The Relationship Between Physical Activity Levels and Pain in Children with Juvenile Idiopathic Arthritis A cluster-randomized controlled trial to reduce sedentary behavior and promote physical activity and health of 8-9 year olds: The Transform-Us! Study Methotrexate improves the health-related quality of life of children with juvenile idiopathic arthritis. Health-Related Quality of Life, Physical Function, Fatigue, and Disease Activity in Children with Established Polyarticular Juvenile Idiopathic Arthritis High prevalence of temporomandibular joint arthritis at disease onset in children with juvenile idiopathic arthritis, as detected by magnetic resonance imaging but not by ultrasound. A two-year prospective controlled study of bone mass and bone turnover in children with early juvenile idiopathic arthritis. Measuring health status in early juvenile idiopathic arthritis: determinants and responsiveness of the child health questionnaire. Trends in prescription of biological agents and outcomes of juvenile idiopathic arthritis: results of the Dutch national Arthritis and Biologics in Children Register The effect of a movement-to-music video program on the objectively measured sedentary time and physical activity of preschool-aged children and their mothers: A randomized controlled trial Correlates of preschool children’s objectively measured physical activity and sedentary behavior: a cross-sectional analysis of the SPLASHY study Long-term safety of etanercept and adalimumab compared to methotrexate in patients with juvenile idiopathic arthritis (JIA) Pilot study of fitness training and exercise testing in polyarticular childhood arthritis. Markedly decreased antibody titers against hepatitis B in previously immunised children presenting with juvenile idiopathic arthritis. Patterns of pain over time among children with juvenile idiopathic arthritis The iPeer2Peer Program: a pilot randomized controlled trial in adolescents with Juvenile Idiopathic Arthritis Intervening to Reduce Sedentary Behaviors and Childhood Obesity among School-Age Youth: A Systematic Review of Randomized Trials Hepatitis B vaccination in children with juvenile idiopathic arthritis A prospective study comparing infection risk and disease activity in children with juvenile idiopathic arthritis treated with and without tumor necrosis factor-alpha inhibitors A cluster-randomized controlled trial of strategies to increase adolescents’ physical activity and motivation during physical education lessons: the Motivating Active Learning in Physical Education (MALP) trial Anti-adalimumab antibodies in a cohort of patients with juvenile idiopathic arthritis: incidence and clinical correlations Efficacy of measles, mumps and rubella revaccination in children with juvenile idiopathic arthritis treated with methotrexate and etanercept. The effects of vigorous exercise training on physical function in children with arthritis: a randomized, controlled, single-blinded trial. Preliminary validation of clinical remission criteria using the OMERACT filter for select categories of juvenile idiopathic arthritis.
Objective . Pain and reduced physical activity levels are common in children with juvenile idiopathic arthritis ( JIA ) . Currently , there is no consensus about the role of physical activity in managing pain in JIA . The purpose of our study was to assess the relationship between physical activity level and pain in children ages 11 to 18 years with JIA . Methods . A r and om sample of 50 patients with JIA were approached by mailed question naires . Physical activity was determined using the Physical Activity Question naire ( PAQ ) .  Pain measures included the Numerical Rating Scale ( pain severity ) , SUPER-KIDZ body diagram ( number of painful areas ) , and the Child Activities Limitations Inventory-21 ( pain interference ) . Generalized linear models were used to assess the relationship between physical activity and pain , as well as the roles of sex and age . Results . The response rate was 84 % . Thirty-four respondents completed the question naire package . The median age was 15 years . The mean PAQ score was 2.16/5 . Physical activity declines with increasing age in youth with JIA ( r = 0.53 , p = 0.0014 ) . Lower physical activity is associated with greater pain interference ( r = 0.39 , p = 0.0217 ) and more severe pain ( r = 0.35 , p = 0.0422 ) . Conclusion . Children with JIA report significantly less activity than healthy children based on PAQ scores , with physical activity declining throughout adolescence . Physical activity is inversely related to pain interference and severity in children with JIA . Our findings suggest that physical activity interventions may play an important role in the management of pain in JIA Background Physical activity ( PA ) is associated with positive cardio-metabolic health and emerging evidence suggests sedentary behavior ( SB ) may be detrimental to children 's health independent of PA . The primary aim of the Transform-Us ! study is to determine whether an 18-month , behavioral and environmental intervention in the school and family setting s results in higher levels of PA and lower rates of SB among 8 - 9 year old children compared with usual practice ( post-intervention and 12-months follow-up ) . The secondary aims are to determine the independent and combined effects of PA and SB on  children 's cardio-metabolic health risk factors ; identify the factors that mediate the success of the intervention ; and determine whether the intervention is cost-effective . Methods / design A four-arm cluster-r and omized controlled trial ( RCT ) with a 2 × 2 factorial design , with schools as the unit of r and omization . Twenty schools will be allocated to one of four intervention groups , sedentary behavior ( SB-I ) , physical activity ( PA-I ) , combined SB and PA ( SB+PA-I ) or current practice control ( C ) , which will be evaluated among approximately 600 children aged 8 - 9 years in school year 3 living