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Ped Rheumatologists Most Likely to Give COX-2s to Kids

Astudy that analyzed data on almost 49,000 children and adolescents enrolled in a U.S. pediatric rheumatology registry found that the overall mortality for pediatric rheumatic diseases was not increased when compared to the general population, results that require further follow-up but were described as “encouraging” by the authors. “Even for those diseases and conditions associated with increased mortality, the rates were significantly lower than those reported in previous studies,” especially for systemic juvenile rheumatoid arthritis ( JRA), childhood systemic lupus erythematosus (SLE), dermatomyositis (DM), and vasculitis, reported Dr. Philip J. Hashkes of the Cleveland Clinic and his associates. The study, which they said was “the largest systematic mortality outcome study in pediatric rheumatology published to date,” analyzed mortality outcomes among the 48,885 children newly diagnosed with a rheumatic disease between 1992 and 2001 and enrolled in the Indianapolis PRDR (Pediatric Rheumatology Disease Registry), involving patients from 62 centers in the United States. Children with a malignancy were excluded. Patients were followed for a mean of 8 years. Almost 64% had an inflammatory diagnosis, of which the majority (almost 40%) was JRA, followed by SLE in almost 6% and Raynaud’s phenomenon in almost 5%. Arthralgia was the most common noninflammatory diagnosis, affecting 36% of those with a noninflammatory rheumatic disease. Almost 7,000 patients had more than one rheumatic diagnosis. To compare the observed survival rates to the expected survival rates, the authors calculated the SMR (standardized mortality ratio, defined as the number of observed deaths divided by the number of expected deaths). The mortality of the patients in the registry was significantly lower than was the expected mortality of the U.S. population, adjusted for age and sex. Overall, there were 110 deaths (0.23%) among the nearly 48,000 patients for whom complete data were available, for an SMR of 0.65. Put another way: The 5-year survival rate was 99.77% for the entire group, and was slightly lower for those with connective tissue disease, systemic JRA, and those with primary vasculitis other than Kawasaki disease. There were significant differences in the SMR for several diagnostic categories and specific diseases. SMR was significantly increased for the categories of