The role of physical activity (PA) in the development of juvenile idiopathic arthritis (JIA) remains unclear, and the evidence addressing this question is limited. Therefore, this study aimed to investigate the longitudinal association between early-life PA and the risk of JIA, using a symptom-free baseline design to minimize bias from early disease manifestations. A total of 16,415 participants were included from the All Babies in Southeast Sweden cohort. PA was assessed at age 5, 8, and 10–12 years using a composite Total Activity Score by categorizing participants into less active and highly active groups based on z-score threshold. Incident JIA cases (n = 88) were identified through Swedish National Patient Registers. At each age, individuals with a diagnosis of JIA prior to or at the time point were excluded. Participants reporting joint symptoms (pain, swelling, limited mobility, or limping) were excluded to create a symptom-free baseline population. Remaining participants were followed for incident JIA. Cox proportional hazard models were used to estimate hazard ratios (HRs) with 95
Neonatal-onset Aicardi–Goutières syndrome (AGS) is a rare monogenic type I interferonopathy that may mimic congenital infection and can present with severe multisystem inflammation. The distinction between primary hemophagocytic lymphohistiocytosis (HLH) and AGS-associated macrophage activation syndrome (MAS)-like hyperinflammation can be challenging in neonates. We report a term neonate presenting with cholestatic jaundice, a generalized blueberry muffin-like ecchymotic-purpuric rash, cytopenias, hyperferritinemia, hepatosplenomegaly, intracranial calcifications, and severe bilateral ocular disease including cataract, congenital glaucoma, corneal perforation, and endophthalmitis. Extensive infectious evaluation was negative. The patient fulfilled five of eight HLH-2004 criteria, consistent with a severe MAS-like hyperinflammatory phenotype. Dexamethasone and intravenous immunoglobulin had been initiated at the referring centre for presumed virus-associated HLH but were not continued after transfer to our unit. With persistent disease activity, negative microbiological studies, and neuroimaging strongly suggestive of a type I interferonopathy, ruxolitinib was initiated on day of life (DOL) 34 before molecular confirmation. Exome sequencing subsequently identified homozygous pathogenic variants in RNASEH2B and CYP1B1, supporting AGS type 2 and primary congenital glaucoma (glaucoma 3 A), respectively. Serial laboratory data showed sustained improvement after initiation of JAK1/2 inhibition, although the observational nature of a single case and other immunomodulatory exposures limit causal attribution. This case illustrates the clinical overlap between neonatal AGS and MAS-like hyperinflammation, the potential role of early mechanism-based therapy in selected critically ill neonates with suspected interferonopathy, and the importance of comprehensive genomic evaluation when severe ocular disease accompanies AGS. The CYP1B1 variant provides a strong molecular explanation for the congenital glaucoma, while the broader ocular phenotype may have been multifactorial.