in Melbourne , Australia . All children in year 3 at intervention schools in 2010 ( 8 - 9 years ) will receive the intervention over an 18-month period with a maintenance ' booster ' delivered in 2012 and children at all schools will be invited to participate in the evaluation assessment s. To maximize the sample and to capture new students arriving at intervention and control schools , recruitment will be on-going up to the post-intervention time point . Primary outcomes are time spent sitting and in PA assessed via accelerometers and inclinometers and survey . Discussion To our knowledge , Transform-Us ! is the first RCT to examine the effectiveness of intervention strategies for reducing children 's overall sedentary time , promoting PA and optimizing health outcomes . The integration of consistent strategies and messages to children from teachers and parents in both school and family setting s is a critical component of this study , and if shown to be effective , may have a significant impact on educational policies as well as on pedagogical and parenting practice s . Trial registration ACTRN12609000715279 ; Current Controlled Trials IS RCT OBJECTIVES To examine the change in health-related quality of life ( HRQOL ) and its determinants in children with juvenile idiopathic arthritis ( JIA ) treated with methotrexate ( MTX ) .  METHODS Patients were extracted from the PRINTO clinical trial which aim ed to evaluate the efficacy and safety profile of MTX administered in st and ard , intermediate or higher doses ( 10 , 15 and 30 mg/m(2)/week respectively ) . Children with polyarticular-course JIA , who were less than 18 years and had a complete HRQOL assessment were included . RESULTS A total of 521 children were included . At baseline , patients with JIA showed poorer HRQOL ( p<0.01 ) than healthy children . In 207/412 ( 50 % ) and 63 ( 15 % ) children , HRQOL values were 2 st and ard deviations below the mean of healthy controls in the physical and psychosocial summary scale , respectively . After 6 months of treatment with st and ard dose MTX , there was a statistically significant improvement in all HRQOL health concepts , particularly the physical ones . Similar improvements were observed in those who did not respond to a st and ard dose of MTX and were subsequently r and omised to a higher dose . The presence of marked disability at baseline was associated with a fivefold increased risk of retaining poor physical health after 6 months of active treatment with st and ard dose MTX . Other less important determinants of retaining poor physical well-being were the baseline level of systemic inflammation , pain intensity and an antinuclear-antibody-negative status . CONCLUSIONS MTX treatment produces a significant improvement across a wide range of HRQOL components , particularly in the physical domains , in patients with JIA Objective . To compare child  self-report and parent/proxy report of health-related quality of life ( HRQOL ) , disability , and fatigue in children with active polyarticular juvenile idiopathic arthritis ( JIA ) to that of children with inactive polyarticular JIA and to previous data from healthy controls . Methods . Cross-sectional survey of children with polyarticular JIA diagnosed and treated between 2000 to 2006 and their parent/proxy . The Childhood Health Assessment Question naire , Pediatric Quality of Life Inventory ( PedsQL ) Generic Core Scales , PedsQL Rheumatology Module , and PedsQL Multidimensional Fatigue Scale were administered . Disease activity data were collected from the physician clinic notes . Comparisons were performed with t tests . Correlations between patient and parent/proxy reports were measured with Pearson correlation coefficients . Results . Sixty children and /or their parents/proxies participated ( 79 % response rate ) . Disease activity status was available for 52 , and 32 met criteria for inactive disease ( 62 % ) . Participants reported lower scores on the PedsQL Generic Core Scales ( range 2.54–9.13 points lower ) and the PedsQL Rheumatology Module ( range 2.46–6.96 points lower ) than those with inactive disease . Participants also reported lower scores on the PedsQL Multidimensional Fatigue Scale than did healthy controls , regardless of disease activity status ( range 0.06–9.2 points lower ) . Conclusion . Although children in this cohort with polyarticular JIA and inactive disease reported HRQOL scores similar to those of healthy controls , children with polyarticular JIA and their parents/proxies tended to report more fatigue than controls , regardless of disease activity . Application of these measures prospect ively to larger cohorts of children with JIA is needed to assess these differences OBJECTIVE To determine the prevalence of temporom and ibular joint ( TMJ ) disease in a cohort of children with new-onset juvenile idiopathic arthritis ( JIA ) , and to compare magnetic resonance imaging ( MRI ) with ultrasound ( US ) for the detection of acute and chronic changes of TMJ arthritis . METHODS Between January 2005 and April 2007 , children with newly diagnosed JIA were prospect ively evaluated for TMJ arthritis . Prior to imaging , jaw pain and disability were assessed with question naires and physical examination . The TMJs of all patients were imaged with MRI and US within 8 weeks of diagnosis . RESULTS Of the 32 patients enrolled , 78 % were female , and the median age was 8.6 years ( range 1.5 - 17.2 years ) .  