Sulfasalazine (SSZ) is a commonly used disease-modifying antirheumatic drug for juvenile idiopathic arthritis (JIA) that is primarily recommended within the group of juvenile spondyloarthropathies. Current treatment guidelines increasingly limit its role in the management of JIA. This study aimed to evaluate the effectiveness, tolerability and predictive factors of SSZ response in children with JIA, focusing on the impact of ILAR and PRINTO classifications and specific clinical characteristics. This is a multicenter retrospective cohort study of 70 children (≤ 16 years) with JIA treated with SSZ. Effectiveness was assessed by rates of inactive disease, remission and clinical remission off medication. Tolerability was evaluated by the incidence and nature of adverse events. Univariate and multivariate logistic regression analyses were used to identify predictors of SSZ remission, including ILAR and PRINTO categories, polyarticular disease, axial disease and hip involvement. SSZ induced inactive disease in 70
Kawasaki disease (KD) is associated with long-term vascular sequelae, including persistent endothelial abnormalities. Data on laboratory-based markers of oxidative stress during long-term follow-up of KD patients from developing countries are limited. This study aimed to evaluate extracellular nitric oxide metabolites and neutrophil-derived reactive oxygen species (ROS) in patients with KD during follow-up and to explore their associations with coronary artery abnormalities (CAAs). In this prospective, single-centre study, 62 children with KD and 20 age- and gender-matched healthy controls (HC) were enrolled. KD patients were stratified into three groups based on time since diagnosis and further categorised by the presence or absence of CAAs. Serum nitrite and nitrate levels were measured as indicators of extracellular nitric oxide metabolism. Neutrophil ROS production was assessed using a dihydrorhodamine-123 flow cytometric assay. Serum nitrite levels were comparable across the 3 groups (Group 1: 3.46 ± 1.64; Group 2: 5.04 ± 2.55; Group 3: 5.22 ± 3.00) and HC (3.33 ± 1.98) (p = 0.06). The serum nitrate levels in KD patients across all three groups (Group 1: 63.07 ± 41.32; Group 2: 58.63 ± 27.12; Group 3: 64.57 ± 26.36) were also comparable to HC (57.49 ± 8.68) (p = 0.43). In subgroup analysis, serum nitrate levels and serum nitrite levels in KD patients with CAAs and without CAAs were comparable (Group 1: p = 0.60; Group 2: p > 0.99; Group 3: p = 0.10) and (Group 1: p > 0.99; Group 2: p > 0.99; Group 3: p = 0.90), respectively. Neutrophil ROS production (ΔMFI) was increased in KD patients, with a significant rise observed in the intermediate follow-up group 2 (> 1.5–3 years) compared with healthy controls (p = 0.03). No significant correlations were found between oxidative stress markers and systemic inflammatory parameters. Children with KD exhibit persistent oxidative stress during follow-up, as evidenced by increased neutrophil ROS production, indicating ongoing cellular oxidative activity. Elevated ROS may serve as an accessible biomarker for CAAs and long-term cardiovascular risk in KD patients on follow-up.