Enthesitis/spondylitis-related juvenile idiopathic arthritis (ESR-JIA) is a subtype of JIA characterized by peripheral arthritis and enthesitis, with possible axial skeleton involvement. Fatigue is a common and challenging symptom in JIA, often persisting despite pharmacological treatment, and may be particularly pronounced in ESR-JIA. It can impair physical and psychological well-being, daily activities, and academic performance. However, factors associated with fatigue in children with ESR-JIA remain poorly understood. This cross-sectional study recruited 77 children diagnosed with ESR-JIA. Fatigue was assessed using the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL-MFS) where higher scores indicate less fatigue. Associations between fatigue and clinical disease characteristics, objective clinical measures, subjective patient-reported factors, and blood biomarkers were examined. Spearman correlation analyses and simple and stepwise multivariable linear regression were performed to identify factors associated with fatigue. Univariable linear regression showed body composition parameters (free fat mass, skeletal muscle mass, and skeletal muscle index) and muscle strength (ankle dorsiflexion strength and ankle plantarflexion strength) were positively correlated with PedsQL-MFS total scores. In contrast, pain intensity, depression-related symptoms, and sleep efficiency were negatively associated with PedsQL-MFS total scores. Subsequent stepwise multivariable regression analysis showed pain intensity, depression-related cognitive changes, ankle plantarflexion strength, and sleep efficiency were independently associated with PedsQL-MFS total scores, collectively explaining 33.6
Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Adenitis (PFAPA) syndrome is the most common autoinflammatory periodic fever disorder of childhood. This study aimed to compare the effectiveness and safety of surgical and medical treatments for PFAPA using a systematic review and network meta-analysis (NMA). Medline, Embase, and CENTRAL were searched through November 2025. Randomized and non-randomized comparative studies evaluating surgical interventions (tonsillectomy, adenotonsillectomy, tonsillotomy) and medical therapies (corticosteroids, cimetidine, colchicine, and others) in PFAPA were included. The primary outcome was clinical remission or symptom resolution; secondary outcomes included variation with age and duration of disease. Pairwise and network meta-analyses were performed using random-effects models. Risk of bias was assessed using RoB 2 and ROBINS-I, and certainty of evidence was evaluated using GRADE. Sixteen studies involving 2,048 patients were included. In the primary NMA, no statistically significant difference was observed between pooled surgical and medical management (OR 1.10, 95
Chronic anterior uveitis represents the most important extra-articular manifestation of Juvenile Idiopathic Arthritis (JIA). Previous reviews have shown that outcome measures for this condition are widely heterogeneous. Therefore, our aim was to update the 2019 systematic literature review and to identify similarities, differences, and emerging outcome domains reported over the subsequent five years. We performed a systematic literature review from 1st January 2019 to 28th February 2025 to identify studies investigating outcome measures used in JIA-associated uveitis (JIA-U), according to PRISMA guidelines. We identified 261 papers, of whom 90 potentially eligible. After the full-text revision, 37 studies plus the previous 27, including 1 randomized clinical trial (RCT), were included. Among these studies, 15 outcome measures for JIA-U were identified. Based on their characteristics, we categorized them into three different subgroups: outcome measures for disease activity (30 studies); outcome measures correlated to structural damage (29 studies); and outcome measures of severe disease course (20 studies). The most frequent outcome measures used were the assessment of anterior chamber (AC) cells (29 studies), the visual acuity (21 studies), the development of structural complications (20 studies) and the use and sparing of immunosuppressive therapies (15 studies). Compared with the 2019 review, we identified four studies reporting novel objective techniques for inflammation assessment, including laser flare photometry and anterior segment optical coherence tomography. Our review confirms the variety of outcome measures for JIA-U while highlighting the emergence of novel imaging and biomarker-based measures. These findings provide an updated evidence base for revising the core outcome set and emphasize the urgent need for a consensus and a composite score, which are essential both for designing endpoints in clinical trials and for guiding treatment choices in clinical practice.
