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Biomedical subjects

J T Cassidy

Publications and source records attributed to J T Cassidy.

At least 19 recordsLinked to original sources
PubMed1999

Medical management of children with juvenile rheumatoid arthritis.

One of the most important and changing areas of research in paediatric rheumatology is the optimum approach to the treatment of children with chronic arthritis. Until recently all medications for children with arthritis were nonspecific in terms of our understanding, albeit poor, of the pathogenesis of these diseases. Of current therapies, low dose, once-a-week methotrexate has emerged as the therapeutic agent of choice for children who fail to respond adequately to administration of a nonsteroidal anti-inflammatory drug. Thereby, it has displaced the more traditional slower acting anti-rheumatic drugs, although one or more of them are often combined with methotrexate in the polypharmaceutical approach to childhood arthritis. Better and more specific agents are needed, especially for systemic onset disease, unremitting polyarticular involvement, and certain complications such as resistant chronic uveitis. At this time the introduction of the cyclo-oxygenase 2 inhibitors and etanercept (soluble tumour necrosis factoralpha.p75 fusion protein) may herald an era of more specific and effective therapy.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1998

Disease and family contributors to adaptation in juvenile rheumatoid arthritis and juvenile diabetes.

OBJECTIVE: Research in the areas of pediatric rheumatology and pediatric chronic illness has emphasized comprehensive models of adaptation involving risk and resistance factors. This study examined adaptation, within this framework, among a large sample of children with chronic illness and children without chronic illness. METHODS: A comprehensive battery of adaptation measures was administered to a sample of 107 children with juvenile rheumatoid arthritis, 114 children with insulin-dependent diabetes mellitus, and 88 healthy controls. RESULTS: Medical diagnosis was associated with mothers' depression and a composite measure of parental (mother and father) distress and passive coping. Children's emotional and behavioral functioning was not related to medical diagnosis, but mothers' depression and parental distress were associated with child behavior problems. CONCLUSION: Because parental distress was associated with child functioning, interventions to ameliorate parental distress may have beneficial effects on the children's behavior and on parents' reactions to their children.

Adaptation, Psychological↗
PubMed1998

Trajectories of adaptation in pediatric chronic illness: the importance of the individual.

This study used individual growth modeling to examine individual difference and group difference models of adaptation. The adaptation of 27 children with juvenile rheumatoid arthritis (JRA) and 40 children with insulin-dependent diabetes mellitus (IDDM) was tracked for 18 months from diagnosis. A control group of 62 healthy children was followed over the same time period. Clustering procedures indicated that child and family adaptation could be described by a number of distinct adaptation trajectories, independent of diagnostic group membership. In contrast, parental adaptation trajectory was associated with diagnostic group membership and control over disease activity for the JRA group and with diagnostic group membership for healthy controls. The observation of common patterns across trajectory sets, as well as the finding that trajectories were differentially related to a number of variables of interest, support the use of trajectories to represent adaptation to chronic disease.

Adaptation, Psychological↗
PubMed1998

Progress in diagnosis and understanding chronic pain syndromes in children and adolescents.

The frequency of chronic pain syndromes in pediatric rheumatology has increased over the past 25 years. Diagnosis is complex: underlying organic illness, somatization, and growing pains are all possibilities. The author reviews pain studies involving children and adolescents, offers guidelines to classify chronic pain syndromes, and describes different pain modalities.

Adolescent↗
PubMed1997

Abnormalities in skeletal growth in children with juvenile rheumatoid arthritis.

A review of the acquisition of peak skeletal mass in normal children and studies that have been reported for children with JRA lead to the following tentative conclusions: (1) The appendicular skeleton is predominantly the overall status of skeletal mineralization; (2) a failure to develop adequate bone mineralization is virtually universal in children with JRA and is characterized by a failure of bone formation. A failure to undergo the normal increase in bone mass during puberty is common in children with JRA and markedly decreases their potential to achieve an adequate peak skeletal mass; (3) the onset of accelerated skeletal maturation with puberty is a critical period of potential intervention in JRA. Conversely, therapeutic interventions later during adolescence offer less promise of reversal of inadequate bone mineralization; and (4) the most important therapeutic maneuver is likely to be control of the inflammation process, although there is hope, at present unsubstantiated, that supplemental dietary calcium and vitamin D, and normalization of physical activity, many lead to some "catch-up" mineralization.

