Joost F Swart

Utrecht University | UU · University Medical Center Utrecht

Background: To our knowledge, the characteristics and burden of childhood arthritis have never been studied on a worldwide basis. We aimed to investigate, with a cross-sectional study, the prevalence of disease categories, treatment methods, and disease status in patients from across different geographical areas and from countries with diverse wea...

Background The availability of methotrexate and the introduction of multiple biological agents have revolutionized the treatment of juvenile idiopathic arthritis (JIA). Several international and national drug registries have been implemented to accurately monitor the long-term safety/efficacy of these agents. This report aims to present the combine...

In the last years, the interest in the concept of comorbidity and its societal as well as individual impact has increased. Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease starting in childhood which often persists into adulthood. Clinicians are facing an aging population with multiple morbid conditions occurring in one individ...

The translation of basic insight in immunological mechanisms underlying inflammation into clinical practice of inflammatory diseases is still challenging. Here we describe how - through continuous dialogue between bench and bedside - immunological knowledge translates into tangible clinical use in a complex inflammatory disease, juvenile idiopathic...

Background The Pharmachild study is aimed at observing children with JIA undergoing treatment primarily with biologics±methotrexate (MTX). It is conducted by the participating centres of over 60 countries belonging to PRINTO and PReS. Objectives Primary endpoint of the study is safety in JIA patients undergoing immunosuppressive therapy. A prelimi...

Jeugdreuma of juveniele idiopathische artritis is de meest voorkomende oorzaak van chronische gewrichtsontsteking op de kinderleeftijd. Het voldoet aan de volgende kenmerken: ontstaan voor het 16e levensjaar, duur langer dan zes weken én geen aanwijsbare oorzaak. Bewegingsbeperking staat bij kinderen meer op de voorgrond dan andere symptomen van ar...

Hereditary autoinflammatory diseases (AID) are characterized by recurrent bouts of systemic inflammation caused by dysregulation of the innate immunity system. The genotype-phenotype correlation can be highly variable which makes a genetic diagnosis in AID patients complex and laborious. A clear and definitive diagnosis cannot be provided for up to...

Background Treatment of juvenile idiopathic arthritis (JIA) has greatly changed in the past 15 years thanks to the introduction of biologic agents but little is known on the long-term safety profiles. Objectives To evaluate the long-term safety profile of a large cohort of JIA patients treated with methotrexate (MTX) alone or in combination with on...

Background and objectives Mesenchymal stromal cells (MSC) are multipotent cells with an immunosuppressive capacity. In the last decade the feasibility and safety of MSC therapy has been established in various inflammatory diseases. MSC are known to suppress T cell function and modulate T helper 17 (Th17) cells and regulatory T cells (Tregs), which...

The availability of methotrexate (MTX) and biological agents has provided a major change in the treatment of children with juvenile idiopathic arthritis (JIA). An international registry named Pharmachild (European Union grant 260353) has been set up by the Pediatric Rheumatology International Trials Organisation (PRINTO)/Pediatric Rheumatology Euro...

Patients with refractory inflammatory arthritis can still respond favourable to autologous haematopoietic stem cell transplantation. However, this treatment has a high morbidity and even 5% mortality. Mesenchymal stromal cells (MSC), a subset of the non-haematopoietic stromal cells obtained from bone marrow, were found to have a strong immunosuppre...

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...

Introduction: Recombinant interleukin-1 receptor antagonist (rIL-1RA or anakinra) is a recombinant IL-1RA protein capable of binding with high affinity to the IL-1 receptor type I, thus competitively blocking IL-1 signaling in IL-1-receptor-expressing cells. It is FDA-approved for a periodic fever syndrome called cryopyrin-associated periodic syndr...

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 MSC’s are adult stem cells present in many tissues, potently immunosuppressive, shown to specifically migrate to damaged areas. MSC’s have been shown to diminish arthritis in animal models although the mechanism of action remains unclear. Objectives To look for specific migration to inflamed joints, in vivo expansion and elimination of l...