Acute TMJ arthritis was diagnosed in 75 % of the children by MRI and in none by US ; chronic arthritis was diagnosed in 69 % by MRI and in 28 % by US . Findings of both acute and chronic TMJ disease were detected by MRI in 53 % of the patients . Of those with acute TMJ arthritis , 71 % were asymptomatic , and 63 % had normal findings on jaw examination . Fifty-six percent of patients with acute disease had an improved maximal incisal opening after corticosteroid injection . Among these responders , 56 % had been asymptomatic and had normal jaw examination findings . CONCLUSION TMJ arthritis was present in the majority of patients with new-onset JIA . Findings on MRI along with responses to treatment among asymptomatic patients with normal jaw examination findings suggest that a history review and physical examination are not sufficient to screen for TMJ disease . Our results also suggest that MRI and US findings are not well correlated , and that MRI is preferable for the detection of TMJ disease in new-onset JIA OBJECTIVE To explore early changes and predictors of bone mass in children with juvenile idiopathic arthritis ( JIA ) in order to identify patients who will develop bone mass reductions . METHODS We conducted a prospect i ve cohort study of 108 children with early JIA ( ages 6 - 18 years ; mean disease duration 19.3 months ) who were individually matched with 108 healthy children for age , sex , race , and county of residence .  Bone mass and changes in total body , spine , femur , and forearm bone mineral density and bone mineral content ( BMC ) , body composition , growth , and biochemical parameters of bone turnover were examined at baseline and at followup a mean of 24 months later . Low bone mass was defined as a Z score > 1 SD below the reference population . RESULTS Of the 200 children evaluated at followup , the 100 healthy children had greater gains in total body BMC ( P = 0.035 ) , distal radius BMC ( P < 0.001 ) , and total body lean mass ( P < 0.001 ) than did the 100 JIA patients . Low or very low total body BMC was observed in 24 % of the patients and 12 % of the healthy children . Bone formation , bone resorption , and weight-bearing activities were reduced in the patients compared with the healthy children . Multiple regression analysis showed that in patients with JIA , serum bone-specific alkaline phosphatase , serum C-telopeptide of type I collagen , and weight-bearing activities were independent predictors of changes in total body BMC . Total body BMC was lower in patients with polyarticular onset than in those with oligoarticular disease onset . CONCLUSION Patients with JIA have moderate reductions in bone mass gains , bone turnover , and total body lean mass early in the disease course OBJECTIVE To assess the determinants and responsiveness of the Norwegian version of the Child Health Question naire ( CHQ ) in patients with early juvenile idiopathic arthritis ( JIA ) and to compare health status in patients and controls . METHODS A total of 116 children ( median age 8.4 yrs ) with JIA and < 2.5 years of disease duration ( median 11.0 mo ) were examined by a pediatric rheumatologist and reassessed after a median of 10.0 months . Physical and psychosocial health were assessed by means of the CHQ , which provides summary scores for physical and psychosocial health , the Childhood Health Assessment Question naire ( CHAQ ) , and the Child Behavior Checklist ( CBCL , n = 32 ) . Matched controls ( n = 116 ) , r and omly selected from the general population , completed the CHQ at baseline . RESULTS The patients with JIA had poorer physical health and slightly impaired psychosocial health compared with the controls [ 41.2 + /- 13.6 vs 55.2 + /- 7.3 ( p < 0.001 ) and 51.0 + /- 7.5 vs 54.1 + /- 5.7 ( p = 0.002 ) , respectively ] . The most important determinants of the CHQ physical summary score were the child 's pain , morning stiffness , the CHAQ disability index , erythrocyte sedimentation rate ( ESR ) , overall well-being , and physician 's global assessment of disease activity . The psychosocial summary score correlated with the CBCL level of internalizing , externalizing , and total behavior problems . The st and ardized response mean for the physical summary score was large ( 0.96 ) for those who improved , and moderate ( -0.60 ) for those who became worse . CONCLUSION The CHQ discriminated between patients with early JIA and controls . The most important determinants of the CHQ physical summary score were the child 's pain , morning stiffness , CHAQ , ESR , overall well-being , and physician 's global assessment of disease activity . The CHQ was sensitive to clinical changes in children with JIA Background Treatment of  juvenile idiopathic arthritis ( JIA ) has changed dramatically since the introduction of biological agents in 1999 . Objective To evaluate trends in prescription patterns of biological agents and the subsequent outcome of JIA . Methods The Arthritis and Biologics in Children register ( multicentre prospect i ve observational study ) aim ed to include all consecutive patients with JIA in the Netherl and s who had started biological agents since 1999 . Patients were divided according to year of introduction of first biological agent . Patient characteristics at introduction of the first biological agent and its effectiveness were analysed over 12 years . Results 335 patients with non-systemic JIA and 86 patients with systemic JIA started a biological agent between 1999 and 2010 . Etanercept remained the most often prescribed biological agent for non-systemic JIA ; anakinra became first choice for systemic JIA . The use of systemic glucocorticoids and synthetic disease-modifying antirheumatic drugs before biological agents decreased . During these 12 years of observation , biological agents were prescribed earlier in the disease course and to patients with lower baseline JADAS ( Juvenile Arthritis Disease Activity Score ) disease activity . All baseline disease activity parameters were lowered in patients with non-systemic JIA . In systemic JIA , prescription patterns changed towards very early introduction of biological agents ( median 0.4 years of disease duration ) in patients with a low number of joints with active arthritis and high erythrocyte sedimentation rates . These changes for both systemic and non-systemic JIA result ed in more patients with inactive disease after 3 and 15 months of treatment . Conclusions Biological agents are increasingly prescribed , earlier in