Chronic non-bacterial osteomyelitis (CNO) is a rare autoinflammatory bone disorder affecting mainly children. While non-steroidal anti-inflammatory drugs (NSAIDs) are the first-line therapy, bisphosphonates (BPs) are frequently used in refractory cases despite limited evidence. This study evaluated the clinical, laboratory, and radiological outcomes of BPs therapy in children affected by CNO. We conducted a single-centre retrospective study of 30 children with CNO treated with intravenous BPs between 2010 and 2023. Data were collected at diagnosis, 12 months after BPs initiation (T2), and at last follow-up (T3). Multivariate analyses were performed to identify factors associated with treatment outcomes. At baseline, 80
To explore perspectives of adolescents with chronic musculoskeletal pain and their caregivers regarding clinical encounters with healthcare providers during their diagnostic journey with implications for pediatric rheumatology. We conducted a secondary qualitative analysis of data from the Journey in Pain Care study. Semi-structured interviews were performed with 15 adolescent-caregiver dyads recruited from the Stanford Pediatric Pain Clinic. Participants included adolescents (ages 11–18) with chronic musculoskeletal pain who had rheumatology consultations during their care journey, along with one caregiver each. Interviews explored diagnostic processes, care team interactions, and meaningful moments in the diagnostic process. Data were analyzed using qualitative content analysis. Four themes were developed in the adolescent and caregiver interviews about their clinical encounters with providers during the diagnostic process: (1) Acknowledgement of Pain is Validating (based on subthemes Pain Disbelief from Providers and Acknowledgement of Pain Regardless of Diagnosis); (2) Lack of Communication Is Dismissive and Uncaring (based on subthemes Impersonal Diagnostic Process, and Passed Around Without Explanation); (3) Inclusion Strengthens Trust In The Process (based on subthemes Listen Provide Information and Demonstrate Engagement Commitment to Answers); and (4) Perceiving Whole Persons Rather Than Diagnostic Puzzles (based on subthemes Dehumanization In Diagnostic Uncertainty and Whole Person Approach). Adolescents with chronic musculoskeletal pain often experience clinical encounters with providers at the intersection of pain disbelief and diagnostic uncertainty. Pediatric rheumatologists can improve care by validating pain experiences, maintaining transparent communication about uncertainty and the diagnostic process, involving adolescents in decision-making, and adopting personalized, relational approaches that acknowledge patients’ humanity beyond their symptoms. To our knowledge, this is the first qualitative study to characterize pediatric rheumatology as a clinical juncture at the intersection of pain disbelief and diagnostic uncertainty in the US, dynamics that may reinforce one another and shape adolescents’ and caregivers’ experiences of care. Using dyadic semi-structured interviews with 15 adolescent–caregiver pairs, we identify four distinct themes from clinical encounters that impact the diagnostic process (1) Acknowledgement of Pain is Validating (2) Lack of Communication Is Dismissive and Uncaring (3) Inclusion Strengthens Trust in the Process and (4) Perceiving Whole Persons Rather Than Diagnostic Puzzles. Findings translate directly into actionable strategies for pediatric rheumatologists helping patients at the intersection of pain disbelief and diagnostic uncertainty, including validating pain regardless of diagnostic clarity, communicating transparently about uncertainty and the diagnostic process, involving adolescents in decision-making, and engaging patients as whole persons not a diagnostic mystery. By centering both adolescent and caregiver perspectives, this work provides a foundation for developing interventions to enhance clinical encounters for patients with chronic musculoskeletal pain in pediatric rheumatology practice.
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
Autosomal dominant pathogenic variants in PLCG2 are associated with autoinflammation and PLCG2–associated antibody deficiency and immune dysregulation (APLAID), characterized by immunological abnormalities and multi-system inflammation. Descriptions of associated neurological manifestations and vascular anomalies are limited. We describe three patients with APLAID, vasculopathies, neuroinflammation, and cerebral vascular tortuosity. These cases highlight underrecognized and clinically important manifestations of APLAID. All three patients had de novo variants in PLCG2 and early systemic inflammatory and immunodeficiency findings within the spectrum of APLAID (e.g. immune laboratory abnormalities, skin and gastrointestinal inflammation, and frequent infections). Additionally, they had notable neurological and vascular findings. Patient #1 (PLCG2 c.3420T > A; p.Asp1140Glu) is a female who had focal seizures at 16 months old. Magnetic resonance imaging (MRI) revealed right parietal leptomeningeal enhancement with white matter changes. MR angiography (MRA) showed cerebrovascular tortuosity and stenoses without evidence of vasculitis. She had extensive veno-lymphatic malformation in the thorax, abnormal renal vasculature, inferior vena cava (IVC) atresia, and bilateral pulmonary vein stenosis (PVS). Patient #2 (PLCG2 c.2122G > C; p.Ala708Pro) is a male who at four years old had an episode of status epilepticus. MRI revealed a right parietal infarct with surrounding leptomeningeal enhancement and MRA demonstrated abnormal caliber of the right middle cerebral artery (MCA), arterial tortuosity, and carotid aneurysms. His course was complicated by aortic root dilation and bilateral PVS. Patient #3 (PLCG2 c.2122G > C; p.Ala708Pro) is a male who at 16 months had a right sided focal motor seizure. MRI demonstrated infarct with associated sulcal enhancement predominantly in the left cerebral hemisphere. MRA found excessive vascular tortuosity and fenestrations. He has a dilated aortic root and ventricular septal defect (VSD). We present three cases of APLAID complicated by significant cerebrovascular tortuosity and seizure and two with cerebral ischemia. The etiology of stroke and/or seizures in these patients is unclear, but vasculopathy leading to perfusion deficits, neuroinflammation, or thrombosis due to underlying thrombotic diathesis or abnormal vascular anatomy may have contributed. We recommend all patients with APLAID undergo monitoring for neurologic manifestations. Additionally, we highlight important vasculopathic findings such as PVS, where early recognition for directed treatment is critical.
Juvenile localised scleroderma (jLS) is a rare disease which impacts negatively on health-related quality of life (HRQoL). We aimed to undertake the cross-cultural adaptation and validation of a novel disease-specific HRQoL measure, the Localised Scleroderma Quality of Life Instrument (LoSQI). In phase I, cross-cultural adaptation was completed using established methodology involving forward/backward translation and cognitive interviews to develop a final version in each language. In phase II, validation was performed using the translated versions. Statistical analyses addressed confirmatory factor analysis, item-level analysis and construct validity. There were 236 participants included in the study (162 participants from 20 sites in the cross-cultural adaptation phase; 213 patients from 36 sites in the validation phase; with 139 participants taking part in both phases). Of the phase II participants 67
Children with giant coronary artery aneurysms (gCAA) after Kawasaki disease (KD) are at high risk of coronary artery thrombosis (CAT), associated with adverse cardiovascular events (ACEs). Long-term anticoagulation is the standard regimen, but evidence comparing rivaroxaban with warfarin in gCAA after KD remains limited. We performed a retrospective observational study at 2 pediatric centers from 2020 to 2025, enrolling children with gCAA after KD. Participants received rivaroxaban or warfarin. The primary efficacy assessment included ACEs and CAT outcomes within 6 months. CAA changes and safety outcomes were assessed. The final cohort included 30 patients, 14 treated with rivaroxaban and 16 with warfarin. ACEs were infrequent, occurring in 1 patient (7.1
Mevalonate kinase deficiency (MKD) is an autosomal-recessive autoinflammatory disorder spanning a clinical continuum from the hyperimmunoglobulin-D syndrome/recurrent-fever phenotype to severe mevalonic aciduria. In infants, the first attacks can resemble infection, incomplete Kawasaki disease, or other forms of systemic hyperinflammation. Comparative evidence to guide treatment choice and dose adjustment remains limited. We describe a female infant with recurrent high fever and a generalized erythematous rash beginning at 1 month and 23 days of age. She was initially treated for suspected incomplete Kawasaki disease because fever, rash, leukocytosis, elevated C-reactive protein, and qualitatively reported mild coronary-artery dilatation were present; segment-specific coronary measurements and z scores were not available. Ferritin 1101.72 ng/mL, soluble CD25 34,200 pg/mL, reduced natural-killer-cell activity, cervical lymphadenopathy, and mild splenomegaly indicated marked hyperinflammation, but the available data were insufficient to diagnose hemophagocytic lymphohistiocytosis or macrophage activation syndrome. Trio whole-exome sequencing identified MVK c.439G > A (p.Ala147Thr), maternally inherited, and c.827 A > G (p.Glu276Gly), paternally inherited. The second variant was not listed in Infevers and was not identified in ClinVar or the peer-reviewed MKD literature searched on 13 July 2026. It was classified as likely pathogenic by the reporting laboratory, but laboratory-specific ACMG/AMP evidence codes and biochemical confirmation were unavailable. We also updated a systematic review of IL-1-targeted treatment in systemic MKD. Intravenous immunoglobulin and systemic corticosteroids produced transient improvement. An etanercept