salicylates and Arthritis--Juvenile

Topics: Arthritis, Juvenile; Child; Diagnosis, Differential; Humans; Pediatrics; Salicylates

Arthritis, following infection caused by group A beta-hemolytic streptococcus, is classically attributed to acute rheumatic fever. However, a new clinical syndrome, called poststreptococcal reactive arthritis, as a distinct entity from acute rheumatic fever, was described recently. The purpose of this paper is to provide a summary of published information on poststreptococcal reactive arthritis. The paper outlines its clinical description and proposed diagnostic criteria. Similarities and differences between poststreptococcal reactive arthritis and acute rheumatic fever are discussed. Information regarding long-term risk of carditis following poststreptococcal reactive arthritis is provided, and therapeutic recommendations are outlined.

Topics: Acute Disease; Adolescent; Adult; Age Factors; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Juvenile; Arthritis, Reactive; Child; Diagnosis, Differential; Humans; Rheumatic Fever; Risk Factors; Salicylates; Streptococcal Infections; Time Factors

Juvenile arthritis includes a variety of rheumatic disorders with varied articular and extraarticular manifestations. The heterogeneity of JA cannot be overemphasized in a rational approach to therapy. Fortunately, most children with JA improve significantly with first-line treatment, especially those with pauciarticular disease. Only a small number of these patients go on to require second-line treatment, usually because of the evolution of their condition into the polyarticular type. Patients with polyarticular, RF-positive disease and patients with early-onset polyarthritis in association with systemic-onset disease both have poor prognoses in terms of ultimate joint function, and should receive second-line treatment early in their therapy. Injectable gold is the drug of choice for the former patients, if an initial trial of NSAIDs has failed. Patients with polyarticular onset, RF-negative disease generally have a better prognosis than other patients with polyarticular involvement. One may wait considerably longer before introducing a second-line agent for these patients. An antimalarial agent may be a reasonable choice for these patients, especially those with limited polyarticular involvement (5 to 10 active joints). This latter principle may also be applied to patients who evolve from pauciarticular to polyarticular involvement. In all such cases, penicillamine is almost never used as first choice. If the patient is a young child, the difficulty with injecting gold and the hazards of antimalarial agents may limit the use of these treatments. In situations such as this, auranofin or sulfasalazine may be the drug of choice. Cytotoxic/antimetabolic therapy should be reserved for those children who have continued active disease despite full courses of two SAARDs, or for those who have been unable to take SAARDs because of their side effects. Corticosteroid therapy should be used only when specifically indicated, and every attempt should be made to wean the patient from it as soon as feasible. The aim of therapy is to ensure that patients enter their remission in the best condition possible. For this to be assured, a sensible approach to drug therapy is mandatory.

Topics: Adolescent; Adrenal Cortex Hormones; Anti-Inflammatory Agents, Non-Steroidal; Antimalarials; Antimetabolites; Antirheumatic Agents; Arthritis, Juvenile; Child; Humans; Infant; Organogold Compounds; Penicillamine; Salicylates; Sulfasalazine

Topics: Anti-Inflammatory Agents; Arthritis, Juvenile; Arthritis, Rheumatoid; Azathioprine; Chloroquine; Cyclophosphamide; Drug Therapy, Combination; Felty Syndrome; Gold; Humans; Hydroxychloroquine; Immunosuppressive Agents; Leukapheresis; Lung Diseases; Lymphoid Tissue; Methotrexate; Penicillamine; Plasmapheresis; Radiotherapy; Rheumatic Diseases; Salicylates; Sjogren's Syndrome; Spinal Diseases; Vasculitis

Aspirin can be more closely controlled than other nonsteroidal anti-inflammatory drugs because serum salicylate levels can be measured. Dosages of 80 to 100 mg/kg per day usually lead to the desired serum salicylate levels of 20 to 25 mg/dl. Gastric irritation, the most frequent cause for cessation of aspirin therapy, is significantly reduced by the use of enteric-coated aspirin. At the onset of aspirin therapy in children, there is frequently moderate elevation of SGOT and SGPT liver enzyme levels. With continued treatment these levels usually fall into the range of mild elevations. Although these children with arthritis often take high doses of aspirin for years, Reye's syndrome is virtually never seen.

Topics: Arthritis, Juvenile; Aspirin; Chemical and Drug Induced Liver Injury; Child; Clinical Trials as Topic; Humans; Liver Diseases; Protein Binding; Salicylates; Serum Albumin

Topics: Anti-Inflammatory Agents; Antibodies, Antinuclear; Arthritis, Juvenile; Child; Child, Preschool; Female; Gold; Humans; Joints; Male; Rheumatoid Factor; Salicylates; Synovial Membrane; Time Factors; Uveitis, Anterior

Topics: Anti-Inflammatory Agents; Arthritis, Juvenile; Arthritis, Rheumatoid; Chemical and Drug Induced Liver Injury; Cryoglobulinemia; Felty Syndrome; Giant Cell Arteritis; Humans; Liver Diseases; Lupus Erythematosus, Systemic; Polymyalgia Rheumatica; Rheumatic Diseases; Rheumatic Fever; Salicylates; Scleroderma, Systemic; Sjogren's Syndrome; Vasculitis

Topics: Adolescent; Adrenal Cortex Hormones; Antimalarials; Arthritis, Juvenile; Child; Female; Gold; Humans; Hydrocortisone; Injections, Intra-Articular; Male; Physical Therapy Modalities; Puberty; Pyrazoles; Rheumatoid Factor; Salicylates

A 2-dose regimen and a 3-dose regimen, both with the same daily dose of acetylsalicylic acid, were compared in 8 patients with juvenile rheumatoid arthritis. The regimens were given according to a cross-over design. The serum salicylic acid levels over 24 hours were studied at the end of each treatment period. As expected somewhat greater fluctuations in the salicylic acid levels were observed with the 2-dose than with the 3-dose regimen. However, therapeutically effective serum levels were observed for most of the 24 hour period with both regimens. It is suggested that a 2-dose regimen has advantage with regard to simplicity and compliance. The pharmacokinetic findings indicate that a 2-dose regimen may be useful in patients with juvenile rheumatoid arthritis.