Children with rheumatologic diseases often require immunosuppressive therapies, which can compromise their immune response and increase susceptibility to infections. Despite the heightened risk, vaccination coverage in this population is frequently suboptimal, largely due to concerns over vaccine safety, especially live attenuated vaccines, and the absence of clear, universally adopted guidelines. This retrospective study aims to evaluate the vaccination status and serological immunity of pediatric patients with rheumatologic diseases at the time of diagnosis, prior to initiation of immunosuppressive therapy. We conducted a retrospective review of medical records from children under 16 years of age diagnosed with a rheumatologic disease at Geneva University Hospitals (HUG) between 2005 and 2023. Demographic data, clinical diagnosis, vaccination history, and available vaccine-specific serologies were collected and analysed. Seventy-four patients were included, with a median age at diagnosis of 6 years. At the time of diagnosis, vaccination coverage was highest for Haemophilus influenzae type b (Hib; 93
The purpose of the study is to evaluate the demographic characteristics, clinical features, and management strategies of TNF inhibitor-related autoimmune disorders (TIRAIDs) in pediatric rheumatology practice. The medical records of 71 pediatric patients treated with a TNF inhibitor for a rheumatologic disease and who exhibited any TIRAIDs during a 10-year period were retrospectively evaluated. The prevalence of TIRAIDs was 2.8
Tumour necrosis factor (TNF) receptor-1 associated periodic syndrome (TRAPS) is an autoinflammatory condition. Most treatment options require regular injections, posing challenges for individuals with needle phobia. We reviewed the medical records of two siblings, a now 14-year-old female, and her 10-year-old brother, both diagnosed with TRAPS in early infancy. Both children responded to on-demand oral corticosteroid therapy, but due to frequent flares, persistent biochemical inflammation and poor growth, steroid-sparing therapies were required. Non-standard first-line therapies were subsequently selected as the eldest child had developed a needle phobia, and she was commenced on an oral Janus kinase (JAK) inhibitor. The younger brother was treated with tocilizumab, reflecting parental preference to minimise frequent injections. Over the last two years, both children have demonstrated significant improvement, with almost no further TRAPS flares, normalisation of baseline inflammatory markers and improvements in their growth trajectories. No adverse effects were reported on either agent. JAK inhibitor therapy and tocilizumab were effective in our two cases of TRAPS. To our knowledge, this is the first report describing the use of a JAK inhibitor in TRAPS, while also adding to the limited published experience with tocilizumab in TRAPS.
BACKGROUND:Juvenile dermatomyositis (JDM) is a complex multi-system disease that significantly impacts the health and development of affected children. Accurate and comprehensive measurement of disease activity and outcomes is essential for effective clinical management and research. Traditional unidimensional measures are insufficient for capturing the multifaceted nature of JDM, necessitating the development of specialized clinimetric tools that integrate multiple health domains and perspectives. MAIN BODY:Over the past decades, significant advances have been made in developing and validating clinimetric assessments for JDM. Core domains such as muscle strength, skin involvement, global disease activity, and patient-reported outcomes are now routinely evaluated using established instruments like the Childhood Myositis Assessment Scale, Manual Muscle Testing, and various skin assessment tools. Composite indices, including the Juvenile Dermatomyositis Activity Index and the ACR/EULAR Total Improvement Score, enhance sensitivity to clinical changes by integrating multidimensional data. Imaging modalities such as magnetic resonance imaging and muscle ultrasound provide objective insights into muscle inflammation and damage, while histopathology scoring offers valuable research and prognostic information. Despite these advances, challenges remain in standardizing assessments, particularly for skin disease and patient-reported symptoms like fatigue and social participation. Emerging digital health technologies and biomarker integration hold promise for improving longitudinal monitoring and precision in disease evaluation. Additionally, the treat-to-target approach in JDM underscores the need for frequent, accurate measurements to guide therapy adjustments. However, practical barriers including resource limitations and tool complexity hinder widespread clinical adoption. CONCLUSION:Considerable progress has been achieved in the development of clinimetric tools for JDM, enabling more nuanced and patient-centred disease assessment. Future efforts should prioritize the creation of disease-specific patient-reported outcome measures, streamlined and feasible assessment protocols, and the integration of biological markers and digital innovations. These advances will support precision medicine approaches and improve outcomes for children living with JDM. CLINICAL TRIAL NUMBER:Not applicable.