the disease and in patients with JIA with lower disease activity . These changes are accompanied by better short-term disease outcomes Regular physical activity ( PA ) and the avoidance of prolonged sitting are essential for children ’s healthy growth , and for the physical and mental wellbeing of both children and adults . In the context of exercise , music may promote behavioral change through increased exercise adherence and participation . The purpose of this study was to determine whether a movement-to-music video program could reduce sedentary behavior ( SB ) and increase PA in mother-child pairs in the home environment . A r and omized controlled trial was conducted in the Pirkanmaa region , Finl and , in 2014–2016 . The participants consisted of 228 mother-child pairs ( child age 5–7 years ) . The primary outcomes of interest were tri-axial accelerometer-derived SB and PA , which were measured in weeks one ( baseline ) , two , and eight in both the intervention and control groups . Further , the mothers and children in the intervention group used a movement-to-music video program from the beginning of week two to the end of week eight . Secondary outcomes included self-reported screen time . The statistical methods employed comprised an intention-to-treat and linear mixed effects model design . No statistically significant differences between groups were found in primary or secondary outcomes . Among the children in the control group  , light PA  decreased significantly over time and screen time increased from 89 ( st and ard deviation , SD 37 ) to 99 ( SD 41 ) min/d . Among mothers and children in the intervention group , no statistical differences were found . In supplementary analysis , the children who stayed at home instead of attending daycare/preschool had on average 25 ( 95 % confidence interval , CI 19–30 ) min/d more sedentary time and 11 ( 95 % CI 8–14 ) min/d less moderate-to-vigorous PA than those who were at daycare/preschool . The higher body mass index of mothers was related with 5 ( 95 % CI 2–7 ) min/d more sedentary time and 1 ( 95 % CI 0–2 ) min/d less moderate-to-vigorous PA . The movement-to-music video program did not change the objective ly measured SB or PA of the mother-child pairs . However , mothers and children seemed to be more sedentary at home , and therefore interventions for decreasing SB and increasing PA should be targeted in the home environment Background Identifying ways to promote physical activity and decrease sedentary time during childhood is a key public health issue . Research on the putative influences on preschool children ’s  physical activity ( PA ) and  sedentary behavior  ( SB ) is limited and has yielded inconsistent results . Our aim was to identify correlates of PA and SB in preschool children . Methods Cross-sectional data were drawn from the Swiss Preschoolers ’ Health Study ( SPLASHY ) , a Swiss population -based cohort study . Of 476 two to six year old children , 394 ( 54 % boys ) had valid PA data assessed by accelerometry .  Information on exposure data was directly measured or extracted from parental question naires . Multilevel linear regression modeling was used to separately assess associations between 35 potential correlates and  total PA ( TPA ) , moderate-to-vigorous PA ( MVPA ) and SB . Results In total , 12 correlates from different domains were identified . TPA and MVPA were greater in boys than girls , increased with age and were positively associated with gross motor skills . Children from single parent families had a higher level of TPA and spent less time sedentary than those living with two parents . Time spent outdoors was positively associated with TPA and negatively with SB . The child ’s activity temperament was related all three outcomes , whereas parental sports club membership , living area per person and neighborhood safety were associated with SB only . Fixed and r and om factors in the final models accounted for 28 % , 32 % and 22 % of the total variance in TPA , MVPA and SB , respectively . Variance decomposition revealed that age , sex and activity temperament were the most influential correlates of both , TPA and MVPA , whereas the child ’s activity temperament , time outdoors and neighborhood safety were identified as the most important correlates of SB . Conclusions A multidimensional set of correlates of young children ’s  activity behavior has been identified . Personal factors had the greatest influence on PA , whereas environmental-level factors had the greatest influence on SB . Moreover , we identified a number of previously unreported , potentially modifiable correlates of young children ’s PA and SB . These factors could serve to define target groups or become valuable targets for change in future interventions .Trial registration Current Controlled Trials IS RCT N41045021 ( date of registration : 21.03.14 ) Importance Published evidence on the long-term safety of etanercept ( ETA ) and adalimumab ( ADA ) in patients with polyarticular juvenile idiopathic arthritis ( pJIA ) is still limited . Objectives To investigate the rates of serious adverse events ( SAE ) and of events of special interest ( ESI ) under ETA and ADA treatment . Design , setting and participants Patients with pJIA were prospect ively observed in the national JIA biological register , Biologika in der Kinderrheumatologie , and its follow-up register , Juvenile arthritis Methotrexate/Biologics long-term Observation . Main outcomes and measures We calculated the relative risks of SAE and ESI for ETA and ADA compared with methotrexate ( MTX ) . Results Among the 1414 patients treated with ETA ( n=1414 ; 4461 exposure years ( EY ) ) and ADA ( n=320 ; 493 EY ) , significantly more SAE , infections and medically important infections were observed ( ETA : 4.5 , 5.7 , 0.9 ; ADA : 4.7 , 11.4 , 0.4 per 100 EY ) compared with those treated with MTX alone ( n=1455 ; 2.907 EY ; 2.6 , 5.5 , 0.5 per 100 EY ) . The risk for malignancies was not