Adolescent↗
PubMed1996

Bone mineralization and bone mineral metabolism in children with juvenile rheumatoid arthritis.

OBJECTIVE: To identify mechanisms of the osteopenia associated with juvenile rheumatoid arthritis (JRA) by determining parameters of bone mineralization, and bone mineral content and density (BMC and BMD), in children with JRA. METHODS: BMC and BMD were measured by dual x-ray absorptiometry in 41 children with JRA and 62 healthy children. Serum samples were analyzed for concentrations of minerals, vitamin D, parathyroid hormone, osteocalcin, bone-specific alkaline phosphatase (BAP), procollagen I carboxy-terminal propeptide, and tartrate-resistant acid phosphatase (TRAP), and urinary excretion of deoxypyridinoline crosslinks and calcium. RESULTS: BMD was decreased in all sites in JRA patients. BMD, corrected for age, height, weight, and bone area, was decreased at cortical bone sites (1/3 radius, upper and lower extremities, and whole body). Low concentrations of osteocalcin and BAP suggested reduced bone formation, and low TRAP levels suggested decreased resorption. Clinical scales of disease severity were negatively correlated with measures of bone mass. Laboratory markers of disease severity were highly correlated with decreases in markers of bone formation, but not with those of resorption. Although laboratory findings were similar for children with oligoarticular and polyarticular disease, differences in bone mass were greater in children with polyarticular disease. CONCLUSION: These data suggest an association between decreased bone mineralization in JRA and low bone formation that is related to disease severity. Efforts to stimulate bone formation, therefore, need to be considered clinically in prepubertal children with active JRA.

Adolescent↗
PubMed1996

Legal rights of children with musculoskeletal disabilities.

As market forces increasingly control medicine, we must not forget the disabled, especially children. Although the costs of appropriate comprehensive services are substantial, it is well worth the cost to facilitate an adulthood in which these patients are on their own, possibly earning their livelihood, and experiencing the best quality of life our society can provide.

Adult↗
PubMed1995

Predicting pain among children with juvenile rheumatoid arthritis.

OBJECTIVE: Children and adolescents with juvenile rheumatoid arthritis (JRA) often report pain as a major symptom that affects their daily activities. Little is known about the factors that contribute to pain, however. Demographic, disease status, and social-psychologic variables were used to predict pain of JRA. METHODS: Participants were 37 girls and 23 boys who were 7 to 17 years old. Measures included the Hopelessness Scale for Children, the Sadness Scale from the Differential Emotions Scale--IV, and the Social Support Questionnaire--Revised. A pain visual analogue scale served as the criterion measure. RESULTS: Reported pain was modestly correlated with disease duration and age. A hierarchical regression indicated that the predictor variables accounted for a modest amount of variance in pain scores. CONCLUSIONS: The results suggest that the factors contributing to pain in children with JRA are different from those in adults with rheumatoid arthritis (RA). Research is needed to identify the psychologic and socioenvironmental variables that influence pain among children with JRA.

Adolescent↗
PubMed1995

Bone mineral metabolism in children with juvenile rheumatoid arthritis.

Osteopenia has emerged as a major determinant of the outcome of children with juvenile rheumatoid arthritis. Although vertebral compression fractures and fractures of long bones were recognized historically as important clinical developments in the course of disease, a decrease in skeletal mass could only be quantitated and documented early in disease by the recent introduction of bone absorptiometry. This article is limited to recent data from studies on osteopenia in juvenile rheumatoid arthritis and suggests directions of future research that have relevance to current unanswered questions in prevention or management.

Arthritis, Juvenile↗
PubMed1995

Elevated serum prolactin levels in children with juvenile rheumatoid arthritis and antinuclear antibody seropositivity.

OBJECTIVE: To determine if antinuclear antibody seropositivity in girls with juvenile rheumatoid arthritis (JRA) is associated with elevated serum levels of the anterior pituitary hormone prolactin. METHODS: Nineteen premenarchal girls meeting ACR classification criteria for JRA were evaluated for disease activity, antinuclear antibodies (ANA) seropositivity, and serum concentrations of prolactin, estrogen, and thyroid stimulating hormone. RESULTS: The mean serum prolactin concentration of ANA seropositive patients with JRA (10.9 +/- 1.9 micrograms/l) was significantly higher than that for ANA negative patients (5.7 +/- 1.0 micrograms/l; p = 0.043) and an age matched control group (5.8 +/- 1.3 micrograms/l; p = 0.048). CONCLUSION: Children with ANA seropositive JRA have elevated serum levels of the immunostimulatory hormone prolactin.

