Basic information

The office provides comprehensive care for children and adults with all systemic autoimmune diseases at the level of ambulatory care. The basic goal of the workplace is to limit the hospitalization of patients to the necessary minimum and to deal with diagnosis and treatment primarily on an outpatient basis.

 

doc. MUDr. Rudolf Horváth, Ph.D.
e-mail: rudolf.horvath@fnmotol.cz

Secretariat:
Veronika Špinglova
e-mail: veronika.spinglova@fnmotol.cz
phone: 224 433 829
fax: +224 433 820 XNUMX

Station nurse:
Indira Jankovičová
 e-mail: indira.jankovicova@fnmotol.cz

Ambulance:  (information and ordering):
tel: 224 433 819

The ambulances are now located in the Children's Building of the Motol General Hospital on the bed section B on the 10th floor. Patients can be ordered by calling 224 433 819. The patient must be recommended for examination by a general practitioner or other attending physician. Examination of a new patient takes about 60 minutes, control examination is shorter.

Office hours:

Monday - Friday: 7.30 am - 15.30 pm

The department focuses on the diagnosis and treatment of children and adults with inflammatory rheumatic diseases (rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and other inflammatory spondyloarthritis, juvenile idiopathic arthritis, systemic connective tissue diseases and primary vasculitis). The department works closely with specialized laboratories and clinics at the University Hospital in Motol and provides treatment with state-of-the-art preparations as part of international research. The department has an established Center for Biological Treatment in Rheumatology for Children and Adults.

MTX: In case of acute febrile illness or the need for antibiotics, it is advisable to discontinue MTX. If a child has smallpox, it is advisable to discontinue MTX and give an antiviral medicine for 1-2 weeks (eg aciclovir).

MTX is contraindicated in pregnancy. 

Biological therapy: Live vaccines are not appropriate for biological therapy. In case of severe acute febrile infection and administration of antibiotics, it is advisable to discontinue treatment until the end of treatment of the infection.
In the case of a planned operation, it is appropriate to consider discontinuing the biological treatment before the operation in pediatric patients and to restart it after the operation has healed.
Early treatment of antibiotic infections in a chronically immunosuppressed patient is important.    

Systemic form of JIA for tocilizumab or anakinra therapy

There is an increased risk of neutropenia, thrombocytopenia and hepatopathy during treatment with the systemic form of JIA with tocilizumab.

Bacterial infections can occur with the systemic form of JIA without fever or with paradoxically low CRP values and leukocytes (treatment effect). Therefore, it is necessary to actively search for the event. other signs of acute infection (ENT examination, X-ray of the lungs) and start early treatment with antibiotics. 

Rheumatic diseases of childhood are usually chronic and represent an increased risk of infectious diseases, which is also potentiated by immunosuppressive treatment. Vaccination is an effective form of protection against some infectious diseases. Vaccination has not been clearly shown to induce the development of autoimmune diseases or to increase the risk of relapse.

Children with rheumatic diseases can be vaccinated with inanimate vaccines (tetanus, diphtheria, whooping cough, parenteral polio, hemophilus, hepatitis A, C, pneumococcus, meningococcus, tick-borne encephalitis, cholera, typhus, rabies, Japanese encephalitis). Vaccination can take place according to the valid vaccination schedule, regardless of the type of disease or immunosuppressive treatment. According to current national recommendations, vaccines against HPV (human papillomavirus) can also be given, especially in patients with SLE who have a higher risk of HPV infection.

• Vaccination of a patient on immunosuppressive therapy
  • There is no need to interrupt treatment due to live vaccination
  • Vaccination with a live vaccine should be given at a time of low disease activity
  • In immunocompromised patients, regular annual influenza vaccination with an inactivated vaccine is recommended
  • Specific recommendations are for patients on treatment with rituximab and other B-depletion drugs
  • Vaccine response is usually adequate, except in patients on high doses of corticosteroids and rituximab, in these patients it is recommended to check the level of specific antibodies after vaccination, in patients on anti-TNF treatment it is at the discretion of the attending physician.
  • Methotrexate reduces the response to pneumococcal polysaccharide vaccines, in these patients it is recommended to measure the level of antibodies after vaccination