Topics: Adolescent; Arthritis, Juvenile; Aspirin; Child; Clinical Trials as Topic; Drug Administration Schedule; Female; Humans; Male; Salicylates

Aspirin can be more closely controlled than other nonsteroidal anti-inflammatory drugs because serum salicylate levels can be measured. Dosages of 80 to 100 mg/kg per day usually lead to the desired serum salicylate levels of 20 to 25 mg/dl. Gastric irritation, the most frequent cause for cessation of aspirin therapy, is significantly reduced by the use of enteric-coated aspirin. At the onset of aspirin therapy in children, there is frequently moderate elevation of SGOT and SGPT liver enzyme levels. With continued treatment these levels usually fall into the range of mild elevations. Although these children with arthritis often take high doses of aspirin for years, Reye's syndrome is virtually never seen.

Topics: Arthritis, Juvenile; Aspirin; Chemical and Drug Induced Liver Injury; Child; Clinical Trials as Topic; Humans; Liver Diseases; Protein Binding; Salicylates; Serum Albumin

Topics: Arthritis, Juvenile; Child; Clinical Trials as Topic; Humans; Placebos; Salicylates; Time Factors

Topics: Acetaminophen; Adolescent; Arthritis, Juvenile; Child; Child, Preschool; Clinical Trials as Topic; Double-Blind Method; Drug Evaluation; Female; Humans; Infant; Male; Salicylates

Topics: Adolescent; Arthritis, Juvenile; Aspartate Aminotransferases; Aspirin; Capsules; Child; Child, Preschool; Clinical Trials as Topic; Drug Evaluation; Humans; Salicylates; Tablets, Enteric-Coated

Topics: Adolescent; Arthritis, Juvenile; Aspirin; Child; Delayed-Action Preparations; Humans; Rheumatic Fever; Salicylates; Time Factors

Topics: Analysis of Variance; Antirheumatic Agents; Arthritis, Juvenile; Azathioprine; Capillaries; Child; Child, Preschool; Erythema; Glucocorticoids; Humans; Methotrexate; Oxygen; Regression Analysis; Salicylates; Skin; Statistics, Nonparametric

A procedure for the determination of salicylic acid from human serum is presented. It is based on an acidic extraction, a basic reextraction and the detection of salicylic acid as its iron-III-complex by photometry. The procedure is quantitative over a wide range of linearity, easy to carry out and is especially suitable for therapeutic drug monitoring in the treatment of juvenile rheumatoid arthritis.

Topics: Arthritis, Juvenile; Calibration; Drug Monitoring; Ferrous Compounds; Humans; Photometry; Salicylates; Salicylic Acid

A high performance liquid chromatography (HPLC) method has been developed for measuring salicylic acid in the plasma and saliva of children with juvenile chronic arthritis (JCA). Samples were extracted with diethyl ether and, after drying, redissolved in methanol to be chromatographed. Quantitation of salicylic acid was performed by reverse phase HPLC on a spherisorb ODS-2 column, using methanol: water: acetic acid as mobile phase. Phenolic was monitored by absorbance at 237 nm. Linearity between the amount of mass injected and the response in the detector was determined. This method was applied to compare concentrations of salivary and plasma salicylic acid. The method also permitted the quantitation of salivary salicylate as a non-invasive, indirect method for monitoring the concentration of plasma salicylate in patients with JCA.

Topics: Adolescent; Arthritis, Juvenile; Aspirin; Child; Chromatography, High Pressure Liquid; Female; Humans; Male; Salicylates; Salicylic Acid; Saliva

The plasma level profile of SA and SUA after a single oral dose of ASA was studied in 8 children with juvenile rheumatoid arthritis, aged 3.5-15.0 years. Pharmacokinetic parameters were on average similar to those reported in the literature for adult subjects, although a somewhat larger intersubject variability was found.

Topics: Adolescent; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Juvenile; Child; Child, Preschool; Female; Hippurates; Humans; Male; Salicylates; Salicylic Acid

Administration of salicylates during prodromal viral illness has been associated with the development of Reye's syndrome (RS). We studied salicylate biotransformation in RS patients and compared it with those on chronic salicylate therapy for juvenile rheumatoid arthritis (JRA). Urine of RS patients contained significantly more salicylic acid and less gentisic acid than that of JRA patients while the conjugated metabolites were not different between the two groups. These results suggest decreased salicylate microsomal oxidation in RS. The role of altered salicylate metabolism in the pathogenesis of RS is unclear.

