Lisette W A Van Suijlekom-Smit

Erasmus MC Sophia Childrens Hospital

Background Etanercept has been studied in doses up to 0.8 mg/kg/week (max 50 mg/week) in juvenile idiopathic arthritis (JIA) patients. In clinical practice higher doses are used off-label, but evidence regarding the relation with outcomes is lacking. We describe the clinical course of JIA-patients receiving high-dose etanercept (1.6 mg/kg/week; max...

Background The aim of this study was to compare pain-scores in three targeted treatment-strategies in JIA-patients and to identify characteristics predicting persistent pain. Methods In the BeSt-for-Kids-study 92 DMARD-naïve JIA-patients were randomized in 3 treatment-strategies: 1) initial sequential DMARD-monotherapy 2) initial methotrexate (MTX...

Objectives We studied patterns of joint inflammation in juvenile idiopathic arthritis (JIA) to assess whether joint activity recurs locally in the same joints. Methods Joints of 91 patients of the BeSt for Kids study, a treat-to-target trial for children with recent-onset oligoarticular, rheumatoid factor-negative polyarticular and psoriatic JIA,...

Background Genuine uncertainty on superiority of one intervention over the other is called equipoise. Physician-investigators in randomized controlled trials (RCT) need equipoise at least in studies with more than minimal risks. Ideally, this equipoise is also present in patient-participants. In pediatrics, data on equipoise are lacking. We hypothe...

Question Which is the best strategy to achieve (drug-free) inactive disease in juvenile idiopathic arthritis (JIA)? Methods In a randomised, single-blinded, study in disease-modifying anti-rheumatic drug (DMARD)-naive patients with JIA, three treatment-strategies were compared: (1) sequential DMARD-monotherapy (sulfasalazine or methotrexate (MTX))...

Objective: Around one-third of patients with juvenile idiopathic arthritis (JIA) fail to respond to first-line methotrexate (MTX) or anti-tumor necrosis factor (TNF) therapy, with even fewer achieving ≥ American College of Rheumatology Pediatric 70% criteria for response (ACRpedi70), though individual responses cannot yet be accurately predicted....

Background: Pulled elbow (nursemaid's elbow) is a common injury in young children. It often results from a sudden pull on the arm, usually by an adult or taller person, which pulls the radius through the annular ligament, resulting in subluxation (partial dislocation) of the radial head. It can also be caused by a fall or twist. The child experien...

Background: Molluscum contagiosum is a common skin infection that is caused by a pox virus and occurs mainly in children. The infection usually resolves within months in people without immune deficiency, but treatment may be preferred for social and cosmetic reasons or to avoid spreading the infection. A clear evidence base supporting the various...

Background To characterize the existing national and multi-national registries and cohort studies in juvenile idiopathic arthritis (JIA) and identify differences as well as areas of potential future collaboration. Methods We surveyed investigators from North America, Europe, and Australia about existing JIA cohort studies and registries. We exclude...

Over the past decades, the intestinal microbiota has increasingly gained attention in studies addressing the pathophysiology of (pediatric) autoimmune diseases, including inflammatory joint diseases, inflammatory bowel disease (IBD), and type 1 diabetes. In this study, we have analyzed the composition of gut microbiota of newly diagnosed juvenile i...

Background Combination therapy with prednisone or etanercept may induce earlier and/or more improvement in disease activity in Disease Modifying Anti Rheumatic Drug (DMARD) naïve non-systemic Juvenile Idiopathic Arthritis (JIA) patients. Here we present three months clinical outcome of initial treatments of the BeSt-for-Kids study. Methods Included...

Approximately 30 % of juvenile idiopathic arthritis (JIA) patients fail to respond to anti-TNF treatment. When clinical remission is induced, some patients relapse after treatment has been stopped. We tested the predictive value of MRP8/14 serum levels to identify responders to treatment and relapse after discontinuation of therapy. Samples from 88...

Juvenile idiopathic arthritis (JIA) affects bone mineral density (BMD). Dual-energy X-ray absorptiometry (DXA) is the most widely used technique to determine BMD. Digital X-ray radiogrammetry (DXR) is a feasible method for determination of cortical BMD on hand radiographs. This study aimed to compare DXR and DXA in the assessment of BMD in JIA pati...

