Rheumatoid Arthritis: Davies K

Davies K, Woo P, Anonymous00129. · Department of Rheumatology, Great Ormond Street Hospital, London WC1N 3EJ, UK. · Rheumatology (Oxford). · Pubmed #12154212 links to  free full text

Abstract: OBJECTIVES: To establish opinion and clinical practice of senior clinicians working with children with rheumatic diseases with regard to immunization and to determine whether or not this is in accordance with current recommendations. To review published guidelines on the subject and examine the evidence base supporting them. METHODS: A questionnaire was sent to all consultant members of the British Paediatric Rheumatology Group. Information on a variety of issues relating to immunization practice in children with rheumatic diseases was collected. A review of published guidelines and the medical literature on the subject was undertaken to assess current recommendations for immunization in patients on immunosuppressive agents and the evidence supporting these. RESULTS: A number of different sources of information are being used to decide whether or not to immunize patients with rheumatic diseases. Clinical practice varies between individuals. Areas of discordance include the doses of corticosteroids and disease-modifying drugs at which significant immunosuppression is felt likely to occur, the level of immunosuppression conferred by rheumatological diseases themselves and whether or not vaccination should be deferred in the presence of active disease. There was also variation in policy with regard to immunizations not part of the routine recommended schedule. CONCLUSIONS: There is variation in both opinion and clinical practice regarding immunization in children with rheumatic diseases amongst senior clinicians working in the field of paediatric rheumatology. This reflects the lack of consistency between various sets of published guidelines and their non-specificity for rheumatic diseases and their treatment, and the lack of published evidence on the safety and efficacy of different vaccines in these situations. Further research is indicated in the hope that more specific guidelines may be developed for this not uncommonly encountered area of uncertainty.

Otter S, Springett K, Lucas K, Moore A, Horne R, Davies K, Young A. · School of Health Professions, University of Brighton. · J Tissue Viability. · Pubmed #15516102 No free full text.

Abstract: In common with other outcome measures, those for the at-risk rheumatoid foot need to be sensitive, specific and patient focussed, although currently these combined features are not available within one measure. There is also the issue of cross-validation with other commonly used measures to be considered. Both government policy and clinical need predicate development of suitable measures for the rheumatoid foot. In the first part of this paper, general issues relating to outcome measures and some government policy are considered and in the second, outcome measures relating to the at-risk rheumatoid foot are introduced alongside a discussion on the implications for practitioners.

Davies K, Stiehm ER, Woo P, Murray KJ. · Department of Rheumatology, Great Ormond Street Hospital for Sick Children, London, UK. · J Rheumatol. · Pubmed #11669177 No free full text.

Abstract: Five patients with the 22q11 deletion syndrome (velocardiofacial syndrome) developed chronic inflammatory polyarticular arthritis. These new cases add to 8 previously reported and confirm the association. The arthritis in all cases was moderate to severe, but at least partially responsive to methotrexate and/or corticosteroids, and was clinically indistinguishable from juvenile idiopathic arthritis (JIA). Analysis of the total 13 patients indicates that 2 are rheumatoid factor positive, 6 are antinuclear antibody positive, 5 have subtle T cell deficiencies, and 6 have hypergammaglobulinemia. Of particular interest is the occurrence of IgA deficiency in 4 patients, including 2 from our own series. Although IgA deficiency is seen in both JIA (2-4%) and 22q11 deletion syndrome (2-4%), the prevalence of low IgA in this series (31%) is much greater than expected. This phenomenon and the true association of inflammatory arthritis and a chromosome deletion disorder provides further evidence of important genetic factors in the pathogenesis of JIA.