Topics: Arthritis, Juvenile; Biotransformation; Gentisates; Humans; Hydroxybenzoates; Oxidation-Reduction; Reye Syndrome; Salicylates; Salicylic Acid

The mechanisms leading to the previously reported difficulties in achieving therapeutic serum concentrations of salicylates in Kawasaki disease were studied in eight children, once during the acute (febrile) phase and again during the nonfebrile (subacute) phase of the disease. Salicylate bioavailability was impaired during the acute phase of the disease (47.7% +/- 6.6%), and increased significantly thereafter to 75.1% +/- 9.3%. During the febrile phase there was a significant correlation between salicylate bioavailability and steady-state serum concentrations. Salicylate renal clearance was significantly higher during the febrile phase (14.45 +/- 2.5 mL/kg.h), compared with the nonfebrile phase (7 +/- 1.6 mL/kg.h, P less than 0.05). The change in salicylate clearance could be explained by decreased protein binding in the acute phase (82.5% +/- 1.9%) with substantially more free salicylates caused by significantly lower serum albumin concentrations. Changes in urine metabolites during the acute and subacute phases were consistent with the changes in dose administered (100 mg/kg in the acute phase vs 10 mg/kg in the subacute phase). The pattern of metabolites excreted in the urine of children with Kawasaki disease receiving 100 mg/kg was similar to that in children with juvenile rheumatoid arthritis receiving the same dose.

Topics: Arthritis, Juvenile; Biological Availability; Child; Fever; Humans; Kidney; Metabolic Clearance Rate; Mucocutaneous Lymph Node Syndrome; Salicylates

In an 11-year-old child with juvenile rheumatoid arthritis (JRA), the addition of prednisone caused a significant decrease in salicylate serum concentrations. A pharmacokinetic assessment suggested that these changes were not the result of altered compliance or impaired absorption of salicylate but rather an increase in salicylate clearance induced by the corticosteroid.

Topics: Arthritis, Juvenile; Aspirin; Child; Drug Interactions; Drug Therapy, Combination; Humans; Kinetics; Male; Prednisone; Salicylates

Topics: Adolescent; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Juvenile; Child; Female; Humans; Imidazoles; Male; Salicylates

All drugs should be given with caution to pregnant or breast feeding women. Recent concern about the role of salicylates in the aetiology of Reye's syndrome has prompted the DHSS to restrict the use of aspirin in children. The case of a 9 week old breast fed infant whose serum contained 0.47 mmol/l of salicylate is reported. Her mother was taking aspirin 2.4 g/day, and it is concluded that salicylates must not be taken by breast feeding mothers.

Topics: Adult; Arthritis, Juvenile; Aspirin; Breast Feeding; Female; Humans; Infant; Milk, Human; Pregnancy; Salicylates; Salicylic Acid

We reviewed the long-term natural history of 21 adult-onset Still's disease patients. Patient subsets were identified according to clinical course patterns. These included monocyclic systemic disease in 4, polycyclic systemic disease in 2, chronic articular monocyclic systemic disease in 10, and chronic articular polycyclic systemic disease in the remaining 5 patients. Functional outcome differed according to course patterns and the extent of articular involvement. Systemic manifestations, per se, did not contribute to poor functional prognosis. Chronic articular disease had the worst outcome: 27% evolved to functional class III status, compared with none in the cyclic systemic groups. Those patients who had a chronic articular pattern or a polyarticular onset and course were at higher risk to develop disabling arthritis. An aggressive approach to therapy, including the early use of remittive agents, should be considered in these patient subsets.

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Age Factors; Aged; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Juvenile; Female; Humans; Male; Risk; Salicylates

Topics: Arthritis, Juvenile; Diagnosis, Differential; Female; Fever of Unknown Origin; Humans; Male; Middle Aged; Salicylates

A patient who developed chronic salicylism associated with salicylate therapy for treatment of juvenile rheumatoid arthritis is described, and the clinical presentation and treatment of chronic salicylism are reviewed. A 5 1/2-year-old boy was receiving aspirin 150/mg/kg/day for treatment of juvenile rheumatoid arthritis. While on salicylate therapy, the patient developed tachypnea and became increasingly hyperthermic, lethargic, and disoriented. The patient developed a maculopapular rash, weakness, and a decreased level of consciousness during the 11 days before admission to the hospital. Physical examination and laboratory determinations revealed that the patient had hypoprothrombinemia, hypoglycemia, and severe hepatic encephalopathy secondary to long-term salicylate toxicity. The patient was treated for hypoglycemia, electrolyte imbalances, thrombocytopenia, and anemia and was discharged after 24 days. Diagnosing chronic salicylism with hepatic dysfunction was difficult because the symptoms are similar to those of stage I to stage II Reye's syndrome. Liver enzymes, including aspartate aminotransferase (also called SGOT), alanine aminotransferase (also called SGPT), alkaline phosphatase, and lactate dehydrogenase, may be elevated in juvenile arthritis patients with hepatic dysfunction. Liver dysfunction usually improves when salicylate therapy is discontinued. Supportive therapy should always be used in symptomatic patients. Children on long-term, high-dose salicylate therapy should be monitored closely, and baseline liver function tests should be performed. The clinical effectiveness of administering sodium bicarbonate in attempts to alkalinize urine and increase salicylate elimination is controversial. In patients with juvenile rheumatoid arthritis who develop chronic salicylism, careful analysis of the patient's medication history, laboratory values, and clinical presentation are necessary to rule out Reye's syndrome.