Antibodies, Antinuclear↗
PubMed1995

Evaluation of growth hormone secretion in children with juvenile rheumatoid arthritis and short stature.

Children with juvenile rheumatoid arthritis (JRA) often exhibit delayed skeletal development. Previous evaluations of growth hormone (hGH) levels in these children have used single-value blood determinations. We sought to extend information on possible hGH deficiency in children with short stature and JRA by measuring 24-hour hGH pulsatile secretion. Five children with JRA were identified as having a height less than the 3rd percentile, and one child with a height at the 25th percentile. Three of these had abnormally low 24-hour serum hGH secretion. Two underwent a 24-month trial of human recombinant hGH; both exhibited only marginally accelerated growth. These results suggest that children with JRA and persistent short stature may have low hGH secretion without an adequate physiologic response to exogenous hGH administration.

Adolescent↗
PubMed1994

Vitamin D metabolism and bone mineralization in children with juvenile rheumatoid arthritis.

OBJECTIVE: To examine bone mineralization and bone mineral content in a cross-sectional population of children with juvenile rheumatoid arthritis (JRA). METHODS: Bone mineral content was measured by single-photon absorptiometry in 44 children with JRA and 37 control children. Serum concentrations of minerals, vitamin D, parathyroid hormone, osteocalcin, bone alkaline phosphatase, and tartrate-resistant acid phosphatase, and urinary concentrations of minerals, were determined. RESULTS: Bone mineral content was decreased in children with JRA. Significantly lower concentrations of osteocalcin (7.4 +/- 3.4 vs 12.5 +/- 2.5 micrograms/L) and bone alkaline phosphatase (78.8 +/- 36.4 vs 123.0 +/- 46.0 IU/L) suggested reduced bone formation; lower levels of tartrate-resistant acid phosphatase (10.3 +/- 4.1 vs 14.4 +/- 5.8 IU/L) and a lower urinary calcium/creatinine ratio (0.07 +/- 0.06 vs 0.12 +/- 0.09) suggested decreased bone resorption. The serum calcium concentration was significantly lower (9.3 +/- 1.0 vs 10.0 +/- 0.4 mg/dl), as was the parathyroid hormone concentration (19.8 +/- 8.6 vs 26.7 +/- 9.3 ng/L); 1,25-dihydroxyvitamin D values (30.1 +/- 10.5 vs 30.4 +/- 9.3 pg/ml) were normal. CONCLUSION: These data suggest that decreased mineralization in JRA is related to low bone turnover; parathyroid hormone and 1,25-dihydroxyvitamin D levels may be inappropriately normal for the decreased serum calcium concentration in children with JRA.

Adolescent↗
PubMed1994

Assessing anger expression in children and adolescents.

Anger expression styles are associated with psychological and physical well-being among adults. Little is known about the role of anger expression in children's functioning. This lack of knowledge has resulted, in part, from a lack of validated tools for anger expression measurement. The Pediatric Anger Expression Scale-3rd edition (PAES-III; Jacobs, Phelps, & Rohrs, 1989; Jacobs & Kronaizl, 1991) has been proposed as a reliable and valid assessment instrument of anger expression styles. The PAES-III includes three scales that measure anger turned inward, anger expressed outwardly, and anger controlled cognitively or behaviorally. We evaluated the psychometric properties of this instrument when it is administered verbally to children with juvenile rheumatoid arthritis, children with juvenile diabetes mellitus, and healthy children. Internal consistency was adequate for anger-in and anger-out, but marginal for anger-control. Concurrent validity was supported for the total sample. A principal components analysis suggested a four-factor model of anger expression. Overall, the PAES-III was found to have psychometric limitations. Use of a modified PAES-III may facilitate pediatric behavioral medicine research addressing risk factors for maladjustment among children with chronic illnesses.

Adaptation, Psychological↗
PubMed1994

Progress in diagnosing and understanding chronic pain syndromes in children.

Chronic pain syndromes such as fibromyalgia and reflex sympathetic dystrophy constitute an increasing percentage of new patient referrals to pediatric rheumatology clinics. It is surprising then that so few studies have been published on these syndromes. This review focuses on the investigations that are central to our understanding of this difficult diagnostic area.

Adolescent↗