Abstract Background Juvenile dermatomyositis (JDM) is a complex multi-system disease that significantly impacts the health and development of affected children. Accurate and comprehensive measurement of disease activity and outcomes is essential for effective clinical management and research. Traditional unidimensional measures are insufficient for capturing the multifaceted nature of JDM, necessitating the development of specialized clinimetric tools that integrate multiple health domains and perspectives. Main body Over the past decades, significant advances have been made in developing and validating clinimetric assessments for JDM. Core domains such as muscle strength, skin involvement, global disease activity, and patient-reported outcomes are now routinely evaluated using established instruments like the Childhood Myositis Assessment Scale, Manual Muscle Testing, and various skin assessment tools. Composite indices, including the Juvenile Dermatomyositis Activity Index and the ACR/EULAR Total Improvement Score, enhance sensitivity to clinical changes by integrating multidimensional data. Imaging modalities such as magnetic resonance imaging and muscle ultrasound provide objective insights into muscle inflammation and damage, while histopathology scoring offers valuable research and prognostic information. Despite these advances, challenges remain in standardizing assessments, particularly for skin disease and patient-reported symptoms like fatigue and social participation. Emerging digital health technologies and biomarker integration hold promise for improving longitudinal monitoring and precision in disease evaluation. Additionally, the treat-to-target approach in JDM underscores the need for frequent, accurate measurements to guide therapy adjustments. However, practical barriers including resource limitations and tool complexity hinder widespread clinical adoption. Conclusion Considerable progress has been achieved in the development of clinimetric tools for JDM, enabling more nuanced and patient-centred disease assessment. Future efforts should prioritize the creation of disease-specific patient-reported outcome measures, streamlined and feasible assessment protocols, and the integration of biological markers and digital innovations. These advances will support precision medicine approaches and improve outcomes for children living with JDM. Clinical trial number Not applicable.
This study sought to evaluate the clinical implications of thrombocytopenia in pediatric patients diagnosed with systemic lupus erythematosus (SLE) and to explore its relationship with various disease features. Furthermore, the research aimed to identify risk factors that affect the occurrence of SLE-associated thrombocytopenia. A single-center retrospective study was conducted involving 236 pediatric patients diagnosed with SLE at Children’s Hospital of Fudan University from January 2020 and December 2025. Clinical information and laboratory parameters, such as complement levels, autoantibody profiles, and platelet counts, were systematically collected. Participants were divided into two groups and those without, based on their platelet counts at the time they were diagnosed with SLE. The presence of thrombocytopenia was determined at diagnosis, and further subgroup analyses were carried out based on the severity of the condition. All statistical analyses, such as logistic regression and one-way ANOVA, were conducted using SPSS version 26.0. Thrombocytopenia was observed in 19.5
Macrophage activation syndrome (MAS) complicating pediatric systemic lupus erythematosus (cSLE) is a life-threatening hyperinflammatory state driven by dysregulated cytokine release. A recent systematic literature review identified only a limited number of cSLE-MAS cases treated with IL-1 inhibitors, with variable efficacy, underscoring the need for evidence-based salvage strategies when first-line biologic therapy fails. We report a 17-year-old female with cSLE who developed secondary hemophagocytic lymphohistiocytosis/MAS fulfilling HLH-2004 criteria approximately 17 months after initial diagnosis, in the setting of medication nonadherence and nutritional failure. The MAS course was refractory to intravenous immunoglobulin, pulse methylprednisolone, dexamethasone, cyclosporine, and intravenous anakinra, and was further complicated by a secondary Clostridioides difficile superinfection precipitating a MAS flare with ferritin peaking at > 10,000 ng/mL. Following transfer to our institution, subcutaneous canakinumab at standard weight-based dosing produced prompt defervescence, sustained ferritin normalization, and clinical stabilization permitting transition to outpatient immunomodulation. This case highlights canakinumab as a viable salvage therapeutic option for patients with biologic-refractory cSLE-MAS. Emerging evidence supports an expanding role for selective IL-1β blockade in pediatric lupus-associated hyperinflammatory syndromes; prospective studies are needed to define optimal dosing, sequencing, and treatment duration.