Topics: Arthritis, Juvenile; Child, Preschool; Diagnosis, Differential; Hepatic Encephalopathy; Humans; Liver Function Tests; Male; Reye Syndrome; Salicylates

Topics: Arthritis, Juvenile; Child; Humans; Salicylates

Topics: Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Juvenile; Child; Costs and Cost Analysis; Humans; Indomethacin; Propionates; Salicylates; Salicylic Acid

Topics: Adult; Arthritis, Juvenile; Biopsy; Drug Therapy, Combination; Endocardium; Humans; Indomethacin; Male; Myocarditis; Prednisone; Salicylates

Topics: Anti-Inflammatory Agents; Arthritis, Juvenile; Child; Humans; Salicylates; Saliva

Down's syndrome (trisomy 21) is associated with a variety of skeletal abnormalities and an increased incidence of joint hypermobility. Children with Down's syndrome are known to have a number of immunologic abnormalities and an increased incidence of autoimmune phenomena. We report 7 patients with Down's syndrome and arthritis. Four children had polyarticular disease and 3 had pauciarticular disease at onset. Only 1 child had significant cardiac disease. HLA typing in 5 children did not show specific correlations. Mean duration of followup was 3 years and 7 months. All children responded to nonsteroidal antiinflammatory drugs, but only 1 child is in clinical remission. Two children have died: 1 secondary to cervical spine instability and the other secondary to cardiac compromise. Arthropathy associated with Down's syndrome should be an additional exclusion for the diagnosis of juvenile rheumatoid arthritis. Further investigation of this association may give clues to the relationship between genetic and immunologic factors in the pathogenesis of joint inflammation.

Topics: Adolescent; Adult; Arthritis, Juvenile; Arthrography; Child; Down Syndrome; Female; Humans; Joint Diseases; Knee Joint; Male; Salicylates

The nature and treatment of the three major types of juvenile rheumatoid arthritis--systemic, polyarticular, and pauciarticular--are presented.

Topics: Adolescent; Anti-Inflammatory Agents; Arthritis, Juvenile; Aspirin; Child; Child, Preschool; Female; Gold; Humans; Hydroxychloroquine; Joint Prosthesis; Male; Penicillamine; Physical Therapy Modalities; Prednisone; Rheumatoid Factor; Salicylates; Social Support

Topics: Arthritis, Juvenile; Child, Preschool; Female; Humans; Mouth Diseases; Salicylates; Salicylic Acid; Tooth Erosion

Topics: Arthritis, Juvenile; Child, Preschool; Cystic Fibrosis; Humans; Salicylates

Topics: Acetaminophen; Arthritis, Juvenile; Child, Preschool; Cystic Fibrosis; Humans; Male; Salicylates

This study was designed to improve understanding of adolescents' compliance with medical regimens. Compliance with salicylate therapy among adolescents with juvenile rheumatoid arthritis was examined in relationship to two of the most important issues of adolescent psychosocial development--self-image and autonomy. Standardized instruments that assessed these variables were administered to 38 adolescents with juvenile rheumatoid arthritis during the year in which compliance was determined, utilizing serum salicylate measurements. Patients and disease-related characteristics were also recorded, and interactions with personality variables were examined. The data show that adolescents with juvenile rheumatoid arthritis who comply with their medical regimen are those who have high self-esteem and are allowed more autonomy than the noncompliers. The longer the duration of the illness and the more symptoms present at onset, the poorer was self-concept, and hence compliance, at adolescence.

Topics: Adolescent; Arthritis, Juvenile; Dependency, Psychological; Female; Humans; Male; Patient Compliance; Personality; Salicylates; Self Concept

Salicylate (SA) binding to albumin in purified human serum albumin (HSA) solutions was found to be predictably dependent on the concentrations of albumin and total SA. The influence of the presence of other ligands on SA binding in HSA solutions was measured and, in the case of bound fatty acids, free fractions of SA were increased by up to 100%. In sharp contrast, the free fraction of SA present in sera from patients with arthritis who were on long-term aspirin (ASA) therapy was roughly twice that found in HSA solutions. A correlation between serum concentrations of free SA and albumin was evident in sera from one group of children with juvenile rheumatoid arthritis (r = -0.75) but was not seen in sera from the other patients. This would indicate that in vivo, the albumin level is not the sole, or, in some patients, even the dominant determinant of the free fraction of SA. Additional factors such as fatty acids and other hydrophobic ligands, both endogenous and exogenous, should be studied further, especially in adults.

Topics: Adult; Arthritis; Arthritis, Juvenile; Child; Chronic Disease; Fatty Acids; Humans; Protein Binding; Salicylates; Serum Albumin

Salicylate is the drug of first choice in the initial treatment of juvenile rheumatoid arthritis. In therapeutic dosage it will adequately control joint symptoms in the majority of patients. For children who do not respond to or are intolerant of salicylate, a change to one of the other nonsteroidal anti-inflammatory agents is appropriate. In progressive polyarthritis unresponsive to the above agents, the addition of gold, antimalarials, or penicillamine is indicated, preferably in that order. Corticosteroid therapy should be reserved for selected patients meeting specific criteria. Pharmacotherapy of juvenile rheumatoid arthritis should always be individualized. For optimal treatment of the whole child it must be combined with both physical and educational measures.

Topics: Adrenal Cortex Hormones; Antimalarials; Arthritis, Juvenile; Chemical and Drug Induced Liver Injury; Child; Delayed-Action Preparations; Gold; Humans; Ibuprofen; Indomethacin; Penicillamine; Salicylates; Sulindac; Tolmetin

We compared adolescents' compliance with medical regimens with that of younger children and identified characteristics of noncompliant adolescents. Compliance among 82 patients with juvenile rheumatoid arthritis (JRA) was monitored using serum salicylate levels. Fifty-five percent of adolescents and 55% of children were found to have good compliance. Among adolescent patients with JRA, however, the following factors were associated with salicylate therapy non-compliance: longer duration of disease (more than six years); earlier age at onset (under 9 years); later time of referral to a subspecialist; shorter duration of subspecialty clinic care; and fewer clinic visits. Knowledge of these variables will facilitate development of intervention strategies tailored to meet the age-specific needs of this population with chronic illness.

