title: History of infection before the onset of juvenile dermatomyositis: results from the National Institute of Arthritis and Musculoskeletal and Skin Diseases Research Registry.
abstract: OBJECTIVE
  To obtain data concerning a history of infection occurring in the 3 months before recognition of the typical weakness and rash associated with juvenile dermatomyositis (JDM).
  
  
  METHODS
  Parents or caretakers of children within 6 months of JDM diagnosis were interviewed by the registry study nurse concerning their child's symptoms, environment, family background, and illness history. Physician medical records were reviewed, confirming the JDM diagnosis.
  
  
  RESULTS
  Children for which both a parent interview and physician medical records at diagnosis were available (n = 286) were included. Diagnoses were as follows: definite/probable JDM (n = 234, 82%), possible JDM (n = 43, 15%), or rash only (n = 9, 3%). The group was predominantly white (71%) and had a girl:boy ratio of 2:1. Although the mean age at onset was 6.7 years for girls and 7.3 years for boys, 25% of the children were < or =4 years old at disease onset. In the 3 months before onset, 57% of the children had respiratory complaints, 30% had gastrointestinal symptoms, and 63% of children with these symptoms of infection were given antibiotics.
  
  
  CONCLUSIONS
  This study provides evidence that JDM affects young children. The symptoms of the typical rash and weakness often follow a history of respiratory or gastrointestinal complaints. These data suggest that the response to an infectious process may be implicated in JDM disease pathogenesis.
authors.affiliation: The Northwestern University's Feinberg School of Medicine, Chicago, Illinois 60614, USA. pachman@northwestern.edu
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Pachman
authors.forename: Rebecca
authors.initials: R
authors.lastname: Lipton
authors.forename: Rosalind
authors.initials: R
authors.lastname: Ramsey-Goldman
authors.forename: Eli
authors.initials: E
authors.lastname: Shamiyeh
authors.forename: Kathy
authors.initials: K
authors.lastname: Abbott
authors.forename: Eduardo P
authors.initials: EP
authors.lastname: Mendez
authors.forename: Alan
authors.initials: A
authors.lastname: Dyer
authors.forename: Deborah Mc
authors.initials: DM
authors.lastname: Curdy
authors.forename: Larry
authors.initials: L
authors.lastname: Vogler
authors.forename: Ann
authors.initials: A
authors.lastname: Reed
authors.forename: Gail
authors.initials: G
authors.lastname: Cawkwell
authors.forename: Lawrence
authors.initials: L
authors.lastname: Zemel
authors.forename: Christy
authors.initials: C
authors.lastname: Sandborg
authors.forename: Rafael
authors.initials: R
authors.lastname: Rivas-Chacon
authors.forename: Christine
authors.initials: C
authors.lastname: Hom
authors.forename: Norman
authors.initials: N
authors.lastname: Ilowite
authors.forename: Abraham
authors.initials: A
authors.lastname: Gedalia
authors.forename: Jonathan
authors.initials: J
authors.lastname: Gitlin
authors.forename: Michael
authors.initials: M
authors.lastname: Borzy
mesh_terms: D015984:Causality; D002648:Child; D002675:Child, Preschool; D003882:Dermatomyositis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D009316:National Institutes of Health (U.S.); D012042:Registries; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology