ObjectiveConcern exists that medications used to treat patients with systemic juvenile idiopathic arthritis (JIA), particularly interleukin (IL)‐1 and IL‐6 blocking agents, might be causing adverse drug reactions and lung disease (systemic JIA‐LD). Carriage of HLA–DRB1*15 has been reported as a risk factor for adverse drug reactions among patients with systemic JIA. We performed a retrospective chart review to evaluate these factors at our center.MethodsWe reviewed the records of 86 subjects with systemic JIA followed for at least 6 months between 1996 and 2022. HLA typing was performed in 23 of the subjects. We compared characteristics of patients with or without eosinophilia. Among patients with HLA typing, we compared clinical characteristics of subjects with or without DRB1*15 and with or without systemic JIA‐LD.ResultsAmong the 23 patients with HLA typing, 74% carried DRB1*15, and 63% of patients without systemic JIA‐LD carried DRB1*15. Seven subjects had systemic JIA‐LD, all of whom carried DRB1*15. Patients with systemic JIA‐LD were younger at the time of diagnosis and more likely to have had macrophage activation syndrome. Exposure to IL‐1 and IL‐6 blockers was common, occurring in 95% of patients. Eosinophilia occurred in 39% of patients with systemic JIA, often before IL‐1 or IL‐6 blockade. Eosinophilia was associated with adverse drug reactions and macrophage activation syndrome. There was 1 death, unrelated to active systemic JIA disease.ConclusionCarriage of DRB1*15 was more common in this cohort of patients with systemic JIA than in the general population. Eosinophilia and systemic JIA‐LD were more common among patients with severe systemic JIA complicated by macrophage activation syndrome.
Objectives: Adolescents with psychiatric conditions more commonly engage in high-risk sexual behaviors and are at increased risk of sexually transmitted infections (STIs) and when presenting to pediatric emergency departments (PEDs) may be an important population in which to target screening efforts. This study aimed to determine frequency of physiciandocumented sexual history and STI screening in adolescents presenting to a PED with mental health-related complaints.Methods: Retrospective study of patients aged 14 to 18 years presenting to a PED February 2015 to September 2016. Electronic records were reviewed for demographics, chief complaint, sexual history documentation, STI screening, resident involvement in patient care, and disposition. Proportions were calculated for frequencies, whereas χ 2 and Fisher exact tests evaluated factors associated with documentation of sexual history and STI screening.Results: Two hundred eighty-five patient encounters were identified.Age range was 15 to 18 years with an average of 16 years, and 58% were girls. The most common chief complaint was "intentional ingestion/ overdose" (169 encounters, 59%) followed by "suicidal/attempted suicide" (59, 21%). Seventy-seven patients (27%) had sexual history documented. Girls were more likely to have sexual history documented (75% vs 52%, P = 0.0004). Forty-five (59%) patients were noted to be sexually active, and 17 (38%) of these were screened for STI. There was no relationship between screening and race, sex, or involvement of a resident in patient care.
Conclusions:In a high-risk PED population, physicians documented sexual history only 27% of the time. Female patients were more likely to have a sexual history documented. In patients with sexual history indicating risk for STI, less than half were screened.
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