significantly increased for ETA and ADA compared with MTX ( 0.09 , 0.27 and 0.07/100 person-years ) . Patients under ETA monotherapy developed more frequently incident inflammatory bowel disease ( IBD ) and incident uveitis ( 0.5 and 0.8/100 EY ) than patients treated by ETA in combination with MTX ( 0.1 and 0.2/100 EY ) or MTX alone ( 0.03 and 0.1/100 EY ) . Conclusions and relevance Our data confirm the acceptable long-term tolerability of ETA and ADA in pJIA . However , whether the onset of IBD and uveitis during ETA monotherapy is a paradoxical effect or an inadequate response to therapy remains unclear and requires further investigation in this growing cohort OBJECTIVE To 1 ) assess the safety and feasibility of laboratory-based exercise testing in juvenile idiopathic arthritis ( JIA ) , 2 ) test the safety and feasibility of a 3-month exercise program in JIA , 3 ) assess pain during exercise in JIA , 4 ) compare ratings of perceived effort ( RPE ) with heart rate ( HR ) achieved , and 5 ) estimate the training effect on metabolic efficiency of gait as measured by submaximal exercise testing . METHODS Nine children with JIA were enrolled in a 12-week circuit training program involving pool , stationary bicycle , treadmill , and Fitball . They underwent formal exercise testing before and after the program , underwent a full joint assessment , were administered the Childhood Health Assessment Question naire and Juvenile Arthritis Functional Status Index , and were assessed for overall quality of life and health-related quality of life . A visual analog scale was used to assess pain during testing and training , and the Borg scale was used to measure RPE . RESULTS Children with JIA were able to participate in exercise testing without any significant problems . Children with severe hip disease dropped out of the exercise program due to  pain  during the exercise sessions and worsened arthritis symptoms . Target HR was achieved and correlated with RPE in the bicycle and treadmill sessions . Submaximal exercise testing showed an improvement with a small to moderate effect size . CONCLUSION This study suggests that it is safe , feasible , and acceptable for children with arthritis , in the absence of severe hip involvement , to participate in formal exercise testing and structured fitness programs OBJECTIVES Hepatitis B is a vaccine preventable disease with intermediate endemicity in Greece . Patients with juvenile idiopathic arthritis ( JIA ) on immunomodulating therapy  are prone to infection or reactivation of hepatitis B virus ( HBV ) . The aim of this study is to define the immune status against HBV in children newly-diagnosed with JIA . METHODS Case-control prospect i ve study including 89 JIA patients and 89 controls matched for age and gender . Eighty-nine JIA patients were included in the study ( 22 males ) , with a mean age of 6.8 years . Sera were tested for hepatitis B surface antigen , hepatitis B core antibody , and anti-HBs . Patients with anti-HBs titers ≥10 IU/L were considered immune . Data were analysed with SPSS 18.0 version . RESULTS In the JIA group 55 % were HBV immune ( anti-HBs level ≥10 IU/L ) while in the control group 92 % were immune against HBV ( p<0.001 ) . Antibody levels in the patient group were significantly lower compared to the control group . The mean concentration of anti-HBs levels in JIA patients was 18.3 IU/L versus 82.6 IU/L in the control group ( p<0.001 ) . CONCLUSIONS Antibody titers against HBV in fully vaccinated JIA patients due to start treatment are significantly lower compared to matched healthy children in this study . Diagnosis of JIA and older age were associated with the absence of protective antibodies . Although there is no evidence to support the introduction of a booster HBV dose in healthy children who mount low antibody response following immunisation , further studies are required to address this question in patients with JIA Objectives Pain is a very common symptom of juvenile idiopathic arthritis ( JIA ) . Disease activity alone can not explain symptoms of pain in all children , suggesting other factors may be relevant . The objectives of this study were to describe the different patterns of pain experienced over time in children with JIA and to identify predictors of which children are likely to experience ongoing pain . Methods This study used  longitudinal- data from patients ( aged 1–16 years ) with new-onset JIA .  Baseline and up to 5-year follow-up pain data from the Childhood Arthritis Prospect i ve Study ( CAPS ) were used . A two-step approach was adopted . First ,  pain trajectories  were modelled using a discrete mixture model . Second , multinomial logistic regression was used to determine the association between variables and trajectories . Results Data from 851 individuals were included ( 4 years , median follow-up ) . A three-group trajectory model was identified : consistently low pain ( n=453 ) , improved pain ( n=254 ) and consistently high pain ( n=144 ) . Children with improved pain or consistently high pain differed on average at baseline from consistently low pain . Older age at onset , poor function/disability and longer disease duration at baseline were associated with consistently high pain compared with consistently low pain . Early increases in pain and poor function/disability were also associated with consistently high pain compared with consistently low pain . Conclusions This study has identified routinely collected clinical factors , which may indicate those individuals with JIA at risk of poor pain outcomes earlier in disease . Identifying those at highest risk of poor pain outcomes at disease onset may enable targeted pain management strategies to be implemented early in disease thus reducing the risk of poor pain outcomes Background Adolescents with Juvenile Idiopathic Arthritis ( JIA ) are at risk for physical , emotional , social and role challenges that negatively impact quality of life .  