A sizeable proportion of elementary schoolchildren sleep less than the recommended 9 hours. Across the age range, decreases in sleep time and, in ethnic minorities, increasingly delayed bedtimes suggest emerging sleep restriction in preadolescents. Observed ethnic differences in sleep behavior highlight the need for better understanding of the social and environmental influences encouraging these sleep patterns.

A novel B-Mode and Doppler image acquisition and scoring system for assessing synovitis in the pediatric knee was successfully developed through practical exercises and consensus process. Study results demonstrate overall good to excellent reliability. This article is protected by copyright. All rights reserved.

Objective To determine the relationship between race, income, and disease outcomes in children with juvenile dermatomyositis (JDM). Study design Data from 438 subjects with JDM enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Legacy Registry were analyzed. Demographic data included age, sex, race, income and insurance status. Clinical outcomes included muscle strength, presence of rash, calcinosis, weakness, physical function and quality of life measures. Disease outcomes were compared based on race and income. Results Minority subjects were significantly more likely to have low family income, and significantly worse scores on measures of physical function, disease activity and quality of life measures. Lower income subjects had worse scores on measures of physical function, disease activity and quality of life scores, as well as weakness. Black subjects were more likely to have calcinosis. Despite these differences in outcome measures, there were no significant differences in time to diagnosis or disease duration. Using calcinosis as a marker of disease morbidity, Black race, annual family income less than $50,000 per year, negative ANA, and delay in diagnosis greater than 12 months were associated with calcinosis. Conclusions Minority race and lower income are associated with worse morbidity and outcomes in subjects with JDM. Calcinosis was more common in Black subjects. Future studies are needed to further understand these associations so that efforts may be developed to address health disparities in subjects with JDM and improve disease outcomes.

As rheumatology is facing workforce shortages, the ACR/ARHP rheumatology curriculum outline can be utilized to train NPs and PAs and create more efficient integration of NPs and PAs into rheumatology practice.

Objective Musculoskeletal ultrasound (MSUS) is increasingly being utilized in the evaluation of pediatric musculoskeletal diseases. In order to provide objective assessments of arthritis, reliable MSUS scoring systems are needed. Recently, joint-specific scoring systems for arthritis of the pediatric elbow, wrist and finger joints were proposed by the Childhood Arthritis and Rheumatology Research Alliance (CARRA) MSUS workgroup. This study aims to assess reliability of these scoring systems when used by sonographers with different levels of expertise. Methods Members of the CARRA MSUS workgroup attended training sessions for scoring the elbow, wrist and finger. Subsequently, scoring exercises of B-mode and Power Doppler (PD)-mode still-images for each joint were performed. Inter-reader reliability was determined using two-way single score intra-class correlation coefficients (ICC) for synovitis and Cohen's kappa for tenosynovitis. Results Seventeen pediatric rheumatologists with different levels of MSUS expertise (1 – 15 years) completed a 2-hour training session and calibration exercise for each joint. Excellent reliability (ICC>0.75) was found after the first scoring exercise for all of the finger and elbow views evaluated on B-mode and PD-mode, and for all of the wrist views on B-mode. After a second training session and a scoring exercise the wrist PD-mode views reached excellent reliability as well. Conclusion The preliminary CARRA MSUS scoring systems for assessing arthritis of the pediatric elbow, wrist and finger joints demonstrate excellent reliability among pediatric MSUS sonographers with different levels of expertise. This reliable joint-specific scoring system could serve as a clinical tool and scientific outcome measure with further validation.