Topics: Adolescent; Arthritis, Juvenile; Child; Female; Humans; Male; Patient Compliance; Salicylates

Topics: Adolescent; Arthritis, Juvenile; Child; Child, Preschool; Female; Humans; Male; Physical Therapy Modalities; Salicylates; Steroids; Zambia

A revision of the treatment of the juvenile chronic arthritis (JCA) is made, Salicylates, still in use, require control of the salicylate level in order to obtain a higher efficiency and to prevent toxicity. New drugs appeared in the last years (by-products of propionic acid, tolmetin acid, fenclofenic...), are useful as an alternative for salicylates and with very little toxicity. Steroid therapy has to be reserved for serious systemic illness only, and slow acting drugs as antimalarials, gold and pencillamine, were only used in those cases with severe persistant activity and in cases of corticosteroid dependents. Use of the immunosuppressive therapy, is justified only in exceptional cases. Immunostimulants (transfer factor, Levamisol) are still in experimental phase. Presentation of the last five years' experience of the Pediatric Department is given. It concerns 25 cases of JCA, 5 systemic forms, 9 polyarticular and 11 forms of pauci-articular. Therapy is based on the predominant use of aspirin and on steroid therapy for the system forms. The efficiency of the treatment is not easy to evaluate regarding consideration of the unpredictable evaluation of the illness.

Topics: Adjuvants, Immunologic; Adrenal Cortex Hormones; Anti-Inflammatory Agents; Arthritis, Juvenile; Child; Child, Preschool; Female; Humans; Immobilization; Immunosuppressive Agents; Infant; Male; Physical Therapy Modalities; Rest; Salicylates; Social Environment

Topics: Adult; Alkaline Phosphatase; Arthritis, Juvenile; Aspirin; Chemical and Drug Induced Liver Injury; Female; Humans; Liver Diseases; Salicylates; Transaminases

The mechanism for aspirin-caused liver injury is not clear. Aspirin produces hepatotoxic reactions as a cumulative phenomenon, requiring days or weeks to develop. Patients with active rheumatic or collagen disease, as well as children, are especially susceptible. Blood levels of salicylate higher than 25 mg/dL are particularly likely to lead to hepatic injury. Levels lower than 15 mg/dL rarely do. The mechanism for acetaminophen liver damage is quite clear. It produces hepatic injury as a result of a large single overdose, usually suicidal in intent. Patients with acetaminophen blood levels higher than 300 mg/dL at four hours after intake are most likely to develop hepatic damage; when N-acetylcysteine is used within the first ten hours after ingestion of an overdose, the recovery rate is reported to be virtually 100%. The conditions of patients receiving long-term full doses of either aspirin or acetaminophen should be intermittently monitored for hepatic injury.

Topics: Acetaminophen; Adolescent; Adult; Alcoholism; Arthritis, Juvenile; Aspirin; Child; Female; Humans; Liver; Lupus Erythematosus, Systemic; Male; Salicylates

Topics: Adolescent; Arthritis, Juvenile; Aspirin; Blood Proteins; Child; Child, Preschool; Female; Heparin; Humans; Individuality; Male; Protein Binding; Salicylates; Saliva; Time Factors

In a prospective study of aspirin therapy for 67 children with juvenile rheumatoid arthritis, we have found that (1) doses greater than 100 mg/kg/day of aspirin may be necessary to achieve therapeutic salicylate levels greater than 20 mg/dL; (2) no improvement in clinical remission rate is seen at salicylate levels greater than 30 mg/dL; (3) clinical toxicity to aspirin is of relatively low incidence (16%), and infrequently causes serious morbidity; (4) symptomatic SGOT elevations are common in the first three months after onset of therapy; and (5) these elevated SGOT levels generally return to normal despite continuation of therapy.

Topics: Adolescent; Arthritis, Juvenile; Aspirin; Child; Child, Preschool; Humans; Infant; Prospective Studies; Salicylates

Juvenile rheumatoid arthritis (JRA) in the Union of Soviet Socialist Republics (USSR) and the United States (USA) shows a remarkable similarity in age of disease onset, subtype onset, frequency, and most laboratory measurements. There is variation in the therapeutic approach with heavier reliance on aspirin in the USA. The evolution of JRA from onset subtype to final subtype over 5 years was the same in both groups and was independent of the type of therapy.

Topics: Adrenal Cortex Hormones; Arthritis, Juvenile; Blood Sedimentation; Body Height; Body Weight; Child; Child, Preschool; Hemoglobins; Humans; Indomethacin; Male; Phenylbutazone; Salicylates; United States; USSR

Free and total (sum of free and protein bound) salicylate concentrations in serum were determined in 17 children (age: 4-17 years) with definite juvenile rheumatoid arthritis. These measurements were carried out immediately before and 2, 4, and 8 hours after the morning dose during a strict 8 hourly aspirin treatment regimen (regular tablets) started 5 days earlier. The ratio of the 0 to 8 hour total salicylate concentrations was 0.95 +/- 0.10 (mean +/- SD), indicating that steady state had been attained. The ratio of the maximum to minimum concentrations during the dosing interval ranged from 1.05 to 2.26 and decreased with increasing average concentration. The concentration ratio was less than 1.3 at average salicylate concentrations above 20 mg/100 ml. It is concluded that the timing of a blood sample is not critical for monitoring steady state serum salicylate concentrations in the usual therapeutic range if the dosing interval is 8 hours or less. Free salicylate concentrations increased more than proportionately with increasing total concentrations due to the concentration dependent protein binding of the drug in serum.