Abstract Background Children with juvenile dermatomyositis (JDM) and juvenile idiopathic arthritis (JIA) have increased rates of anxiety and depression (15–65%) when compared to healthy children. Narrative medicine, a group-based intervention that allows patients to reflect on medical experiences, improves patient-reported outcomes with reduces depression rates in adults. Given limited data in pediatric rheumatology, this study assesses feasibility of a patient-targeted narrative medicine intervention and its impact on mental health burden in JDM and JIA. Methods We prospectively recruited patients ages 6 to 21 with JDM and JIA for a narrative medicine intervention. Participants were divided by diagnosis and age into four narrative medicine groups, with six sessions held over 3 months. Demographic and medical information were collected by chart review. Patients completed pre- and post-intervention questionnaires including Patient-Reported Outcomes Measurement Information System Depression Scale, Generalized Anxiety Disorder-7 (GAD-7), Childhood Attitude Towards Illness Scale, Patient Health Questionnaire-8 (PHQ-8), and CoVID Stress Scale. Results Twelve patients with JDM (67% female) and nine with JIA (78% female) participated in the narrative medicine intervention. All patients participated in at least 50% of sessions and 91% participated in at least four of the six sessions. Wilcoxon signed-rank test revealed no statistically significant difference between pre- and post-intervention questionnaires for any scales. Sub-analysis of those with elevated GAD-7 and PHQ-8 pre-intervention showed a trend towards improvement in anxiety (p=0.057) and no change for depression (p=0.171). Conclusion Ninety-one percent participated in at least four of the six sessions, demonstrating feasibility. This exploratory study showed trend toward improved anxiety following narrative medicine session participation for those with elevated GAD-7.
This study aimed to analyze the allele frequencies and genotype distributions of key FKBP4 single nucleotide polymorphisms (SNPs) (rs11833878, rs1981655, and rs41456246) in pediatric systemic lupus erythematosus (pSLE) patients versus healthy controls and to evaluate their association with glucocorticoid (GC) treatment efficacy. Forty-five patients with pSLE and 45 age- and sex-matched healthy controls were recruited between October 2022 and June 2024. Genotyping was performed using the imLDR® kit. The patients received standard GC treatment. Clinical assessments (SLEDAI-2K, laboratory parameters, and GC dosage) were performed at baseline, 3, and 6 months. Genotypes at rs11833878 and rs41456246 were significantly correlated with clinical indicators. rs11833878 was associated with a significant difference in baseline platelet (PLT) count (P = 0.037) and PLT improvement at 3 months (P = 0.016). From baseline to 6 months, it correlated with SLEDAI-2K reduction (P = 0.019) and PLT change (P = 0.035). Between 3 and 6 months, it was associated with a 24-hour urinary protein reduction (P = 0.047). rs41456246 was associated with a significant difference in baseline white blood cell (WBC) count (P = 0.011) and GC dosage at 3 months (P = 0.029). From baseline to 6 months, it correlated with the magnitude of GC tapering (P = 0.021) and PLT improvement (P = 0.034). Between 3 and 6 months, it was associated with the extent of GC tapering (P = 0.011). No significant associations were found for rs1981655. FKBP4 polymorphisms may modulate the therapeutic response in pSLE, potentially influencing GC receptor function. rs11833878 was linked to improvements in PLT, SLEDAI-2K score, and proteinuria, whereas rs41456246 was associated with WBC, GC dosage, and PLT recovery. Genotyping these loci may serve as a valuable reference for developing personalized treatment strategies.
