IVIG in KD A persistent fever may be a reaction to treatment with IVIG and therefore children are not usually retreated until at least 36 hours after the initial IVIG infusion It is, however, extremely important to confirm the diagnosis; it must be remembered that failure to respond to IVIG might indicate that the child has a different source of fever, such as a bacterial or viral infection, or a chronic inflammatory disease Approximately two-thirds of children with KD who fail to respond to an initial dose of IVIG improve with a second course A small number seem to be resistant to IVIG, and they should be treated with intravenous pulsed-dose methylprednisolone (30 mg/kg/day) for days Infliximab may be an alternative to a second infusion of IVIG or corticosteroids for IVIG-resistant patients Patients who fail to respond to this regimen may be candidates for cyclosporine, cytotoxic agents, or other monoclonal antibody therapy LYME DISEASE Please see Chapter 94 Infectious Disease Emergencies Suggested Readings and Key References Juvenile Rheumatoid Arthritis Adams A, Lehman TJ Update on the pathogenesis and treatment of systemic onset juvenile rheumatoid arthritis Curr Opin Rheumatol 2005;17:612–616 Cassidy JT, Petty RE Juvenile rheumatoid arthritis In: Textbook of Pediatric Rheumatology 3rd ed Philadelphia, PA: WB Saunders; 1995 Cunnane G, Doran M, Bresnihan B Infections and biological therapy in rheumatoid arthritis Best Pract Res Clin Rheumatol 2003;17:345–363 Duffy CM, Colbert RA, Laxer RM, et al Nomenclature and classification in chronic childhood arthritis Time for a change? Arthritis Rheum 2005;52:382–385 Hashkes PJ, Laxer RM Update on the medical treatment of juvenile idiopathic arthritis Curr Rheumatol Rep 2006;8:450–458 Ilowite NT Current treatment of juvenile rheumatoid arthritis Pediatrics 2002;109:109–115 Ilowite NT Update on biologics in juvenile idiopathic arthritis Curr Opin Rheumatol 2008;20:613–618 Kelly A, Ramanan AV Recognition and management of macrophage activation syndrome in juvenile arthritis Curr Opin Rheumatol 2007;19:477–481 Murray K, Thompson SD, Glass DN Pathogenesis of juvenile chronic arthritis: genetic and environmental factors Arch Dis Child 1997;77:530–534 Schneider R, Passo MH Juvenile rheumatoid arthritis Rheum Dis Clin North Am 2002;28:503–530 Systemic Lupus Erythematosus