JAK) inhibitors. Since the introduction of ruxolitinib, the first non-selective JAK inhibitor approved for use in myelofibrosis, many other JAK inhibitors have been tried in a wide spectrum of immune-mediated disorders. Although various trials have shown the promising efficacy of JAK inhibitors in immune-mediated inflammatory disorders (IMIDs), there is a growing concern over the major cardiovascular events and malignancies associated with the use of these molecules in older adults, particularly those over 65 years of age.

Kawasaki disease or polyarteritis nodosa: coronary involvement, a diagnostic conundrum.

Polyarteritis nodosa (PAN) is a medium-vessel vasculitis presenting with cutaneous and multisystem involvement with considerable morbidity. The necrotizing vasculitis in PAN typically involves renal, celiac, and mesenteric vascular beds. Coronary artery involvement is a characteristic feature of Kawasaki disease, another medium-vessel vasculitis; however, it has been rarely reported with PAN.

Conception of National Biologics Registry for Pediatric Rheumatology: Need of the Hour and the Way Forward.

The outcome for children with rheumatic diseases has been dramatically altered by the use of biological therapies. Increasing use of these agents will need careful monitoring for long term safety, particularly in children. Current data on safety of these drugs stem exclusively from Western literature.

Initial Immunomodulation and Outcome of Children with Multisystem Inflammatory Syndrome Related to COVID-19: A Multisite Study from India.

Objective: To determine the outcomes in children with MIS-C receiving different immunomodulatory treatment.

Methods: In this multicentric, retrospective cohort study, data regarding treatment and outcomes of children meeting the WHO case definition for MIS-C, were collected. The primary composite outcome was the requirement of vasoactive/inotropic support on day 2 or beyond or need of mechanical ventilation on day 2 or beyond after initiation of immunomodulatory treatment or death during hospitalization in the treatment groups.