Peer mentoring has been shown to improve positive health behaviours in adolescents with chronic disease while simultaneously providing social support . The objectives of this paper are to examine the feasibility and acceptability of an online peer mentoring program ( iPeer2Peer Program ) for adolescents with JIA . Methods The iPeer2Peer program was examined using a waitlist pilot r and omized control trial ( RCT ) . Participants were r and omly allocated to the intervention or wait-list control group via a secure , web-based r and omization service . Health care providers and investigators were blinded to participant group allocation . Trained peer mentors ( 16–25 years ; successfully managing their JIA ) were matched to participants ( 12–18 years ; diagnosed with JIA ) r and omized to the intervention group to provide peer support and education for effective self-management of JIA . Participant-mentor pairings connected ten times over 8 weeks using Skype video calls . Primary outcomes focused on implementation ( i.e. measures of feasibility and acceptability ) . Secondary outcomes focused on effectiveness ( i.e. measures of self-management , self-efficacy , pain , social support and quality of life ) . Results Thirty adolescents ( mean age 14.3 ± 1.7 years , 97 % female ) completed the RCT ( intervention n = 16 , control n = 14 ) . Primary outcomes : One third ( 32 % ) of adolescents approached agreed to participate , completed baseline measures and were r and omized . Half of pairings completed ten calls within 8 weeks . Average call length was twice the required amount with call lengths of 44.72 ± 15.76 min . Participants reported satisfaction with the program and all reported that they would recommend it to their peers . Participants ’ mean engagement level with the program was 8.53/10 ( range = 7–10 ) . Secondary outcomes : Participants who completed the iPeer2Peer Program demonstrated improvements in their perceived ability to manage JIA ( p < 0.04 ) , compared to controls . No adverse events were reported . Conclusion The iPeer2Peer Program is a promising intervention that improves acceptability of self-management and peer support treatments for adolescents with JIA . By using the Internet to connect mentors to adolescents with JIA it may also improve accessibility to these re sources . Findings will be used to adapt the program and refine the methodology for a full-scale RCT .Trial registration Clinical Trials.gov Identifier : NCT01986400 . Registered November 11 , 2013 Objective . To assess the effectiveness of interventions that focus on reducing  sedentary behavior ( SB ) among school-age youth and to identify elements associated with interventions ' potential for translation into practice setting s. Methods . A comprehensive literature search was conducted using 4 data bases for peer- review ed studies published between 1980 and April 2011 . R and omized trials , which lasted at least 12 weeks , aim ed at decreasing  SB among children aged 6 to 19 years were identified . Results . Twelve studies were included ; 3 focused only on SB , 1 focused on  physical activity ( PA )  , 6 were combined SB and PA interventions , and 2 studies targeted SB , PA , and diet .  The majority of the studies were conducted in a school setting , while others were conducted in such setting s as clinics , community centers , and libraries . Conclusions . Overall , interventions that focused on decreasing SB were associated with reduction in time spent on SB and /or improvements in anthropometric measurements related to childhood obesity . Several of the studies did consider elements related to the intervention 's potential for translation into practice setting Objectives : To evaluate the responsiveness of children with juvenile idiopathic arthritis ( JIA ) to hepatitis B vaccination and to determine the most useful vaccination schedule . Methods : 39 children with JIA were enrolled in the study ; all were in remission and negative to serological testing for hepatitis B surface antigen ( HbsAg ) . The control group consisted of 41 healthy children . There were two different vaccination schedules : group I was vaccinated at 0 , 1 , and 3 months ; group II was vaccinated at 0 , 1 , and 6 months .  Positive responsiveness to the vaccine was defined as an anti-hepatitis B antibody titre above 10 mIU/ml . Results : All the children except one with systemic JIA developed an antibody response . None of the JIA patients experienced a flare up or clinical deterioration related to the vaccination . The antibody levels in children with JIA were significantly lower than in the healthy controls . Comparison of the antibody levels between the two vaccination schedules showed no statistical difference in the controls ; in the JIA subjects the group II schedule result ed in a trend to a greater response than the group I schedule ( p<0.07 ) . Vaccine responsiveness was not influenced by either methotrexate or prednisolone treatment . Conclusions : Children with JIA had an adequate response to hepatitis B vaccination and the response was not affected by immunosuppressive treatment . A vaccination schedule at 0 , 1 , and 6 months seems to be preferable to 0 , 1 , and 3 months Tumor necrosis factor-alpha ( TNF-α ) inhibitors are effective treatment for juvenile idiopathic arthritis ( JIA ) but may increase infection rates . However , active JIA may also render patients vulnerable to infection . In this study , we prospect ively assessed infection rates in JIA patients treated with and without TNF-α inhibitors  and correlated disease activity with infection risk .  TNF-α inhibitor-naïve JIA subjects were followed up for 12 months . Subjects initiated on TNF-α inhibitors after enrollment were analyzed in the TNF group . Subjects treated without TNF-α inhibitors were analyzed in the non-TNF group . Question naires captured mild or severe infections . JIA disease activity by Childhood Health Assessment Question naire ( CHAQ ) disability index/pain score and physician joint count/global assessment was recorded . Twenty TNF and 36 non-TNF subjects were analyzed .  