To compare the relative effects of different treatment strategies for Systemic Juvenile Idiopathic Arthritis (sJIA) on clinical inactivity (CID)/remission and safety using a Bayesian network meta-analysis and to rank the treatment options. PubMed, Embase, Web of Science, the Cochrane Library, and Scopus were systematically searched from inception to October 2025 according to PRISMA 2020 and PRISMA-NMA specifications. Randomized controlled trials (RCTs), prospective cohorts, and retrospective/registry studies were included. The primary outcome was the CID/remission rate, and the secondary outcome was the incidence of adverse events (AEs) (normalized per patient-year). Random-effects and Bayesian hierarchical network models were used. Risk of bias was assessed using ROB-2 and NOS, and the certainty of evidence was assessed using GRADE. A total of 2,408 records were retrieved. After deduplication, 1,088 records were screened for titles/abstracts, and 200 were reviewed in full text. Fifteen studies (total sample size 1,548) were ultimately included. A pooled analysis showed that approximately two-thirds of patients achieved CID/remission during follow-up (random-effects model). Stratification suggested that an early IL-1/IL-6 strategy had a more favorable response rate. A network meta-ranking analysis (SUCRA) showed that early IL-1/IL-6 blockade ranked first, followed by anakinra and canakinumab; tocilizumab was in the middle; and conventional care and mixed biologic strategies ranked last. The overall AE rate was low and consistent across studies; IL-1/IL-6 targeted drugs had a favorable safety profile. Multiple sensitivity analyses and cumulative evidence analysis supported the robustness of the conclusions. In sJIA, immediate intensive IL-1/IL-6 therapy at diagnosis is more effective than a step-up approach in achieving and maintaining CID/remission, while also having an acceptable safety profile, supporting the initial “target-to-treat (T2T)” strategy. Future prospective studies and biomarker-stratified validation of each strategy are needed.
Non-infectious uveitis (NIU) are rare in children but might be associated with substantial visual impairment. Most NIU paediatric cohorts originate from Europe, North America, or Asia, with minimal representation of Caribbean populations. Our study aimed to describe the epidemiology, clinical features, aetiologies and outcomes of paediatric NIU in Martinique. We conducted a monocentre, retrospective cohort study that included all children under the age of 18 diagnosed with NIU at the University Hospital of Martinique between 2010 and 2024. We identified cases through paediatric and ophthalmology registries, medical records, and national hospital databases. We excluded infectious uveitis and non-residents. Incidence estimates used population data. A total of 17 children with NIU were included in the study. 41
This study aimed to examine the clinical characteristics, triggers and risk factors for gastrointestinal (GI) complications in anti-NXP2-positive JDM (anti-NXP2-JDM) patients. A retrospective analysis was performed on 57 anti-NXP2-JDM patients, including 19 with severe GI complications (GI group) and 38 without GI involvement (Non-GI group). The GI group had a male-to-female ratio of 6:13 and a mean onset age of 5.83 years, with abdominal pain as the most common initial symptom. All severe GI involvement occurred during active JDM, and 16 patients (84
Abstract Background Physical activity (PA) is important for disease management and overall health in adolescents with juvenile idiopathic arthritis (JIA). In clinical practice, identifying low cardiorespiratory fitness (CRF) and encouraging higher-intensity PA are priorities. We investigated whether introducing submaximal treadmill fitness testing could increase PA, estimated peak oxygen uptake (VO 2peak ), walking distance, physical function, and health-related quality of life (HRQoL) in adolescents with JIA, and examined associations between PA, VO 2peak , and walking distance. Methods In this exploratory pre–post study, adolescents aged 10–18 years with non-systemic JIA were consecutively recruited during routine physiotherapy visits at a rheumatology clinic. A submaximal treadmill test was used to estimate VO 2peak at baseline and follow-up. Self-reported PA was assessed with the International Physical Activity Questionnaire Short-Form (IPAQ-SF), and physical function and HRQoL with the Juvenile Arthritis Multidimensional Assessment Report (JAMAR). Within-participant changes were analysed with paired tests; associations were assessed using Spearman’s rank correlation. Results Thirty-four participants were included; 24 completed follow-up. IPAQ-derived PA did not change significantly between assessments. Estimated VO 2peak was higher at follow-up by 2.4 (SD 4.4) mL∙kg − 1 ∙min − 1 ( P = 0.01) and walking distance was higher by 31 (69) metres ( P = 0.04), whereas no significant changes were observed in JAMAR physical function or HRQoL. Vigorous PA showed the strongest associations with estimated VO 2peak at baseline and follow-up (rho up to 0.51; P < 0.05). Associations of moderate-to-vigorous and total PA with VO 2peak were weaker and evident only at follow-up (rho ~ 0.41–0.43), and vigorous PA correlated with walking distance at follow-up (rho = 0.42; P = 0.040); other associations were low or non-significant. Conclusions Introducing submaximal treadmill fitness testing in routine care did not change self-reported PA, but estimated VO 2peak and walking distance increased significantly. Submaximal testing may be a feasible clinical tool to identify low CRF and support counselling. Larger studies are needed to determine whether fitness testing can promote PA and to identify which adolescents benefit most, using measurement approaches that capture complementary aspects of PA (e.g., self-report for context and perceived behaviour, and device-based metrics for volume and intensity where appropriate).