biosimilar provided only temporary control. Tocilizumab prolonged attack intervals but was discontinued after likely treatment-associated secondary hypogammaglobulinemia requiring intravenous immunoglobulin and subsequent relapse. Firsekibart (Jin Beixin; Changchun GeneScience Pharmaceutical Co., Ltd., Changchun, China), a fully human IgG4λ monoclonal antibody that selectively neutralizes IL-1β, was then given off-label at 40 mg subcutaneously (approximately 4 mg/kg) every 4 weeks; after the second dose, the interval was extended to 40 days. At the latest documented follow-up, five doses had been given and no typical fever-rash attacks or new treatment-related adverse events had been reported. The original database search identified 876 records and 7 eligible reports; a targeted update added 3 full-text studies, including the RELIANCE registry, for 10 reports in the final descriptive synthesis. Trial, extension, cohort, post-marketing, registry, and case-based evidence consistently supported IL-1 pathway inhibition. Dose escalation, interval modification, and individualized treat-to-target adjustment were frequent across the published reports. This case supports early MVK testing when recurrent infantile inflammation persists after treatment for suspected incomplete Kawasaki disease. The patient had marked hyperinflammation with several HLH-associated abnormalities, but not enough evidence for a formal HLH/MAS diagnosis. Her response is consistent with the established therapeutic rationale for IL-1 blockade in systemic MKD; however, the c.827 A > G variant requires fuller laboratory documentation, and the firsekibart observation remains a single-patient, short-term, agent-specific experience.
Juvenile-onset systemic lupus erythematosus (JSLE) is characterized by higher disease activity and greater treatment burden than adult-onset disease, often requiring intensive immunosuppression. Rituximab is used in refractory cases, but re-exposure may not be possible when adverse events such as posterior reversible encephalopathy syndrome (PRES) occur. Obinutuzumab, a type II anti-CD20 monoclonal antibody, has shown efficacy in adult patients with lupus nephritis and in those with active SLE, yet pediatric experience is limited. We report an 11-year-old boy with JSLE and lupus nephritis who developed lupus pneumonitis and increased renal activity while receiving conventional therapy. Rituximab was initiated but complicated by PRES six hours after the first infusion, leading to discontinuation. Despite cyclophosphamide induction and mycophenolate mofetil plus cyclosporine maintenance, he later experienced a disease flare with malar rash, low complement levels, and rising anti-dsDNA titres. Because rituximab re-use was avoided, obinutuzumab was selected as an alternative anti-CD20 agent in the setting of a disease flare. A body-surface-area-adjusted regimen derived from the adult protocol was administered in two infusions under close monitoring. Following obinutuzumab, complement levels normalized, anti-dsDNA declined, and SLEDAI-2K decreased from 6 to 2, and peripheral B-cell depletion was confirmed at eight weeks and maintained at six months, without neurological or infectious complications over six months of follow-up. This case suggests that obinutuzumab may be a feasible alternative anti-CD20 option in rituximab-intolerant JSLE, pending results from ongoing pediatric clinical trials.
Temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA) is common, frequently underrecognized, and may progress despite minimal symptoms. Untreated TMJ arthritis has been associated with pain, functional limitation, and dentofacial growth disturbance, supporting early identification and intervention even in clinically subtle disease. The role of minimally invasive TMJ procedures remains incompletely defined. The aim of this study was to evaluate patient-reported and clinical outcomes following TMJ arthrocentesis or arthroscopy in patients with symptomatic TMJ involvement associated with JIA. We retrospectively evaluated 45 patients with JIA who underwent TMJ arthrocentesis or arthroscopy between 2014 and 2023. The cohort was 96
In this work, we describe the clinical and functional changes in a family with a novel type I interferonopathy phenotype which we suggest could be associated with a TRIM28 variant, presenting with chilblains, skin ulceration, lipodystrophy and calcinosis. TRIM28 has multiple roles in regulating human health and disease, which include DNA repair and anti-viral response. The latter includes negative regulation of IRF7, one of the master regulators of the interferon response. Whole exome sequencing and targeted panel sequencing was performed on DNA extracted from peripheral blood. Functional work included gene (qPCR), protein (WB) and cytokine (MSD and SIMOA) expression studies. Transfection studies of siRNA in control Human Dermal Fibroblast Cells (HDFCs) using RNAiMAX and of wild-type protein in patient HDFCs using FuGENE HD were also performed. Analysis of WES data according to a dominant model with incomplete penetrance revealed TRIM28 c.A623G; p.Y208C in the proband of Family A and his mildly affected mother. Gene expression studies revealed persistent elevation of interferon inducible proteins including increased gene as well as protein expression of IRF7. Cytokine measurements revealed a marked elevation of pro-inflammatory cytokines particularly IFNβ in affected individuals. A good clinical and functional response to treatment with baricitinib was documented, however the proband subsequently died of septic complications. TRIM28-siRNA transfection into control HDFCs resulted in changes in gene, protein and cytokine expression similar to those seen in the proband. Transfection of a wild-type pEGFP-TRIM28 plasmid into the proband’s HDFCs achieved partial rescue of the cellular phenotype. We describe a novel and severe interferonopathy potentially associated with an autosomal dominant TRIM28 variant with an incomplete penetrance disease model, presenting with skin ulceration, calcinosis, high interferon scores, and upregulation of IRF7. Pathogenicity was supported by TRIM28 gene silencing in healthy HDFCs. Polymorphisms in other genes such as ITGAM could modulate penetrance and expressivity.
Developing and validating patient-reported outcome measures (PROMs) requires a specific methodology to ensure that these tools reliably capture patients’ subjective experiences of health without clinician bias, thereby supporting their use in patient-centred care for children with chronic diseases. The aim of this article is to review this methodology, emphasising its advantages, and identify unmet needs and priorities for future research in this area. It also introduces the COSMIN and OMERACT initiatives and related aids, as well as the EULAR OML, all of which are critical for developing and selecting the most adequate PROMs in Paediatric Rheumatology.
Camptodactyly–arthropathy–coxa vara–pericarditis syndrome is a rare autosomal recessive disorder caused by loss-of-function variants in the proteoglycan 4 gene, which encodes lubricin. It is frequently misdiagnosed as juvenile idiopathic arthritis, leading to prolonged immunosuppressive therapy. We report two unrelated boys born to consanguineous parents who presented with progressive large-joint swelling and were initially diagnosed with juvenile idiopathic arthritis. Both received multiple disease-modifying and biologic agents without clinical response. Inflammatory markers remained persistently normal, and radiographs showed preserved joint spaces without erosive changes. Camptodactyly developed later in the disease course. One patient developed pericardial effusion and showed a reduced bone mineral density on dual-energy X-ray absorptiometry with limited hip motion and acetabular changes; the other patient showed only a qualitative radiographic image of a reduced bone mineral density but was not confirmed by dual-energy X-ray absorptiometry. Whole-exome sequencing identified a previously reported homozygous frameshift variant in proteoglycan 4 gene (c.2208del; p.Thr737ProfsTer175) in the first patient and a homozygous nonsense variant (c.4104T > A; p.Tyr1368Ter) in the second which was absent from ClinVar and Varsome (accessed April 2026) and it was classified as pathogenic by ACMG/AMP. Camptodactyly–arthropathy–coxa vara–pericarditis syndrome should be considered in children with non-inflammatory arthropathy unresponsive to immunosuppressive therapy. The recognition of the broader phenotypic burden including reduced bone mineral density supports the need for a standard method to assess bone health beyond the classical tetrad approach. Early whole-exome sequencing can shorten the diagnostic journey and redirect management toward appropriate supportive care.
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