The total infection rate ratio for TNF versus non-TNF group subjects was 1.14 ( 95 % CI , 0.78–1.66 ; p = 0.51 ) . The average rate of infections per month was 0.29 for TNF and 0.24 for non-TNF subjects . No severe infections or hospitalizations occurred in either group . Secondary infectious outcomes were also similar between groups . Controlling for study group , an increase in CHAQ pain score correlated with an increase in several infectious outcome measures . Our results suggest no difference in infection rates between JIA subjects treated with and without TNF-α inhibitors . Additionally , JIA disease activity may have contributed to infection risk in our cohort , irrespective of immunosuppressive therapy . Future analysis of the relationship between treatment regimens , disease activity , and infection rates may help to further delineate predictors of infection risk in JIA patients Background The physical activity ( PA ) levels of many children and adolescents in Australia are currently insufficient to promote health benefits . Physical education ( PE ) programs aim to promote PA and reach nearly all school-aged children , but PA levels within PE lessons are often low . PE teachers may influence children ’s motivation to be physically active in PE lessons , but little is known about teacher strategies that effectively motivate children to participate in PA , and few intervention studies have examined motivational strategies in PE . The purpose of this study was to compare the effect of three motivational strategies , each based on Self-Determination Theory ( SDT ) , on PA levels , and their hypothesized antecedents , during year 8 PE lessons . Methods / design This study employed a cluster-r and omized controlled trial design . Following a familiarization session , PA levels and hypothesized PA antecedents were measured during a baseline lesson and a post-intervention or control lesson .  Teachers ( n = 16 ) and their classes from five secondary schools in Sydney , Australia were r and omly assigned into four blocks and instructed to provide one of four 20-min lesson teaching strategy conditions : ( 1 ) explaining the relevance of activities ; ( 2 ) providing choice from PA options selected by the teacher ; ( 3 ) providing equipment and free choice of activities ; or ( 4 ) usual practice . The primary outcomes were lesson time spent in moderate-to-vigorous PA , and motivation towards the lesson . Secondary outcomes were perceptions of teacher behavior , psychological needs satisfaction , and lesson time spent in sedentary behavior . PA and sedentary behavior were measured during baseline and post-intervention lessons with waist-mounted Actigraph GT3X accelerometers . Teacher behavior , psychological needs satisfaction , and motivation were assessed via question naires at the end of each lesson . Linear mixed-model analyses will be run on all outcomes , with students nested within teachers as a r and om effect . Discussion Study findings will inform the development of effective SDT-based teaching strategy interventions to enhance students ’ psychological needs satisfaction , motivation , and PA levels . More effective teaching strategies may be identified that are capable of improving  adolescents ’ PA levels , and thereby provide beneficial population health outcomes .Trial registration This trial is registered with Current Controlled Trials and is traceable as IS RCT N07038258 Adalimumab is a TNF-α blocker antibody similar in structure and function to natural human IgG1 . Even if adalimumab is fully humanized , the development of anti-drug antibodies has been reported in several inflammatory conditions . The objective of our study was to assess the presence of  anti-adalimumab antibodies ( AAA ) and their clinical relevance in a cohort of juvenile idiopathic arthritis ( JIA ) patients on adalimumab . This is a prospect i ve observational cohort study recruiting JIA children . Experiments were performed using a vali date d surface plasmon resonance (SPR)-based optical assay ( Biacore ® T100 ) . Disease activity was evaluated using the Juvenile Arthritis Disease Activity Score with 10 joint count ( JADAS-10 ) . The Mann – Whitney U test , Wilcoxon signed-rank test for paired sample s , chi-square , and Fisher exact test were used to compare data . Pearson ’s and Spearman ’s correlation tests were used to determine correlation coefficients for entered variables : demographic , clinical , and serological data . Ten ( 37 % ) out of 27 patients included in the study had at least one AAA-positive sample . Patients developed AAA between 3 and 38 months after starting adalimumab . Seven ( 70 % ) out of 10 children with AAA positivity experienced at least a relapse compared to 4 ( 23.5 % ) out of 17 AAA-negative children ( rs 0.45 , p < 0.017 ) . In conclusion , using an innovative and accurate assay method , we found a high incidence of anti-drug antibodies in a cohort of adalimumab-treated JIA patients observed over a mean period of 40 weeks ; the presence of anti-adalimumab antibodies seemed to be related to the number of relapses OBJECTIVES To evaluate the influence of low-dose MTX and etanercept treatment on efficacy of measles , mumps and rubella ( MMR ) revaccination in children with juvenile idiopathic arthritis . METHODS A prospect i ve nested case-control study was performed to investigate markers of MMR revaccination induced humoral and cell-mediated immunity in 15 patients with juvenile idiopathic arthritis ( ages 6 - 17 yrs ) , treated with either low-dose MTX therapy alone or in combination with etanercept . The control group consisted of 22 healthy children .  