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• Many of our patients often have “dry” arthritis (no effusions found on physical exam) but subtle effusions detected by imaging and features of spondyloarthritis, enthesitis, and synovitis. Joint capsule thickening, not previously reported in children, is a common finding in the presented cases and in psoriatic arthritis in adults.
• Due to the severity of psychiatric symptoms in some cases, which often overshadow joint symptoms, and concomitant sensory dysregulation (making the physical exam unreliable in the absence of effusions), we rely on imaging to improve sensitivity and specificity of the arthritis classification.
• We also report the immunomodulatory treatments of these 7 patients (initially nonsteroidal anti-inflammatory drugs and disease-modifying antirheumatic drugs with escalation to biologic medications) and note any coincidental changes to their arthritis and psychiatric symptoms while on immunomodulation.
• Patients with overlapping psychiatric syndromes and arthritis may have a unifying cause and pose unique challenges; a multi-disciplinary team can utilize imaging to tailor and coordinate treatment for this patient population.

Pisetsky, D.S. Pathogenesis of autoimmune disease. Nat Rev Nephrol 19, 509–524 (2023). https://doi.org/10.1038/s41581-023-00720-1

• Autoimmune diseases lead to diverse patterns of inflammation and organ dysfunction.
• Autoantibodies are valuable markers for diagnosis, classification and of disease activity.
• Although T cells play a key part in disease, their assessment is challenging.
• Autoimmune disease reflects the interplay of genetic and environmental factors.
• Pre-clinical autoimmune disease provides a window of time for early or preventive treatment.

Roberta Bovenzi, Matteo Conti & Tommaso Schirinzi (2023) Pharmacotherapy for Sydenham’s chorea: where are we and where do we need to be?, Expert Opinion on Pharmacotherapy, 24:11, 1317-1329, DOI: 10.1080/14656566.2023.2216380

• Sydenham’s chorea (SC) is the most common acquired chorea in children worldwide; still, its therapeutic strategies are empirical and non-evidence based.
• Current pharmacotherapy for SC basically consists of three pillars: antibiotic, symptomatic and immunomodulant medications.
• Antibiotic prophylaxis should be initiated as soon as SC is diagnosed, according to the WHO guidelines, to prevent beta-hemolytic streptococcal (GABHS) re-infection and reduce the risk of cardiac involvement.
• Symptomatic treatments, which consist in anti-seizure medications (ASMs) and dopamine depleting agents, should be considered when symptoms are clinically relevant; however, no consensus exist on which should be the first choice.
• Immunomodulant strategies are gaining increasingly attention given the autoimmune pathogenesis of SC, with promising results.
• There are numerous gaps and unmet needs in SC management and treatment, which highlights the necessity of a deeper comprehension of its pathogenesis and sizable controlled studies to define standardized guidelines.

• Young adults living fairly isolated lives, dependent on care from relatives.
• The illness was a tangible presence.
• They perceived a lack of knowledge among healthcare staff on PANS in healthcare, and negative consequences linked to this. Their experience-based knowledge of their own illness is devalued in healthcare encounters.
• A feeling of being pushed around in healthcare, without anyone taking responsibility for the treatment
• Emphasized the need for increased knowledge among staff to identify PANS and be able to offer effective treatment.

Tian YE, Di Biase MA, Mosley PE, et al. Evaluation of Brain-Body Health in Individuals With Common Neuropsychiatric Disorders. JAMA Psychiatry. 2023;80(6):567–576. doi:10.1001/jamapsychiatry.2023.0791

“This multicenter population-based cohort study including 85 748 adults with neuropsychiatric disorders and 87 420 healthy control individuals found that poor body health, particularly of the metabolic, hepatic, and immune systems, was a more marked manifestation of mental illness than brain changes.”

Felger JC, Miller AH. Cytokine effects on the basal ganglia and dopamine function: the subcortical source of inflammatory malaise. Front Neuroendocrinol. 2012 Aug;33(3):315-27. doi: 10.1016/j.yfrne.2012.09.003. Epub 2012 Sep 21. PMID: 23000204; PMCID: PMC3484236.

• Cytokines released during inflammation target the basal ganglia and dopamine
• Cytokines can disrupt dopamine function by effects on synthesis, packaging, release, and reuptake
• Cytokine effects on basal ganglia dopamine may cause anhedonia, fatigue, and psychomotor slowing
• Cytokines may contribute to behavioral disorders associated with chronic inflammation