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Biomedical subjects

D D Sherry

Publications and source records attributed to D D Sherry.

At least 19 recordsLinked to original sources
PubMed2000

Pain syndromes in children.

The pediatric rheumatologist cares for children who may have a wide variety of causes of musculoskeletal pain. These include such diverse conditions as arthritis, low-back pain, hypermobility, metabolic bone pain, and amplified pain syndromes such as complex regional pain syndrome and fibromyalgia. This review examines the recent literature on these and other conditions causing musculoskeletal pain in children and adolescents. Overall, headway is being made, but differentiating soma from psyche remains a problem. This is perhaps due to the marked and unique effect pain brings to each of us. Children are different from adults in causes, presentations, and outcome. Vigilance in history, physical examination, and judicious use of laboratory investigations are usually sufficient in establishing a diagnosis, as well as an appreciation for the variety of presentations each condition can manifest.

Adolescent↗
PubMed2000

Family reinforcement of illness behavior: a comparison of adolescents with chronic fatigue syndrome, juvenile arthritis, and healthy controls.

Parental encouragement of illness behavior is hypothesized to correlate with psychosocial dysfunction in adolescents with chronic illness. To explore this hypothesis, adolescents aged 11 to 17 years with chronic fatigue syndrome (CFS) (n = 10), juvenile rheumatoid arthritis (JRA) (n = 16), and healthy adolescents (n = 14) were recruited for the study. Measures included the Achenbach parent and youth self report forms, the Family Adaptability and Cohesion Evaluation Scale-II (FACES II), the Children's Depression Rating Scale, and number of days absent from school. The Illness Behavior Encouragement Scale (IBES) generated measures of parental reinforcement of illness behavior. As predicted, the teens with CFS scored statistically higher on measures of depression, total competence, and number of days of school missed in the previous 6 months (mean = 40). Children with JRA scored significantly lower than the CFS group on the measure of parental reinforcement of illness behavior. The healthy group produced intermediate scores. Results and implications for future clinical and research activity are discussed.

Adolescent↗
PubMed2000

Initial intravenous gammaglobulin treatment failure in Kawasaki disease.

OBJECTIVES: To determine initial intravenous gammaglobulin (IVIG) treatment failures in Kawasaki disease (KD) and to report the outcome of retreatment and our use of pulse intravenous (IV) methylprednisolone and cyclophosphamide in patients with persistent KD. STUDY DESIGN: Retrospective analysis of the treatment and response of children with KD over 3 years. RESULTS: Fifty (77%) of 65 patients completely responded to a single treatment with IVIG (2 g/kg). Fifteen patients (23%) required retreatment; 10 patients fully responded but 5 had persistent disease (3 developed coronary aneurysms and 4 developed coronary artery thrombosis). Four of these 5 patients with persistent disease were treated with pulse IV methylprednisolone and 2 were also treated with IV cyclophosphamide. There was no progression of coronary aneurysms and no deaths. No initial patient characteristics predicted IVIG treatment failure or the development of coronary aneurysms. CONCLUSION: Nearly 23% of patients with KD may require retreatment and 8% may develop coronary aneurysm. Additional antiinflammatory therapy, such as IV methylprednisolone and IV cyclophosphamide, may be helpful in treating persistent KD.

Anti-Inflammatory Agents↗
PubMed2000

An overview of amplified musculoskeletal pain syndromes.

Children may have a wide variety of amplified musculoskeletal pain syndromes that may or may not be associated with overt autonomic signs and may be diffuse or localized to one body part. It is most common in pre- to adolescent girls. Hallmarks of the diagnosis include increasing pain over time, allodynia, an incongruent affect, disproportional dysfunction, and the absence of other causes. Psychological distress within the child or family is apparent in most, but not all, since it also is associated with injury or illness. Once the diagnosis is established, all medicines and testing are stopped. A sympathetically driven pain model is used to explain the pain to make it understandable. Treatment is an intense exercise program; ours is 5 hours daily. We focus on functional aerobic training specifically using the involved body part such as sports related drills, running, play activities, and swimming. Allodynia is treated with desensitization such as towel rubbing. A psychological evaluation is done and specific psychotherapy is recommended if indicated. The average duration of the daily program is 2 weeks with a 1 hour home program being done for another 2 to 8 weeks. After one month roughly 80% of the children have no pain and are fully functional, another 15% are fully functional with mild or recurrent pain; 5% are not better. Significant relapses are infrequent; 15% require retreatment. Five to 10% of the children will develop a different symptom of psychological distress. At 5 years, 90% are doing well.

Adolescent↗
PubMed1999

Prevention of leg length discrepancy in young children with pauciarticular juvenile rheumatoid arthritis by treatment with intraarticular steroids.