To carry out a longitudinal investigation of functional outcome, health-related quality of life (HRQoL) and treatment strategies in JIA patients who started etanercept >5 years ago. We approached patients whose HRQoL changes were described previously in a subanalysis of the Dutch Arthritis and Biologicals in Children register. Recent disease status...

Background In the BeSt for Kids (a three-armed treatment strategy study in juvenile idiopathic arthritis (JIA)) time to inactive disease, time to flare after Disease Modifying Anti Rheumatic Drug (DMARD) discontinuation, ACRpedi scores, functional ability, safety, and radiological damage are compared. Follow up will be 2 years. Here we present the...

To evaluate the reliability of a manikin format, patient-reported joint count in juvenile idiopathic arthritis (JIA), and to detect changes in agreement at a second visit. Patients with JIA aged 12-21 were asked to mark joints with active arthritis on a manikin before their regular clinic visit. The physician then performed a joint count without ha...

IntroductionChronic inflammation combined with glucocorticoid treatment and immobilization puts juvenile idiopathic arthritis (JIA) patients at risk of impaired growth and reduced bone mineral density (BMD). Conventional methods for evaluating bone age and BMD are time consuming, or come with additional costs and radiation exposure. In addition, an...

Background Chronic inflammatory activity in juvenile idiopathic arthritis (JIA) affects the bone, possibly resulting in growth abnormalities and decreased bone mineral density (BMD). Monitoring the bone status of JIA patients is important for the prevention of fractures and osteoporosis at later age. Dual-energy X-ray absorptiometry (DXA) is most w...

This chapter deals with Impetigo, which is a contagious superficial skin infection, characterized by superficial erosions covered with honey-colored crusts, most often on the face. Impetigo may be primary or secondary to other skin diseases, such as atopic eczema. It discusses about the incidence, etiology and prognosis of impetigo. The chapter des...

Treatment of juvenile idiopathic arthritis (JIA) has changed dramatically since the introduction of biological agents in 1999. To evaluate trends in prescription patterns of biological agents and the subsequent outcome of JIA. The Arthritis and Biologics in Children register (multicentre prospective observational study) aimed to include all consecu...

Background Treatment of juvenile idiopathic arthritis (JIA) has changed dramatically since the introduction of biologics in 1999. Because of more insight in the immunological and biological pathways involved in the development of JIA the number of available biologic agents increased. Together with the introduction of these new drugs, also new insig...

Background Anti-citrullinated protein antibodies (ACPA) have a low prevalence in Juvenile Idiopathic Arthritis (JIA). Autoantibodies recognizing carbamylated protein (anti-CarP) are a promising new serological marker for ACPA negative Rheumatoid Arthritis and are associated with a more severe clinical course (Shi et al, 2011). Objectives To determi...

Biological therapy has dramatically improved the treatment of patients with JIA. However, there is still a group of patients that shows a lack of clinical response to this treatment. The use of robust predictive markers of response to identify individuals who are likely to respond to etanercept may provide guidance in optimizing treatment strategie...

In the past decade biologics have changed the management of juvenile idiopathic arthritis (JIA). Many studies have evaluated the effectiveness and safety of the available biologics in JIA. Biological therapy used to be reserved for the severely ill JIA patients refractory to conventional therapy. Due to the treatment success of several biologics, m...

Klachten en ziekten van kinderen verschillen van die van volwassenen niet alleen wat etiologie en pathofysiologie, maar ook wat de wijze van uiting van de problemen betreft. Voor ouders zijn klachten en ziekten van kinderen vaak een bron van angst en ongerustheid. Vanuit hun verantwoordelijkheidsgevoel zijn ze mogelijk eerder geneigd om op (special...

Objectives: To evaluate differences in baseline characteristics between etanercept- and adalimumab-treated JIA patients and to reveal factors that influence the choice between these TNF inhibitors, which are considered equally effective in the recent ACR recommendations for JIA treatment. Methods: Biologic-naïve JIA patients with active arthriti...

Biologics are a promising treatment option for juvenile idiopathic arthritis (JIA) but drug costs are very high compared to conventional treatment. From a socioeconomic view the additional costs of new interventions should be weighed against their incremental health benefits compared to standard care. Therefore we evaluated data on cost-effectivene...