BACKGROUNDS:To compare hospitalization characteristics, clinical phenotypes, risk factors for IgA vasculitis nephritis (IgAVN), and prognostic outcomes in children with IgA vasculitis (IgAV) before and after the COVID-19, thereby elucidating the impact of the pandemic on the disease spectrum of IgAV to provide evidence for optimized disease management and precision medicine in the Post-COVID-19 era. METHODS:A single-center retrospective cohort study was conducted involving children hospitalized with IgAV during two periods: Pre-COVID-19 (2017-2019) and the Post-COVID-19 endemic phase (2023-2025). We systematically compared general demographics, clinical phenotypes, and etiological profiles between the two cohorts. IgAV hospitalization proportions were calculated, and time-series models predicted crude hospitalization rates to assess burden trends. Furthermore, a 6-month follow-up was performed for newly-diagnosed non-nephritic patients to evaluate relapse rate and progression to IgAVN. Finally, multivariate logistic regression identified independent IgAVN risk factors. RESULTS:Compared to the Pre-COVID-19 period, patients in the Post-COVID-19 era exhibited significant alterations in humoral immunity and complement profiles, alongside increased rates of Mycoplasma pneumoniae infection. The disease burden intensified markedly: hospitalization duration, costs, and the proportion of IgAV admissions (including both newly-diagnosed and relapsed cases) surged, with the observed crude hospitalization rate significantly exceeding model predictions. Among newly-diagnosed cases, the proportion of the renal subtype increased significantly, while the cutaneous-only form decreased. Follow-up data revealed no significant difference in relapse rates between cohorts; However, the progression rate to nephritis was significantly elevated in the Post-COVID-19 group. Duration of rash emerged as the sole consistent independent predictor of IgAVN across both periods. CONCLUSION:In the post-COVID-19 era, childhood IgAV presents with new clinical characteristics, marked by an increased overall disease burden and a shift towards more severe clinical phenotypes. These changes may be associated with rising Mycoplasma pneumoniae infection and dysregulation of the complement-coagulation system.Notably, newly-diagnosed non-nephritic patients face a significantly higher risk of renal involvement, underscoring the need for enhanced early clinical monitoring and long-term follow-up. While the spectrum of risk factors for IgAVN has evolved, rash duration remains a critical predictor requiring close attention.
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children. Uveitis is the most frequent extra-articular manifestation of JIA and a major cause of visual morbidity. Despite advances in immunomodulatory therapy, many patients reach adulthood with active ocular inflammation or vision-threatening complications. The transition from pediatric to adult care represents a vulnerable period. The primary objective of our study is to describe ophthalmologic and rheumatologic disease characteristics at the time of transition from pediatric to adult care. We conducted a retrospective cohort study of patients with JIA and past or present uveitis who transitioned to adult rheumatology at Cochin Hospital between 2016 and 2024. Clinical, ophthalmologic, and therapeutic data were collected from electronic medical records. Descriptive statistics were performed. Comparative analyses were exploratory and intended to describe differences between subgroups rather than to test predefined hypotheses. A total of 46 patients were included. Median age at JIA diagnosis was 7.5 years [IQR 2.0–16.0] and median age at first uveitis was 6.0 years [IQR 3.0–12.2]. Median follow-up after transition was 2.44 years [IQR 1.17–3.94]. Most patients were female (80