To explore the immunosuppressive effect and mechanism of action of intraperitoneal (ip) and intra-articular (ia) mesenchymal stem cell (MSC) injection in proteoglycan induced arthritis (PGIA). MSC were administered ip or ia after establishment of arthritis. We used serial bioluminescence imaging (BLI) to trace luciferase-transfected MSC. Mice were...

Mesenchymal stromal cells (MSC) are multipotent cells with an immune suppressive capacity. In the last decade the therapeutic application of these cells has been tested in inflammatory diseases like graft versus host disease and rheumatoid arthritis. Injection of MSC can be a potential therapy for juvenile idiopathic arthritis patients refractory t...

Since biologicals antagonize cytokines or receptors involved in the immune system, one could fear that their (long-term) use might affect the quality of the immune system, leading to a defective defense mechanism against infections and tumors, an insufficient response to vaccinations, or a flawed immunoregulation resulting in autoimmunity or autoin...

The immunogenicity and the effects of live attenuated measles-mumps-rubella (MMR) vaccination on disease activity in patients with juvenile idiopathic arthritis (JIA) are matters of concern, especially in patients treated with immunocompromising therapies. To assess whether MMR booster vaccination affects disease activity and to describe MMR booste...

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...

This review summarizes the immunological consequences of biological therapies used in juvenile idiopathic arthritis (JIA). For every frequently used biological agent the characteristics are clearly specified (molecular target, isotype, registered indication for JIA, route of administration, half-life, contraindication, very common side effects, exp...

Background and objective: Monitoring health-related quality of life (HRQoL) by using electronic patient-reported outcomes (ePROs) has been only minimally evaluated in pediatrics. Children with juvenile idiopathic arthritis (JIA) are at risk for HRQoL problems. The aim of this study was to investigate the effectiveness of ePROs in clinical pediatri...

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: 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...

Children with juvenile idiopathic arthritis (JIA) experience functional impairment due to joint manifestations of the disease. The aim of our present study was to assess health-related quality of life (HRQOL) and its predictors in a group of children and adolescents with JIA. The study sample includes all JIA patients (ages 6-18 years) who consulte...

To give an overview of the recent advances in cellular therapies in pediatric autoimmune diseases. Since the 1990s, autologous hematopoietic stem cell transplantation (HSCT) has been applied in more than 800 patients with severe refractory autoimmune diseases. Despite obvious successes, it is clear that the autoimmune disease in many of these patie...

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...

Systemic juvenile idiopathic arthritis (sJIA) is a debilitating childhood disease presenting with fever, rash and arthritis. Current therapy consisting mainly of corticosteroids, NSAIDs and methotrexate, can be inefficient and is often accompanied by many serious adverse events. Although an IL-1 receptor antagonist (anakinra) seems to be very effic...

After bacterial meningitis, about one-third of children develops academic and/or behavioural limitations. The aim of our study was to search for structural differences in the brain, with a special focus on the hippocampus, between childhood survivors of bacterial meningitis with and without academic and/or behavioural limitations and healthy siblin...

Rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) are chronic inflammatory diseases characterized by destruction of cartilage and bone. The destructive lesions result from both immune responses and non-antigen-specific inflammatory processes. Strong evidence indicates that autoantigen recognition by specific T cells is crucial to t...

Even mild iron deficiency and anaemia in infancy may be associated with cognitive deficits. A delay in clamping the cord improves haematocrit levels and results in greater vascular stability and less need for packed cell transfusions for anaemia in the first period after birth. Follow-up data on haemoglobin levels after the neonatal period were not...

Raynaud's phenomenon, fatigue and pain (myalgia and arthralgia) are important presenting symptoms of pediatric-onset mixed connective tissue disease. The difficulty is that many adolescent girls complain of pain along with fatigue without evidence for serious disease. However, in patients with Raynaud's phenomenon one should search for evidence of...

Unlabelled: A girl aged 13 months presented with clinical features of subacute progressive ataxia leading to abasia, astasia, loss of unsupported sitting and apraxia. In addition, an opsoclonus, myoclonia and introvert behaviour developed. MRI of the brain, EEG, extensive tests of blood, urine and CSF showed no abnormalities. Based on clinical sym...