Objective: Because TNF inhibitors are not approved for persistent oligoarticular JIA (oJIA), although they are used off-label, we evaluated their effectiveness in patients in this category. Methods: Persistent oJIA patients were selected from the Dutch Arthritis and Biologicals in Children (ABC) register, an ongoing multicentre prospective study...

Objective: Over the past decade, the availability of biological agents for the treatment of juvenile idiopathic arthritis (JIA) has increased substantially. Because direct head-to-head trials comparing these agents are lacking, we indirectly compared their efficacy. Methods: In a systematic review, all available efficacy data from randomised con...

Objective: To evaluate the effectiveness and safety of switching to a second or third biological agent in juvenile idiopathic arthritis (JIA) after etanercept failure. Methods: The Arthritis and Biologicals in Children Register aims to include all Dutch JIA patients who have used biological agents. Data on the disease course were used to estimat...

In Reply Dr Pang and colleagues bring up the importance of the differences in etiology and pathogenesis between systemic JIA compared with other JIA categories. As more insight into the pathogenesis of systemic JIA has been gained, systemic JIA has been considered by many as a different disease entity because of its clinical features and the involv...

Analysis of myeloid-related protein 8 and 14 complex (MRP8/14) serum concentrations is a potential new tool to support the diagnosis of systemic-onset juvenile idiopathic arthritis (SJIA) in the presence of fever of unknown origin. To test the ability of MRP8/14 serum concentrations to monitor disease activity in patients with SJIA and stratify pat...

Impetigo is a common, superficial bacterial skin infection, which is most frequently encountered in children. There is no generally agreed standard therapy, and guidelines for treatment differ widely. Treatment options include many different oral and topical antibiotics as well as disinfectants. This is an updated version of the original review pub...

Pulled elbow (nursemaid's elbow) is a common injury in young children. It results from a sudden pull on the arm, usually by an adult or taller person, which pulls the radius through the annular ligament, resulting in subluxation (partial dislocation) of the radial head. The child experiences sudden acute pain and loss of function in the affected ar...

Since the introduction of biologic therapies, the pharmacological treatment approach for juvenile idiopathic arthritis (JIA) has changed substantially, with achievement of inactive disease as a realistic goal. To determine the response to therapy after initiation of etanercept therapy among patients with JIA and to examine the association between b...

To evaluate the effectiveness and safety of biological agents in children with enthesitis-related arthritis (ERA). All patients with ERA in whom a biological agent was initiated between 1999 and 2010 were selected from the Dutch Arthritis and Biologicals in Children (ABC) register. In this ongoing multicenter observational register, data on the cou...

In this chapter different treatments of psoriasis are discussed.

To analyse and report the costs and effects of etanercept therapy in patients with JIA. Forty-nine JIA patients were evaluated by means of the JIA core set at the start of etanercept and after 3, 15 and 27 months of therapy. At the same time-points, parents of the patients were asked to complete the Health Utility Index Mark 3 (HUI3). Direct medica...

Gewrichtsklachten komen op de kinderleeftijd regelmatig voor, meestal ten gevolge van een trauma. Bij de niet-traumatische gewrichtsklachten komen acute aandoeningen frequenter voor dan chronische. De in de literatuur vermelde prevalentie van acute versus chronische artritis is respectievelijk 2-8 en 0,1-0,5 per 10.000. Acute (niet-traumatische) ge...

#### Summary points Juvenile idiopathic arthritis is the most common cause of chronic arthritis in childhood; a review of 34 epidemiological studies showed that 0.07-4.01 per 1000 children worldwide are affected.w1 It is characterised by joint inflammation that often leads to joint destruction with physical disability and chronic pain that affects...

Assessing prescription patterns of asthma medication for children is helpful to optimize prescribing by general practitioners (GPs). The aim was to explore prescription patterns in children with physician-diagnosed asthma and its determinants in general practice. We used the Second Dutch National Survey of General Practice (DNSGP-2) with children a...