Topics: Adolescent; Arthritis, Juvenile; Blood Sedimentation; Child; Child, Preschool; Female; Humans; Male; Protein Binding; Rheumatoid Factor; Salicylates

Topics: Acetaminophen; Antidotes; Arthritis, Juvenile; Aspirin; Child, Preschool; Female; Hemostasis; Humans; Hypersensitivity; Infant; Kinetics; Pregnancy; Salicylates; Stomach

Topics: Arthritis, Juvenile; Chemical and Drug Induced Liver Injury; Child; Female; Humans; Liver Diseases; Salicylates

In a case of juvenile rheumatoid arthritis with large synovial cysts, cyst fluid aspiration was performed to relieve pain, but recurrence was prevented with salicylate therapy alone. The mechanism of formation of synovial cysts is discussed.

Topics: Arthritis, Juvenile; Child; Humans; Male; Salicylates; Synovial Cyst

Plasma salicylate concentration was monitored in 42 children on long-term salicylate therapy for rheumatoid arthritis. A given dose of salicylate per kg resulted in large variations in plasma levels, both between individuals and for a single individual at different times. The factors responsible for such variations were studied; in 6 cases urinary metabolites of salicylate were analysed. The relation between salicylate dosage and plasma half-life accounts for the fact that small changes in dosage can result in large changes in plasma concentration. The addition of corticosteroid or ACTH therapy results in lower plasma levels of salicylate, and necessitates higher dosage of salicylate. After the introduction of routine monitoring of plasma salicylate, the incidence of toxic symptoms fell sharply.

Topics: Adolescent; Adrenal Cortex Hormones; Arthritis, Juvenile; Child; Child, Preschool; Dose-Response Relationship, Drug; Female; Humans; Infant; Kinetics; Male; Patient Compliance; Salicylates

The three principal syndromes of juvenile rheumatoid arthritis have distinctive features that aid in early diagnosis and can contribute to specificity of treatment. Guidelines are given for differentiating JRA from other disorders producing joint pain.

Topics: Arthritis, Juvenile; Child; Diagnosis, Differential; Gold Sodium Thiomalate; Humans; IgA Vasculitis; Lupus Erythematosus, Systemic; Salicylates; Spondylitis, Ankylosing; Uveitis, Anterior

Topics: Adolescent; Arthritis, Juvenile; Child; Female; Florida; Humans; Male; Salicylates

Evidence of hepatic disease was sought in 102 children with juvenile rheumatoid arthritis (JRA) who were treated with aspirin. Serum glutamic oxaloacetic transaminase level was elevated (greater than 39 IU/liter) in 59% of the children. The degree and prevalence of SGOT elevations correlated with aspirin dose and serum salicylate level. Nevertheless, increased SGOT values were frequently present in children receiving moderate aspirin doses and having serum salicylate levels less than 25 mg/100 ml. Elevated SGOT values decreased in proportion to the degree of reduction in aspirin dose. The SGOT values above the 100 IU/liter were statistically associated with reduced sedimentation rates. Concomitant improvement in the clinical manifestations of JRA was noted in some children.

Topics: Arthritis, Juvenile; Aspartate Aminotransferases; Aspirin; Chemical and Drug Induced Liver Injury; Child; Female; Humans; Liver; Male; Salicylates

Topics: Adolescent; Arthritis, Juvenile; Child; Child, Preschool; Choline; Drug Tolerance; Humans; Infant; Salicylates

Topics: Arthritis, Juvenile; Child; Child, Preschool; Female; Gold; Humans; Male; Prognosis; Rheumatoid Factor; Salicylates

Topics: Arthritis, Juvenile; Biopsy; Brain; Brain Diseases; Chemical and Drug Induced Liver Injury; Child; Humans; Liver; Reye Syndrome; Salicylates

Topics: Administration, Oral; Arthritis, Juvenile; Aspirin; Humans; Salicylates

Topics: Adrenal Cortex Hormones; Adrenocorticotropic Hormone; Arthritis, Juvenile; Azathioprine; Child; Chloroquine; Education, Special; Gold; Humans; Indomethacin; Penicillamine; Phenylbutazone; Physical Therapy Modalities; Prednisolone; Salicylates

The characteristics of juvenile rheumatoid arthritis have been presented and the important features of its medical and orthopedic management described. Surgical experience in a carefully studied group of 200 patients has been recounted. The increasing importance of reconstructive joint surgery is noted, preferably performed after growth has stopped.

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Arthritis, Juvenile; Child; Female; Gold Sodium Thiomalate; Humans; Hydroxychloroquine; Injections, Intra-Articular; Joints; Male; Methods; Phenylbutazone; Physical Therapy Modalities; Salicylates

Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents; Arthritis, Juvenile; Child; Humans; Salicylates

Topics: Adolescent; Arthritis, Juvenile; Aspirin; Child; Child, Preschool; Humans; Salicylates; Time Factors

Topics: Arthritis, Juvenile; Child; Humans; Salicylates

While rheumatic fever is relatively uncommon except where there are poor and crowded living conditions, sporadic acute attacks continue to occur in a family or pediatric medical practice. The physician's role in management of the sore throat in the diagnosis of suspected cases of rheumatic fever and in follow-up for continued prophylaxis is discussed. The frequency of admissions and presenting features of 159 patients with acute rheumatic fever is reviewed. Continued surveillance is required if we are to achieve a further reduction in attack rate and complications.

