Table 3.

Temporal association between acute respiratory infections and reactivation or worsening of JIA activity parameters in 10 of 70 patients who participated in the epidemiological surveillance 1 and/or 2 for respiratory virus

Vírus detected	ARI	Onset type	Signs of disease worsening or flare	Temporal relationship	Therapeutic decision
RSVA	NILI**	S	10% increase in the number of active joints, 50% worsening of the patient’s subjective evaluation	Concomitant	Increase the dose of cyclosporine
HAdv	ILI***	S	60% increase in the number of active joints and 200% worsening of the patient’s subjective evaluation	3 weeks	Intra-articular infection
HPIV1	ILI	S	Flare#	Concomitant	None. Symptoms improved with resolution of Flu-like symptoms
NC*	ILI	S	Flare	5 days	Increase the dose of methotrexate and oral prednisone course
HPIV3	ILI	S	Flare with systemic symptoms	7 days	Pulse of prednisone
HAdv	ILI	O	Flare	12 days	Restart methotrexate
NC	NILI	P	200% increase in number of active joints and 50% increase in ESR	7 days	Start nonsteroidal antiinflammatory
RSVA/HMPV	NILI	P	Flare	Concomitant	Increase prednisone dose
Flu A	ILI	P	Worsening of morning stiffness and joint effusion. Appearance of cysts on wrists.	Concomitant	Start etanercept and leflunomide
				Confounding factor: varicella 8 days before
NC	ILI	S	Flare	1 week Confounding factor: methotrexate suspended 30 days before	Pulse of prednisone
					Restart methotrexate

Flu: Influenza virus A and B, HRSV: respiratory syncytial virus A and B, HMPV: metapneumovirus, HPIV: parainfluenza virus 1 and 3, HBov: bocavirus, HAdv: adenovirus, HRV: rhinovirus, HCov: coronavirus OC43 and 229E. O: oligoarticular, P: polyarticular, S: systemic *NC: not collected. **NILI: ARI not Flu-like. ***ILI: Flu-like illness # Flare: defined as worsening by 40% in two or more of the six ACRPed criteria with simultaneous improvement of up to one criterion above 30%. Surveillance 1: from March to August 2007. Surveillance 2: from March to August 2008, influenza vaccine was given in this period.