Vaccination with live vaccines (BCG, MMR - measles, mumps, rubella, oral rotaviruses, oral polio, VZV, yellow fever) is not suitable for patients on significant immunosuppressive therapy, administration of a booster dose of live vaccines may be considered according to individual risk

• Booster revaccination with VZV, MMR, yellow fever is possible in patients on low dose corticosteroids or MTX (<15 mg / m²)

Definition of immunosuppressive therapy that results in significant immunosuppression and requires restrictions on live vaccines:

If the patient has been taking in the last 3 months:

• Intravenous methylprednisolone, cyclophosphamide or biological drugs
• Mycophenolate mofetil
• Oral cyclophosphamide (0,5-2 mg / kg / day)
• Cyclosporine 2,5-3 mg / kg / d
• Azathioprine 1-3 mg / kg / d
• Methotrexate 15 mg / m²/ week,> 0,4 mg / kg / d
• Sulfasalazine 40 mg / kg / d or 2g / d
• Leflunomide 0,25-0,5 mg / kg / day
• 6-mercaptopurine 1,5 mg / kg / d
• High dose corticosteroids ≥2 mg / kg / d, ≥20 mg / d, ≥ 2 weeks
• Or a combination of these drugs with other immunosuppressive drugs

For the first examination please bring us:

• fever table 

Please record only the increased temperature values ​​in the table, the highest measured value for each day. In addition, please record any associated manifestations, treatment given (antibiotics, prednisone) and possible examinations (throat swab, CRP, etc.). You can also record other problems in your child, such as common infections. 

• recommendation from a general practitioner for children and adolescents with a history of difficulties
• vaccination calendar
• growth curve (please ask your child's pediatrician)
• all available medical reports from previous examinations and laboratory results.

Without the above documentation, your child will not be examined. Thank you for your understanding.

They are part of the investigation procedure blood and urine samples, which should be examined once at the time of a typical fever attack and once between attacks, when the child is completely healthy and at least 14 days after the last fever (of any origin, including infection).

To eliminate rare congenital periodic fevers, we perform standard examination of urine collected during the 1st day of a typical fever attack. Collect all portions of urine in 12 hours in a clean container (eg PET water bottles) and store in the refrigerator. Please record how long urine collection has taken and the total amount of urine. Take 2 test tubes from the total amount of mixed urine collected, freeze them and bring the unfrozen ones with us for inspection at our place.

Questionnaire for parents and attending pediatrician for download:

Detailed information about the periodic fever syndrome can be found at: https://www.printo.it/pediatric-rheumatology/ 

Patient organizations:

Revmaliga: https://www.revmaliga.cz/

Hinge: https://www.revmaliga.cz/klub/kloubici/

Bechterevik Club: https://www.klub-bechtereviku.cz/

Lupus portal: http://www.lupus-portal.cz/index.php

Information on children's rheumatic diseases and their treatment:

Print: https://www.printo.it/pediatric-rheumatology/CZ/info/CZ

Spa stays for children:

Podebrady: http://www.detska-lecebna.cz/

Janske Lazne: https://www.janskelazne.com

Teplice nad Bečvou: https://www.ltnb.cz/

Primary

doc. MUDr. Rudolf Horváth, Ph.D.
e-mail: rudolf.horvath@fnmotol.cz

Doctors:

MD Jana Hurňáková, Ph.D.
e-mail: jana.hurnakova@fnmotol.cz

MUDr. Radka Jankova
e-mail: radka.jankova@fnmotol.cz

MD Stanislav Machacek
e-mail: stanislav.machacek@fnmotol.cz

MUDr. Hana Malcova, Ph.D.
e-mail: hana.malcova@fnmotol.cz

MUDr. Dita Cebecauer, Ph.D.
e-mail: dita.cebecauerová@ fnmotol.cz

MD Ivan Raška, Ph.D.
e-mail: ivan.raska@fnmotol.cz

Sisters

Indira Jankovičová
e-mail: indira.jankovicova@fnmotol.cz

Zuzana Starková
e-mail: zuzana.starkova@ fnmotol.cz

Hana Šnajdrová
e-mail: hana.snajdrova@ fnmotol.cz

Bohuslava Vališová

e-mail: bohuslava.valisova@fnmotol.cz