Topics: Acute Disease; Adolescent; Antistreptolysin; Arthritis, Juvenile; Arthritis, Rheumatoid; Child; Child, Preschool; Diagnosis, Differential; Heart Murmurs; Heart Valve Diseases; Humans; Manitoba; Penicillins; Prednisone; Rheumatic Fever; Rheumatic Heart Disease; Salicylates; Streptococcal Infections; Streptococcus; Time Factors

Topics: Arthritis, Juvenile; Arthritis, Reactive; Arthritis, Rheumatoid; Chemotaxis; Exudates and Transudates; Humans; Joint Diseases; Leukocytes; Osteoarthritis; Phenylbutazone; Rheumatoid Factor; Salicylates; Synovial Fluid

Topics: Adolescent; Anemia; Arthritis, Juvenile; Body Height; Child; Child, Preschool; Chronic Disease; Drug Therapy, Combination; Elasticity; Female; Fever; Growth; Humans; Male; Pain; Prednisone; Salicylates; Sex Characteristics; Stress, Mechanical

Topics: Adrenal Cortex Hormones; Arthritis; Arthritis, Juvenile; Child; Chronic Disease; Humans; Salicylates; Uveitis, Anterior

The present recommended dose of benorylate is not satisfactory for the management of children suffering from inflammatory polyarthritis. A starting dose of 200 mg/kg/day should be used, and the salicylate level checked at seven days and the dosage adjusted to give an anti-inflammatory effect-that is, a blood salicylate level of between 25 and 30 mg/100 ml. Once a satisfactory level has been achieved, this dosage should be maintained with occasional monitoring of the salicylate level. The paracetamol level does not need to be estimated as it tends to follow the salicylate level, provided that liver function is normal; thus it is quite safe to monitor only the salicylate level. Given in an adequate dosage, benorylate seems to be an acceptable salicylate preparation for use in juveniles suffering from chronic polyarthritis.

Topics: Acetaminophen; Acetanilides; Adolescent; Arthritis, Juvenile; Aspirin; Child; Child, Preschool; Female; Humans; Infant; Liver Function Tests; Male; Salicylates; Time Factors

Topics: Adolescent; Adrenal Cortex Hormones; Antimalarials; Arthritis, Juvenile; Brain; Child; Child, Preschool; Dermatomyositis; Electroencephalography; Female; Gold; Humans; Lupus Erythematosus, Systemic; Male; Phenylbutazone; Psoriasis; Salicylates; Scleroderma, Localized; Sex Factors

Topics: Adult; Age Factors; Arthritis, Juvenile; Diagnosis, Differential; Female; Fever; Gold Sodium Thiomalate; Humans; Latex Fixation Tests; Lupus Erythematosus, Discoid; Middle Aged; Salicylates; Splenomegaly

Topics: Adolescent; Alanine Transaminase; Arthritis, Juvenile; Aspartate Aminotransferases; Blood Cell Count; Blood Platelets; Blood Sedimentation; Chemical and Drug Induced Liver Injury; Disseminated Intravascular Coagulation; Fibrinogen; Humans; L-Lactate Dehydrogenase; Male; Salicylates

A case of juvenile rheumatoid arthritis with vasculitis is presented. Sixteen months after the onset of the disease the patient developed digital artery thrombosis with incipient gangrene. Both the latter and the skin lesions resolved during treatment with azathioprine.

Topics: Arteries; Arteritis; Arthritis, Juvenile; Azathioprine; Blood Vessels; Child, Preschool; Female; Gangrene; Humans; Inflammation; Prednisone; Salicylates; Thrombosis; Thumb

Topics: Adolescent; Antibodies, Antinuclear; Arthritis, Juvenile; Arthritis, Rheumatoid; Autopsy; Biopsy; Blood Pressure; Child; Child, Preschool; Creatinine; Cryoglobulins; Female; Gold; Humans; Infant; Kidney; Kidney Function Tests; Male; Phenylbutazone; Proteinuria; Rheumatoid Factor; Salicylates; Time Factors

Topics: Adolescent; Adult; Arthritis, Juvenile; Child; Diagnosis, Differential; Female; Fever; Fever of Unknown Origin; Humans; Male; Prednisone; Prognosis; Salicylates

A study of 170 patients with juvenile rheumatoid arthritis and a review of the literature indicate that this disease can significantly affect the central nervous system. Signs of CNS dysfunction were observed in 13 children. During the acute toxic stages the EEG is abnormal in many cases. Other manifestations of toxic encephalopathy such as irritability, drowsiness, stupor, convulsions and marked meningismus may be evident in severe cases. Meningitis is often suspected but ruled out by the finding of normal CSF. Steroids can rapidly improve the condition of these children. If ;unexplained' seizures occur during the chronic stage, the diagnosis of cerebral vasculitis should be entertained.

Topics: Arthritis, Juvenile; Central Nervous System Diseases; Child; Child, Preschool; Electroencephalography; Epilepsy; Humans; Infant; Male; Meningism; Prednisone; Salicylates; Seizures; Spinal Puncture

Topics: Adrenal Cortex Hormones; Adult; Antineoplastic Agents; Arthritis, Juvenile; Chronic Disease; Female; Gold; Humans; Prognosis; Salicylates

Topics: Adolescent; Adrenal Cortex Hormones; Arthritis, Juvenile; Child; Child, Preschool; Female; Follow-Up Studies; Gold; Humans; Knee; Knee Joint; Motion; Postoperative Care; Radiography; Salicylates; Synovectomy

Topics: Arthritis, Juvenile; Child; Child, Preschool; Exercise Therapy; Humans; Male; Radiography; Salicylates; Spondylitis, Ankylosing

Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents; Antimalarials; Arthritis, Juvenile; Child; Child, Preschool; Chronic Disease; Gold; Humans; Immunosuppressive Agents; Indomethacin; Salicylates

In 8 out of 32 juvenile patients suffering from chronic polyarthritis and in one patient with dermatomyositis, raised transaminase levels were found; the salicylate level was above 35 mg/100 ml in all except one. Reduction in the salicylate level led to a prompt fall in the serum transaminases. Despite a rise in alkaline phosphatase in three cases there was no other evidence of liver dysfunction in the children. Only one of the adults showed a rise in transaminase levels, and she had mild cirrhosis.