OBJECTIVE: To determine if intraarticular (i.a.) injection of triamcinolone hexacetonide (steroids) used early in the course of pauciarticular juvenile rheumatoid arthritis (pauci JRA) is associated with less leg length discrepancy (LLD) or thigh circumference discrepancy (TCD). METHODS: Children with pauci JRA who had asymmetric lower-extremity arthritis diagnosed before age 7 years in Seattle, Washington (WA; n = 16) and in Chapel Hill and Durham, North Carolina (NC; n = 14) were retrospectively identified. WA children were given i.a. steroids within 2 months of diagnosis; the injections were repeated if synovitis recurred in the same joint or in a different joint. These children were compared with NC children who were not treated with i.a. steroids. Thigh circumference was measured at 10 cm above the patella, and leg length was measured from the anterior superior iliac spine to the mid-medial malleolus, by a single observer. LLD and TCD are reported as the percentage of difference between leg measurements in each subject. RESULTS: The WA and NC subjects had comparable disease severity and duration of followup (in months). Twelve WA children had subsequent i.a. steroid injections (mean 3.25 injections per child over mean +/- SD 42 +/- 11 months). The WA subjects had significantly less LLD (P = 0.005, by Student's 2-sided t-test) and prescriptions for shoe lifts (P = 0.002, by Fisher's 2-sided exact test). There was not a significant difference in TCD between the 2 groups (P = 0.139, by Student's 2-sided t-test). Similar findings were obtained when the analysis was limited to children with monarticular knee arthritis. CONCLUSION: Early and continued use of i.a. steroids may be associated with less LLD in young children with pauci JRA. This may indicate decreased duration of synovitis.

Adolescent↗
PubMed1999

Joint distribution at presentation in children with pauciarticular arthritis.

The most frequently affected joints in 215 children with pauciarticular arthritis (fewer than 5 joints involved) were knees, ankles, fingers, toes, wrists, elbows, and hips, respectively. Antinuclear antibodies were present in 68% and uveitis in 16%. Small joint arthritis should alert the physician to the possibilities of pauciarticular arthritis.

Antibodies, Antinuclear↗
PubMed1999

Episcleritis in childhood.

OBJECTIVE: To describe the characteristics and systemic disease associations of episcleritis in childhood. DESIGN: Retrospective, observational case series. PARTICIPANTS: Twelve children diagnosed with episcleritis between July 1981 and June 1998. METHODS/TESTING: Complete eye and systemic evaluations. MAIN OUTCOME MEASURES: Characteristics of episcleritis and presence and nature of concurrent systemic disease. RESULTS: The 12 children (10 boys and 2 girls) ranged in age from 13 months to 16 years. Five children had bilateral simple episcleritis, one had bilateral nodular episcleritis, and six had unilateral simple episcleritis. The eye examination was otherwise normal and recovery was uneventful in all cases. Six of the nine children older than 5 years of age had one of the following rheumatologic diseases: systemic lupus erythematosus, juvenile rheumatoid arthritis, spondyloarthropathy, inflammatory bowel disease, rheumatic fever, or polyarteritis nodosa. All three children younger than 5 years of age had simple episcleritis, an antecedent viral illness, and presented within 2 months of each other. CONCLUSIONS: Episcleritis is a rare occurrence in childhood, especially in children younger than 5 years of age. In older children, it is frequently associated with rheumatologic disease.

Adolescent↗
PubMed1999

Short- and long-term outcomes of children with complex regional pain syndrome type I treated with exercise therapy.

OBJECTIVE: To report the initial and long-term outcome after an intensive exercise therapy program for childhood complex regional pain syndrome, type I (CRPS). DESIGN: Prospective follow-up. SETTING: A children's hospital. SUBJECTS: We followed 103 children (87 girls; mean age = 13.0 years) with CRPS. Forty-nine subjects were followed for more than 2 years (mean = 5 years 3 months). INTERVENTIONS: An intensive exercise program (most received a daily program of 4 hours of aerobic, functionally directed exercises, 1-2 hours of hydrotherapy, and desensitization). No medications or modalities were used. All had a screening psychological evaluation, and 79 (77%) were referred for psychological counseling. MAIN OUTCOME MEASURES: Outcomes included pain, presence of physical dysfunction, or recurrent episodes of CRPS or other disproportional musculoskeletal pain. RESULTS: The mean duration of exercise therapy was 14 days, but over the past 2 years has decreased to 6 days. Ninety-five children (92%) initially became symptom free. Of those followed for more than 2 years, 43 (88%) were symptom free (15, or 31 %, of these patients had had a reoccurrence), 5 (10%) were fully functional but had some continued pain, and 1 (2%) had functional limitations. The median time to recurrence was 2 months; 79% of the recurrences were during the first 6 months after treatment. CONCLUSION: Intense exercise therapy is effective in initially treating childhood CRPS and is associated with low rate of long-term symptoms or dysfunction.

Adolescent↗
PubMed1999

Current treatment by United States and Canadian pediatric rheumatologists.

