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Colchicine, a plant derivative has established roles in the management of some autoinflammatory disorders. Michael And Raju discuss the practical pediatric usage of this low cost and relatively safe drug. References to the article discussed in the podcast : Lisa K Stamp, Carl Horsley, Leanne Te Karu, Nicola Dalbeth, Murray Barclay, Colchicine: the good, the bad, the ugly and how to minimize the risks, Rheumatology, Volume 63, Issue 4, April 2024, Pages 936–944 : https://academic.oup.com/rheumatology/article/63/4/936/7455266

There are situations when children on Etanercept need to shift drugs.Otions include another TNF blocker vs other molecules. This podcast shows the way based on a recent publication. References : Comparative Effectiveness of a Second Tumor Necrosis Factor Inhibitor Versus a Non–Tumor Necrosis Factor Biologic in the Treatment of Patients With Polyarticular‐Course Juvenile Idiopathic Arthritis - Mannion - 2024 - Arthritis Care & Research - Wiley Onl https://acrjournals.onlinelibrary.wiley.com/doi/10.1002/acr.25339

By far the commonest adverse effects of Methotrexate is vomiting. In this episode Michael and Raju discuss a Dutch paper on the various mechanisms involved and some possible solutions to prevent discontinuation of this vital and otherwise safe drug. References to the article discussed in the podcast : Boris Hügle, E H Pieter van Dijkhuizen, MTX intolerance in children and adolescents with juvenile idiopathic arthritis, Rheumatology, Volume 59, Issue 7, July 2020, Pages 1482–1488, https://doi.org/10.1093/rheumatology/keaa139 Focus on Tables 1 and 2

Kikuchi disease is a rare condition presenting with non specific symptoms like fever and lymphadenopathy. It is part of the differential diagnose of inflammatory diseases. The flares respond well to a short course of steroids, but it can be the first manifestation of Systemic Lupus. References : Deb, A.; Fernandez, V.; Kilinc, E.; Bahmad, H.F.; Camps, N.S.; Sriganeshan, V.; Medina, A.M. Kikuchi–Fujimoto Disease: A Case Series and Review of the Literature. Diseases 2024, 12, 271. https://doi.org/10.3390/diseases12110271 Perry AM, Choi SM. Kikuchi-Fujimoto Disease: A Review. Arch Pathol Lab Med. 2018 Nov;142(11):1341-1346. doi: 10.5858/arpa.2018-0219-RA. PMID: 30407860. https://pubmed.ncbi.nlm.nih.gov/30407860/ Punith, SB1; Agarwal, Ayush1; Garg, Divyani1; Garg, Ajay2; Shamim, Shamim A3; Mallick, Saumya Ranjan4; Gupta, Pranjal5; Srivastava, Achal K1. Kikuchi–Fujimoto Disease Presenting as Autoimmune Limbic Encephalitis: A Case Report with Review of Literature. Annals of Indian Academy of Neurology 28(1):p 116-119, Jan–Feb 2025. | DOI: 10.4103/aian.aian_498_24 https://journals.lww.com/annalsofian/fulltext/2025/01000/kikuchi_fujimoto_disease_presenting_as_autoimmune.20.aspx

IgA Vasculitis remains the commonest form of vasculitis in childhood and Nephritis is the most important long term prognostic indicator. Michael and Raju review a paper and share some of their experiences. References to the article : Sestan M, Jelusic M. Diagnostic and Management Strategies of IgA Vasculitis Nephritis/Henoch-Schönlein Purpura Nephritis in Pediatric Patients: Current Perspectives. Pediatric Health Med Ther. 2023 Mar 7;14:89-98. doi: 10.2147/PHMT.S379862. PMID: 36915829; PMCID: PMC10008002. : https://pubmed.ncbi.nlm.nih.gov/36915829/ Parums DV. A Review of IgA Vasculitis (Henoch-Schönlein Purpura) Past, Present, and Future. Med Sci Monit. 2024 Jan 28;30:e943912. doi: 10.12659/MSM.943912. PMID: 38281080; PMCID: PMC10832303 : https://pubmed.ncbi.nlm.nih.gov/38281080/

IVIG resistance is a major challenge in about 15% of children with Kawasaki disease. The cost and availability of IVIG are challenges which have led to examining alternatives to the second dose of IVIG. References to the article discussed in the podcast : Burns JC, Jain S and al. - Infliximab versus second intravenous immunoglobulin for treatment of resistant Kawasaki disease in the USA (KIDCARE): a randomised, multicentre comparative effectiveness trial - Lancet Child Adolesc Health. 2021 Dec : https://pubmed.ncbi.nlm.nih.gov/34715057/

Michael and Raju discuss learnings from some Danish papers on consequences of involvement of the TM joint and describe the 2 minute internationally derived multidisciplinary protocol to evaluate this joint at every visit. References to the article discussed in the podcast : Incidence of Orofacial Manifestations of Juvenile Idiopathic Arthritis From Diagnosis to Adult Care Transition: A Population‐Based Cohort Study - Glerup - 2023 - Arthritis & Rheumatology - Wiley Online Library : https://acrjournals.onlinelibrary.wiley.com/doi/10.1002/art.42481 Stoustrup P, Herlin T, Spiegel L, Rahimi H, Koos B, Pedersen TK, Twilt M; Temporomandibular Joint Juvenile Arthritis Working Group. Standardizing the Clinical Orofacial Examination in Juvenile Idiopathic Arthritis: An Interdisciplinary, Consensus-based, Short Screening Protocol. J Rheumatol. 2020 Sep 1;47(9):1397-1404. doi: 10.3899/jrheum.190661. Epub 2019 Dec 1. PMID: 31787607 : https://pubmed.ncbi.nlm.nih.gov/31787607/

Obstetricians may reach out directly or via neonatologists for persistent fetal bradycardia.Congenital complete heart block due to neonatal lupus is discussed. References to the article discussed in the podcast : Huang, Y., Deng, J., Liu, J. et al. Autoimmune congenital heart block: a case report and review of the literature related to pathogenesis and pregnancy management. Arthritis Res Ther 26, 8 (2024). https://doi.org/10.1186/s13075-023-03246-w : https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-023-03246-w