Topics: Adolescent; Adult; Age Factors; Aged; Alanine Transaminase; Alkaline Phosphatase; Arthritis, Juvenile; Aspartate Aminotransferases; Aspirin; Chemical and Drug Induced Liver Injury; Child; Child, Preschool; Dermatomyositis; Female; Humans; Liver Cirrhosis; Male; Middle Aged; Salicylates

Topics: Adrenal Cortex Hormones; Adrenocorticotropic Hormone; Arthritis, Juvenile; Azathioprine; Child; Chloroquine; Gold; Humans; Indomethacin; Long-Term Care; Manipulation, Orthopedic; Methotrexate; Phenylbutazone; Physical Therapy Modalities; Pyrazoles; Salicylates; Synovectomy; Uveitis, Anterior

Topics: Arthritis, Juvenile; Female; Humans; Infant; Salicylates

Topics: Adolescent; Alanine Transaminase; Arthritis, Juvenile; Aspartate Aminotransferases; Bilirubin; Child; Child, Preschool; Clinical Enzyme Tests; Diagnosis, Differential; Female; Fever; Hepatomegaly; Humans; Infant; Leukocyte Count; Liver; Liver Function Tests; Lymphatic Diseases; Male; Pain; Pericarditis; Pleurisy; Salicylates; Sex Factors; Splenomegaly; Sulfobromophthalein

Topics: Adolescent; Arthritis, Juvenile; Blood Protein Electrophoresis; Child; Child, Preschool; Female; Hemoglobinometry; Humans; Immunoglobulin G; Infant; Leukocyte Count; Lymphadenitis; Male; Nigeria; Prognosis; Radiography; Salicylates; Skin Diseases; Synovial Fluid

Topics: Adolescent; Amyloidosis; Arthritis, Juvenile; Female; Hematuria; Humans; Indomethacin; Kidney; Liver; Methylprednisolone; Penicillins; Proteinuria; Salicylates

Topics: Arthritis, Juvenile; Chronic Disease; Humans; Methods; Physical Therapy Modalities; Prognosis; Salicylates

Topics: Adolescent; Arthritis, Juvenile; Child; Diagnosis, Differential; Humans; Rheumatic Fever; Salicylates

Topics: Arthritis, Juvenile; Child; Child, Preschool; Chronic Disease; Female; Glucocorticoids; Humans; Hydroxychloroquine; Indomethacin; Male; Phenylbutazone; Salicylates; Synovitis

Topics: Adolescent; Arthritis, Juvenile; Child; Dexamethasone; Female; Humans; Injections, Subcutaneous; Male; Nephrosis, Lipoid; Nicotinic Acids; Pericardium; Postoperative Complications; Rheumatic Heart Disease; Salicylates

Topics: Anti-Bacterial Agents; Arthritis, Juvenile; Child; Child, Preschool; Cortisone; Diagnosis, Differential; Female; Hip; Humans; Infant; Male; Rheumatic Fever; Salicylates; Synovial Fluid

Topics: Adolescent; Adrenocorticotropic Hormone; Arthritis, Juvenile; Child; Cortisone; Diagnosis, Differential; Drug Hypersensitivity; Drug Therapy; Humans; Osteomyelitis; Pathology; Purpura; Rest; Rheumatic Diseases; Rheumatic Fever; Salicylates; Streptococcal Infections; Tonsillitis

Topics: Adolescent; Arthritis; Arthritis, Juvenile; Arthritis, Rheumatoid; Child; Child Care; Chloroquine; Diagnosis; Drug Therapy; Family Practice; General Practice; Gold; Humans; Penicillins; Prednisone; Rheumatic Fever; Salicylates

Topics: Adolescent; Adult; Arthritis, Juvenile; Blood; Child; Child, Preschool; Female; Humans; Hydrocortisone; Hydrogen-Ion Concentration; Kidney Glomerulus; Male; Prednisone; Salicylates; Urine

Topics: Adolescent; Arthritis; Arthritis, Juvenile; Atropine; Cataract; Child; Cocaine; Corneal Opacity; Cortisone; Eye; Humans; Iridocyclitis; Penicillins; Prednisolone; Salicylates

Topics: Adolescent; Adrenal Cortex Hormones; Antimalarials; Arthritis; Arthritis, Juvenile; Arthritis, Rheumatoid; Child; Diagnosis; Drug Therapy; Gold; Humans; Phenylbutazone; Physical Therapy Modalities; Salicylates

Topics: Achlorhydria; Adolescent; Aging; Anemia; Arthritis; Arthritis, Juvenile; Blood Sedimentation; Child; Fever; Follow-Up Studies; Gastric Acidity Determination; Gold; Hormones; Humans; Infant; Leukocyte Count; Physical Therapy Modalities; Prognosis; Salicylates; Sex

Topics: Adolescent; Arthritis; Arthritis, Juvenile; Arthritis, Rheumatoid; Exercise Therapy; Gold; Humans; Phenylbutazone; Salicylates

Topics: Adolescent; Adrenal Cortex Hormones; Arthritis; Arthritis, Juvenile; Arthritis, Rheumatoid; Blood Sedimentation; Child; Chloroquine; Diagnosis, Differential; England; Genetics, Medical; Gold; Hemoglobins; Humans; Infant; Iridocyclitis; Mortality; Pathology; Phenylbutazone; Physical Therapy Modalities; Radiography; Salicylates; Splints; Spondylitis; Spondylitis, Ankylosing