OBJECTIVE: To determine current treatment practices for 11 selected pediatric rheumatic diseases. METHODS: A questionnaire was mailed to 224 US and Canadian physicians who were listed in membership directories that included pediatric rheumatologists. RESULTS: One hundred seventy-four questionnaires (78%) were returned. Board certified pediatricians accounted for 86% of respondents. Nonsteroidal antiinflammatory drugs were the most commonly used medicines for all forms of juvenile rheumatoid arthritis (JRA), seronegative enthesopathy and arthropathy syndrome (SEA), and Henoch-Schönlein purpura, whereas oral corticosteroids were most frequently used for systemic lupus erythematosus (SLE), juvenile dermatomyositis, polyarteritis nodosa, and sarcoidosis. Intraarticular corticosteroid injection was the second most common therapy for pauciarticular JRA, but methotrexate (MTX) was second for polyarticular and systemic onset forms of JRA, and sulfasalazine was second for SEA. For all diseases, MTX was administered orally roughly twice as often as subcutaneously. In treating SLE, cyclophosphamide was used more frequently than azathioprine, cyclosporin A, or intravenous immunoglobulin. CONCLUSION: The results from this survey should allow individual practitioners to compare their treatment patterns to pediatric rheumatologists in the US and Canada as a whole.

Adolescent↗
PubMed1997

Trial of intravenous pulse cyclophosphamide and methylprednisolone in the treatment of severe systemic-onset juvenile rheumatoid arthritis.

OBJECTIVE: Not uncommonly, some children with systemic-onset juvenile rheumatoid arthritis (JRA) have persistently active disease with joint destruction and profound growth delay despite maximum treatment with known medications. Based on previous observations of improvement in synovitis following intravenous (I.V.) cyclophosphamide (CYC) and methylprednisolone (MP) treatments, a group of children with severe systemic-onset JRA was treated in an attempt to control active synovitis and to allow tapering of corticosteroids. METHODS: Four patients with systemic-onset JRA were continued on a daily regimen of nonsteroidal antiinflammatory agents and prednisone, with a weekly subcutaneous dose of methotrexate (1 mg/kg). In addition, 1 patient continued receiving sulfasalazine and 1 patient remained on a regimen of sulfasalazine and hydroxychloroquine. Patients received 6-10 monthly treatments of I.V. CYC (500-1,000 mg/m2) and MP (30 mg/kg; 1 gm maximum) accompanied by I.V. mesna and large amounts of I.V. fluids. Subsequent treatments were given once every 2-3 months. RESULTS: After 12-20 I.V. pulses of CYC, all patients showed improvement, and 3 achieved remission of disease. All were able to discontinue corticosteroid use and all had an increase in linear growth. CONCLUSION: Monthly I.V. pulse CYC treatments can be useful to control disease in selected children with severe, destructive JRA.

Adrenal Cortex Hormones↗
PubMed1997

Musculoskeletal pain in children.

Musculoskeletal pain in childhood due either to underlying known rheumatic diseases or to primary pain syndromes remains a subject infrequently studied in the past year. Fibromyalgia has received the most attention albeit mostly in adult populations. This review examines the recent literature regarding a variety of causes of childhood musculoskeletal pain.

Arthritis, Juvenile↗
PubMed1996

Pediatric rheumatology in adult rheumatology practices in Washington state.

OBJECTIVE: To determine both the extent to which adult rheumatologists treat children and their level of comfort in doing so. METHODS: A questionnaire was sent to all 77 physicians in the state of Washington who were listed as adult rheumatologists in the American College of Rheumatology (ACR) directory. RESULTS: Sixty-six questionnaires (86%) were returned; 50 were identified as being from private-practicing adult rheumatologists and were the focus of this study. Sixty-two percent of the respondents reported that they care for children; predictors included increased exposure to pediatric rheumatology during fellowship (P = 0.003), increased distance from Seattle (P = 0.001), and listing oneself in the ACR directory as treating children (P = 0.03). Most respondents reported feeling discomfort in treating children younger than 6 years of age, treating Kawasaki disease, and treating polyarteritis nodosa, but most reported feeling comfortable treating children with chronic arthritides. Impediments to referring to a pediatric rheumatologist included distance (median distance 35 miles), convenience for the family, personal preference, and experience in caring for children. Twenty-nine percent reported difficulties referring to a pediatric rheumatologist outside of one's managed care plan. Adult rheumatologists expressed interest in continuing medical education dealing with pediatric rheumatology, preferably with a lecture format in their home communities. CONCLUSION: A significant number of adult rheumatologists care for children. Pediatric rheumatologists should provide both educational and consultative support for these adult rheumatologist colleagues.

Adult↗
PubMed1996

Reiter syndrome initially misdiagnosed as Kawasaki disease.

A misdiagnosis of Kawasaki disease was made initially for two patients with Reiter syndrome. The first patient had conjunctivitis, urethritis, arthritis, and the characteristic skin finding of keratoderma blennorrhagicum. The second patient had conjunctivitis, uveitis, dysuria, arthritis, and the characteristic musculoskeletal finding of enthesitis. Neither patient responded to intravenous immunoglobulin therapy but both responded to nonsteroidal antiinflammatory medication. The clinical characteristics of Reiter syndrome and Kawasaki disease in children are similar but specific features should allow for their differentiation.

Anti-Inflammatory Agents, Non-Steroidal↗