This study aimed to determine disease activity patterns in juvenile systemic lupus erythematosus (jSLE) and its relation to early treatment. All jSLE patients who visited the outpatient departments of three Dutch university hospitals for at least 6 months were included. Data were retrospectively collected from each patient visit and hospitalization...

To evaluate the effectiveness of tumour necrosis factor (TNF) blockers in juvenile psoriatic arthritis (JPsA). The study was a prospective ongoing multicentre, observational study of all Dutch juvenile idiopathic arthritis (JIA) patients using biologicals. The response of arthritis was assessed by American College of Rheumatology (ACR) paediatric r...

Krul M, Van der Wouden JC, Schellevis FG, Van Suijlekom-Smit LWA, Koes BW. Acute niet-traumatische heupafwijkingen bij kinderen. Huisarts Wet 2010;53(10):529-32. Achtergrond Acute niet-traumatische heupafwijkingen bij kinderen kunnen het gevolg zijn van een onschuldige coxitis fugax, maar de onderliggende aandoening kan ook ernstiger zijn, zoals de...

To evaluate response in patients with juvenile idiopathic arthritis (JIA) who failed to meet response criteria after 3 months of etanercept treatment. This was a prospective ongoing multicenter observational study of all Dutch patients with JIA using etanercept. Response according to American College of Rheumatology Pediatric 30 criteria was assess...

Juvenile idiopathic arthritis (JIA) is a heterogeneous disease involving chronic arthritis. The clinical course is characterized by a fluctuating pattern of active and inactive disease. We have described in detail the clinical course in different JIA subtypes during the first 2 years after diagnosis and studied its relationship to disease activity...

We developed a brief, new health-related quality of life measure for children with systemic lupus erythematosus that is valid in English for the United States, called Simple Measure of Impact of Lupus Erythematosus in Youngsters© (SMILEY©). The United States-English language questionnaire may not be applicable to most of the countries in the world...

Nursemaid’s elbow—sudden subluxation of the radial head—usually results from forcible traction to a child’s pronated hand or wrist, with the elbow extended. Ironically, this can occur when a parent tries to maneuver a child away from perceived danger, and the child experiences pain and acute loss of function of the affected limb. Nursemaid’s elbow...

The differential diagnosis of children with acute non-traumatic hip pathology varies from quite harmless conditions such as transient synovitis of the hip to more severe problems like Perthes' disease, slipped capital femoral epiphysis (SCFE) and life-threatening conditions such as septic arthritis of the hip. To provide population-based data on sy...

To investigate changes in the craniofacial skeleton in relation to the changes in condylar alterations that occur during long-term follow-up in patients with juvenile idiopathic arthritis. Temporomandibular joint (TMJ) involvement is defined as a condylar alteration that is observed on the orthopantomogram. Lateral cephalograms were used to determi...

Background: Pulled elbow (nursemaid's elbow) is a common injury in young children. It results from a sudden pull on the arm, usually by an adult or taller person, which pulls the radius through the annular ligament, resulting in subluxation (partial dislocation) of the radial head. The child experiences sudden acute pain and loss of function in th...

Background: Molluscum contagiosum is a common skin infection, caused by a pox virus. The infection will usually resolve within months in people with a normal immune system. Many treatments have been used for molluscum contagiosum but a clear evidence base supporting them is lacking.This is an updated version of the original Cochrane Review publish...

Currently, little is known about when or how to stop etanercept in patients with juvenile idiopathic arthritis (JIA) when a good clinical response is reached, and therefore no guidelines are available.1 We evaluated the disease course of patients with JIA who discontinued etanercept because of a sustained good clinical response. This study is embe...

To evaluate changes in health-related quality of life (HRQoL) in patients with refractory juvenile idiopathic arthritis (JIA) who are being treated with etanercept. 53 patients with JIA from seven Dutch centres were included. HRQoL was measured by the Childhood Health Assessment Questionnaire (CHAQ), Child Health Questionnaire (CHQ) and Health Util...

The obesity epidemic in children is spreading at alarming rates. Because musculoskeletal problems can influence physical activity, we compared the frequency of musculoskeletal problems in overweight and obese children with that in normal-weight children. We performed a cross-sectional database and face-to-face interview study that included 2,459 ch...

