Serum homocysteine level in children with Juvenile Idiopathic Arthritis

Alam, Faridul; Islam, Mohammed Mahbubul; Haque, Md. Ashraful; Rahman, Shahana A

doi:10.3329/bmrcb.v46i1.47463

Cited by 3 publications

(3 citation statements)

References 13 publications

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“…Some combination therapies display little difference compared with monotherapy; for example, methotrexate plus sulfasalazine does not produce a significant change in disease activity compared with methotrexate monotherapy 18. Notably, combination therapy of methotrexate plus cyclosporine was measured using the outcome measure of choice for clinical trials of drugs used to treat RA.…”

Section: Discussionmentioning

confidence: 99%

Treating rheumatoid arthritis

Korol,

Baumeister

2023

Jaapa

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Rheumatoid arthritis (RA) affects about 1% of the world's population and can lead to loss of joint function, reduced mobility, and permanent damage to cartilage and bone. Treatment options for RA primarily include disease-modifying antirheumatic drugs (DMARDs) such as methotrexate, but the development of new drugs has complicated treatment decisions. Weighing treatment options for patients with RA largely depends on three major factors: efficacy, adverse reaction profile, and cost. A review of the literature supports methotrexate monotherapy as the current best-practice model for treating RA, compared with combination therapy of methotrexate and/or other DMARDs.

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Section: Discussionmentioning

confidence: 99%

Treating rheumatoid arthritis

Korol,

Baumeister

2023

Jaapa

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“…Meta-analyses reveal that folic acid supplementation can reduce hepatotoxicity and the frequency of GI side-effects associated with MTX, lower transaminases levels and limit the number of patients choosing to discontinue MTX [16]. In parallel, the low folic acid levels associated with MTX treatment are also responsible for the elevated circulating concentrations of homocysteine (HCY) observed among patients with RMDs (including JIA) on MTX, compared to those on anti-tumor necrosis factor-α (anti-TNF-α) treatment [16][17][18][19][20]. HCY reduces the activity of the asymmetric dimethylarginine (ADMA) decomposing enzyme and carotid intima-media thickness, initiating atheromatosis and atherosclerosis, while multiplying the cardiovascular disease (CVD) risk of patients, irrespective of the methylenetetrahydrofolate reductase (MTHFR) C677T genotype [17,21].…”

Section: Medication-induced Nutrition-related Side Effects 211 Mtx Ad...mentioning

confidence: 99%

Nutritional Aspects of Juvenile Idiopathic Arthritis: An A to Z for Dietitians

et al. 2023

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Juvenile idiopathic arthritis (JIA) represents a chronic, autoimmune, rheumatic musculoskeletal disease with a diagnosis before 16 years of age. Chronic arthritis is a common manifestation in all JIA subtypes. The nature of JIA, in combination to its therapy often results in the development of nutrition-, gastrointestinal (GI)- or metabolic-related issues. The most-common therapy-related nutritional issues involve methotrexate (MTX) and glucocorticosteroids (GCC) adverse events. MTX is a folic acid antagonist, thus supplementation with folic acid in required for improving GI side effects and correcting low serum levels. On the other hand, long-term GCC administration is often associated with hyperglycemia, insulin resistance and growth delay. This relationship is further aggravated when more joints are affected and greater doses of GCC are being administered. Apart from stature, body mass index z-scores are also suboptimal in JIA. Other signs of malnutrition include decreased phase angle and muscle mass, especially among patients with polyarthritis JIA. Evidence also points to the existence of an inverse relationship between disease activity and overweight/obesity. Specific dietary patterns, including the anti-inflammatory diet, might confer improvements in selected JIA outcomes, but the level of available research is yet insufficient to draw safe conclusions. The majority of patients exhibit suboptimal vitamin D status; hence, supplementation is recommended. Collectively, the evidence indicates that, due to the age of onset and the complexity of the disease, along with its pharmacotherapy, children with JIA are prone to the development of several nutritional problems, warranting expert monitoring. Vitamin deficiencies, oral and GI-problems limiting dietary intake, faltering growth, overweight and obesity, physical inactivity, or impaired bone health are among the many nutritional issues in JIA requiring dietitian support.

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“… 16 Most studies worldwide have not reported on the appropriateness of antibiotic or antiparasitic use in children under 5 with AD. 19 - 22 A systematic review on harmful practices in the management of childhood diarrhea in low- and middle-income countries revealed a wide range of antibiotic use prevalence, varying from 10% to 77%, suggesting that high rates of antibiotic use may be inappropriate. 23 The review also emphasized the variability in accuracy when analyzing antibiotic use, particularly when relying on questionnaires administered to physicians or caregivers, which often yield highly inaccurate findings.…”

Section: Introductionmentioning

confidence: 99%

Antibiotic Prescription Patterns in Children Under 5 Years of Age With Acute Diarrhea in Quito-Ecuador

Sánchez,

Calderón,

Solis

et al. 2023

J Prim Care Community Health

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Background: Diarrheal disease remains a significant cause of child mortality, particularly in regions with limited access to healthcare and sanitation. Inappropriate practices, including unjustified medication prescriptions, pose challenges in the management of acute diarrhea (AD), especially in low- and middle-income countries. Objective: This study analyzed antibiotic prescription patterns and assessed compliance with Integrated Management of Childhood Illness (IMCI) guidelines in children under 5 with AD in the Ministry of Public Health (MOPH) Ambulatory Care Centers of Quito city, Ecuador. Methods: A cross-sectional design was used, collecting electronic health records (EHR) of patients diagnosed with AD from 21 health facilities in District 17D03. A probabilistic and stratified sampling approach was applied. Patient characteristics, prescriber characteristics, treatments, and compliance of IMCI guideline recommendations were evaluated. A stepwise logistic regression analysis examined the association between antibiotic prescription and patient and physician characteristics. Results: A total of 359 children under 5 years of age were included, with 58.77% being girls. 85.24% of the cases of AD were attributed to gastroenteritis and colitis of infectious and unspecified origin. Amebiasis and other protozoal intestinal diseases accounted for 13.37% and 1.11% of the cases, respectively. The completion rates of recording various IMCI parameters varied; parameters such as duration of diarrhea, presence of blood in stool, and evidence of sunken eyes had high completion rates (100%, 100%, and 87.47%, respectively), while parameters like state of consciousness, presence of thirst, and type of diarrhea had low completion rates (0.28%, 0.28%, and 0.84%, respectively). None of the cases had all parameters fully recorded. Antimicrobials were prescribed in 38.72% of the cases. Children aged 3 to 5 years had higher odds of receiving antimicrobial prescription for AD (aOR: 4.42, 95% CI 2.13-9.18, P < .0001) compared to those under 1 year, after adjusting for the number of loose stools per day, gender, and age of the health professional. Conclusion: Variations in IMCI guideline compliance were observed, with no cases fully adhering to the guidelines. Antimicrobial prescription rates were notably high, especially among older children. Further research and specialized interventions are necessary to gain comprehensive insight into the factors underlying non-compliance with the IMCI guidelines.

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Serum homocysteine level in children with Juvenile Idiopathic Arthritis

Cited by 3 publications

References 13 publications

Treating rheumatoid arthritis

Treating rheumatoid arthritis

Nutritional Aspects of Juvenile Idiopathic Arthritis: An A to Z for Dietitians

Antibiotic Prescription Patterns in Children Under 5 Years of Age With Acute Diarrhea in Quito-Ecuador

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