By far the commonest adverse effects of Methotrexate is vomiting. In this episode Michael and Raju discuss a Dutch paper on the various mechanisms involved and some possible solutions to prevent discontinuation of this vital and otherwise safe drug. References to the article discussed in the podcast : MTX intolerance in children and adolescents with juvenile idiopathic arthritis : https://academic.oup.com/rheumatology/article/59/7/1482/5817465 Focus on Tables 1 and 2

Kikuchi disease is a rare condition presenting with non specific symptoms like fever and lymphadenopathy. It is part of the differential diagnose of inflammatory diseases. The flares respond well to a short course of steroids, but it can be the first manifestation of Systemic Lupus.

IgA Vasculitis remains the commonest form of vasculitis in childhood and Nephritis is the most important long term prognostic indicator. Michael and Raju review a paper and share some of their experiences.

IVIG resistance is a major challenge in about 15% of children with Kawasaki disease. The cost and availability of IVIG are challenges which have led to examining alternatives to the second dose of IVIG. This episode is Free. If you are interested to watch more, go to jircohorte.org/academyforum

Michael and Raju discuss learnings from some Danish papers on consequences of involvement of the TM joint and describe the 2 minute internationally derived multidisciplinary protocol to evaluate this joint at every visit. This episode is Free. If you are interested to watch more, go to https://www.jircohorte.org/jiracademyforum

Obstetricians may reach out directly or via neonatologists for persistent fetal bradycardia.Congenital complete heart block due to neonatal lupus is discussed. This episode is Free. If you are interested to watch more, go to https://www.jircohorte.org/jiracademyforum