Production of IFN-gamma by T memory cells upon in vitro stimulation with measles , mumps and rubella antigens and seroprevalence of virus-specific IgG antibodies were assessed . Medication use , disease activity and patients ' comments on side-effects were observed during the period of 6 months before and after revaccination . RESULTS Low-dose MTX therapy following MMR vaccination proved not to hamper T-cell mediated immunity in vitro . Neither low-dose MTX nor etanercept treatment , given simultaneously with revaccination , markedly interfered with generation of long-lived virus-restricted T cells and protective levels of virus-specific IgG antibodies . No increase in disease activity or medication use was seen within 6 months after MMR revaccination , including JIA patients using etanercept . No overt measles , mumps , rubella or secondary severe infections were noted . CONCLUSIONS Low-dose MTX and etanercept treatment do not seem to interfere with intended outcome of MMR revaccination in children with JIA OBJECTIVE To examine the effectiveness of high-intensity aerobic training compared with low-intensity training in terms of energy cost of locomotion , peak oxygen uptake , peak power , and self-reported physical function in children with juvenile idiopathic arthritis ( JIA ) . METHODS Eighty children with JIA , ages 8 - 16 years , were enrolled in a r and omized , single-blind controlled trial . Both groups participated in a 12-week , 3-times-weekly training program consisting of high-intensity aerobics in the experimental group and qigong in the control group . Subjects underwent exercise testing measuring submaximal oxygen uptake at 3 km/hour ( VO(2submax ) ) as the primary outcome , maximal oxygen uptake , and peak power at the beginning and end of the program . Physical function was measured using the Child Health Assessment Question naire ( C-HAQ ) . RESULTS The exercise program was well tolerated in both groups . There was no difference in VO(2submax ) or any other exercise testing measures between the groups through the study period and no indication of improvement . Both groups showed significant improvements in C-HAQ with no difference between the groups . Adherence was higher in the control group than the experimental group . CONCLUSION Our findings suggest that activity programs with or without an aerobic training component are safe and may result in an important improvement in physical function . The intensity of aerobic training did not seem to provide any additional benefits , but higher adherence in the qigong program may suggest that less intensive regimens are easier for children with JIA to comply with , and provide a degree of benefit equivalent to more intensive programs OBJECTIVE To begin the validation process of the preliminary criteria for inactive disease ( ID ) , clinical remission on medication ( CRM ) , and clinical remission off medication ( CR ) in children with select forms of juvenile idiopathic arthritis ( JIA ) . METHODS We used the OMERACT filter paradigm to estimate the validity of the criteria within each of the filter 's 3 components : truth , discrimination , and feasibility , in 5 categories of JIA : systemic arthritis , persistent and extended oligoarthritis , and rheumatoid factor-positive and negative polyarthritis . Data sources for determining validity estimates included a Delphi question naire survey sent to 246 pediatric rheumatologists in 34 countries , a consensus conference attended by 20 senior pediatric rheumatologists representing 9 countries , a retrospective chart review of 437 patients with JIA from 3 tertiary care clinics who had been followed between 4 and 22 years , and the literature . RESULTS Truth component : face and content validity . These aspects of validity were largely established via the Delphi question naire exercise and the consensus conference . Using an 80 % consensus level , participants felt that a set of non-redundant variables could effectively differentiate the clinical states of ID , CRM , and CR . Criterion validity could not be irrefutably established because no gold st and ard for inactive disease exists for JIA . As an alternative , published investigations of remission in JIA were used to estimate concurrent and convergent validity , as surrogates for criterion validity and as indicators of overall construct validity . Correlational analyses revealed the new criteria to have good construct validity . Discrimination component : the criteria demonstrated moderate to high levels of classification , prognosis , and responsiveness ( sensitivity to change ) using data from the chart review . Patients who were able to attain CR remained disease-free for substantially longer periods than did those who attained only ID or CRM . Responsiveness was evidence d by the ability of the criteria to allow movement of most patients between the disease states , consistent with what is known of the course of the disease . Feasibility component : Results of the Delphi and consensus conference produced a set of criteria that are easily , quickly , and inexpensively completed in the physician 's office , and present minimal or no risk to the patient . CONCLUSION The preliminary criteria demonstrated moderate to excellent validity characteristics in some , but not all components of the OMERACT filter . Prospect i ve validation studies are under way
Results The literature review and meta- analysis identified decreased PA and increased time spent in SB in these population s , which may exacerbate both their lower physical fitness and the symptoms of their health disorders .
Background Physical activity ( PA ) is essential for children throughout their growth and maturation .
It improves physiological and psychological health and limits the risk of developing metabolic disorders .
However , some chronic physiological and metabolic diseases may lead to decreased PA .
The diversity of outcomes in the literature offers no consensus for physical activity and sedentary levels in children with juvenile idiopathic arthritis ( JIA ) or inflammatory bowel disease ( IBD ) .
The aim was to examine  PA and SB  in children with JIA or IBD compared to their healthy peers .