To develop a reliable and user-friendly digital Childhood HAQ (CHAQ) to facilitate systematic monitoring of disease activity at the outpatient clinic in juvenile idiopathic arthritis (JIA) patients. The digital CHAQ was tested with patients who visited the outpatient paediatric rheumatology clinic of the Erasmus MC Sophia Children's Hospital. These...

In recent decades, studies on the management of common foot problems in children have suggested that in many cases, there is no indication for treatment. It is not known whether these studies have changed daily practice. Our aim was to establish and compare incidence and referral rates for foot problems in children in 1987 and 2001. A comparison wa...

This chapter deals with Impetigo, which is a contagious superficial skin infection, characterized by superficial erosions covered with honey-colored crusts, most often on the face. Impetigo may be primary or secondary to other skin diseases, such as atopic eczema. It discusses about the incidence, etiology and prognosis of impetigo. The chapter des...

Bueving HJ, Bernsen RMD, De Jongste JC, Van Suijlekom-Smit LWA, Rimmelzwaan GF, Osterhaus ADME, Rutten-van Mölken MPMH, Thomas S, Van der Wouden JC. Griepvaccinatie bij kinderen met astma: een gerandomiseerd dubbelblind placebo-gecontroleerd onderzoek. Huisarts Wet 2004;47(11):491-7. Achtergrond In de meeste westerse landen wordt geadviseerd kinde...

OBJECTIVE: To study whether overweight and obese children have more frequent musculoskeletal problems and whether they seek medical assistance more often. DESIGN: Cross-sectional study. METHODS: We used information from general practitioners' databases and patient interviews from the Dutch second national study 2001. We obtained useful data from 24...

Objectives Most clinical studies use paper case record forms (CRFs) to collect data. In the Dutch multicentre observational study on biologicals we encountered several disadvantages of using the paper CRFs. These are delay in data collection , lack of overview in collected data, and difficulties in obtaining up-to-date interim reports. Therefore we...

Methotrexate (MTX) is the most commonly used disease-modifying antirheumatic drug in juvenile idiopathic arthritis (JIA). Currently, individual response to MTX cannot be reliably predicted. Identification of clinical and genetic factors that influence the response to MTX could be helpful in realizing the optimal treatment for individual patients. A...

Currently, little is known about when or how to stop etanercept in patients with juvenile idiopathic arthritis (JIA) when a good clinical response is reached, and therefore no guidelines are available. 1 We evaluated the disease course of patients with JIA who discontinued etanercept because of a sustained good clinical response. This study is embe...

Most clinical studies use paper case record forms (CRFs) to collect data. In the Dutch multi-centre observational study on biologicals we encountered several disadvantages of using the paper CRFs. These are delay in data collection, lack of overview in collected data and difficulties in obtaining up-to-date interim reports. Therefore, we wanted to...

We undertook an observational study to obtain a complete overview of the long-term effectiveness and safety of etanercept in patients with different juvenile idiopathic arthritis (JIA) subtypes. At baseline we collected patient and disease characteristics of all Dutch patients with JIA who started treatment with etanercept. Disease activity was eva...

Temporomandibular joint (TMJ) involvement is a frequent feature in cross-sectional prevalence studies among patients with juvenile idiopathic arthritis (JIA). In this followup study, patients were reviewed after 5 years to study the course of TMJ involvement in relation to disease characteristics. Children with JIA from a previous study on TMJ invo...

To validate a core set of outcome measures for the evaluation of response to treatment in patients with juvenile dermatomyositis (DM). In 2001, a preliminary consensus-derived core set for evaluating response to therapy in juvenile DM was established. In the present study, the core set was validated through an evidence-based, large-scale data colle...

Dermatophytosis is a common skin infection in children. Although the epidemiology is relatively unknown it is becoming a major health problem in some countries. We determine the incidence and management of dermatophytosis in Dutch general practice in 1987 and 2001. We used data of all children aged 0-17 years derived from two national surveys perfo...

A previous 24-week randomised trial demonstrated that sulfasalazine (SSZ) treatment was superior to placebo (PLAC) in suppressing disease activity in patients with oligo- and polyarticular onset juvenile idiopathic arthritis (JIA). The current study determines the long-term outcome of the trial participants and evaluates whether the benefits of SSZ...

Etanercept is effective in juvenile idiopathic arthritis (JIA).1–3 Currently it is administered subcutaneously at a dose of 0.4 mg/kg (maximum of 25 mg) twice a week. Clinical trials in adults show that administration of a double dose once a week is effective enough to induce and retain remission.4,5 A pharmacokinetic model developed by Yim et al 6...

Temporomandibular joint (TMJ) involvement is a frequent feature in cross-sectional prevalence studies among juvenile idiopathic arthritis (JIA) patients. The cross-sectional design makes it almost impossible to study the incidence. Follow-up data on TMJ involvement are sparse. In this study patients were reviewed with an interval of a minimum of 1...

ICD-9 codes used for selection of sepsis and bacteraemia cases. discharge diagnoses related to sepsis or bacteraemia according to ICD-9 classification, used for selecting cases.

Chapter S (skin diseases) of the International Classification of Primary Care (ICPC). tabulation of all codes in chapter S (skin diseases) of the International Classification of Primary Care (ICPC).

Otters H, Van der Wouden JC, Schellevis FG, Van Suijlekom-Smit LWA, Koes BW. Verwijzing van kinderen naar de specialist: een vergelijking tussen 1987 en 2001. Huisarts Wet 2006;49(7):348-53. Achtergrond Hoewel huisartsen regelmatig kinderen verwijzen naar een medisch specialist, is er maar weinig gedetailleerde informatie beschikbaar over het patr...

To investigate the facioskeletal morphology in patients with juvenile idiopathic arthritis (JIA) with and without temporomandibular joint (TMJ) involvement. Eighty five patients were included. TMJ involvement was defined by orthopantomogram alterations. Lateral cephalograms were used to determine linear and angular measurements and occlusion. Patie...

Background: Although GPs regularly refer children to a medical specialist, there is little detailed information available on the pattern of referrals and still less on developments over time. Aim: To uncover the pattern of referrals of children aged from 0 to 17 years and to compare the pattern in 2001 with that in 1987. Study design: An analysis o...

Juvenile localized scleroderma (JLS) includes a number of conditions often grouped together. With the long-term goal of developing uniform classification criteria, we studied the epidemiological, clinical and immunological features of children with JLS followed by paediatric rheumatology and dermatology centres. A large, multicentre, multinational...

Sepsis or bacteraemia, however rare, is a significant cause of high mortality and serious complications in children. In previous studies skin disease or skin infections were reported as risk factor. We hypothesize that children with sepsis or bacteraemia more often presented with skin diseases to the general practitioner (GP) than other children. I...

Molluscum contagiosum, in healthy people, is a self-limiting, relatively harmless viral skin infection. It affects mainly children and adolescents. People may seek treatment, however, for social and aesthetic reasons and because of concerns about spreading the disease to others. This review found that many common treatments for molluscum, such as p...

We aimed to investigate incidence rates of urinary tract infections in Dutch general practice and their association with gender, season and urbanisation level, and to analyse prescription and referral in case of urinary tract infections. During one calendar year, 195 general practitioners in 104 practices in the Netherlands registered all their pat...

The increasing proportion of skin diseases encountered in general practice represents a substantial part of morbidity in children. Only limited information is available about the frequency of specific skin diseases. We aimed to compare incidence rates of skin diseases in children in general practice between 1987 and 2001. We used data on all childr...

Impetigo is a common skin infection in children. The epidemiology is relatively unknown, and the choice of treatment is subject to debate. The objective of our study was to determine the incidence and treatment of impetigo in Dutch general practice, and to assess trends between 1987 and 2001. We used data from the first (1987) and second (2001) Dut...

In children with severe rheumatic disease (RD), treatment with corticosteroids (CS) is frequently needed and growth retardation and osteopenia may develop. A beneficial effect of human growth hormone (hGH) has been reported but mostly in trials without a control group. To study the effect of hGH on growth, bone mineral density (BMD), and body compo...

The purpose of this pilot study is to evaluate the feasibility of a cognitive-behavioural training program for adolescents with chronic pain irrespective of pain localisation. A secondary aim was to give an impression of the effect of the program on pain and quality of life. Eight adolescents (14-18 years) with chronic non-organic pain recruited fr...