A 12-year-old girl with rheumatoid factor negative polyarticular juvenile idiopathic arthritis (JIA) attends an outpatient appointment with her mother. Her disease has been controlled by subcutaneous methotrexate, but over the past month, she has stopped taking medication because of adverse effects—in particular, nausea and vomiting after administration of methotrexate injection. On examination, she is found to have a flare of her disease with 10 swollen inflamed joints and early morning stiffness for 2 h/day. You apply for funding for anti-tumour necrosis factor (TNF) treatment and, in the meantime, plan to treat her disease flare with a course of prednisolone. On discussion during the consultation, her mother tells you that she has had a letter from the general practitioner asking her child to attend for a flu vaccination and asks your advice.

Structured clinical questions

Do children with JIA [patient] who become infected with influenza [intervention] have a more prolonged illness [outcome] than healthy children [comparison]? In children with JIA [patient], should flu vaccinations be given [intervention] to prevent flu [outcome]? Do children with JIA respond to flu vaccination [does the vaccination have the required effect]? Does flu vaccination [intervention] cause a flare of JIA [adverse event]?

Search strategy and outcomes

Search terms used for all searches (search date 13 September 2006) were: {vaccine OR vaccination} AND {arthritis}, AND {child OR childhood OR children or juvenile} AND {influenza}.

Primary sources: Medline via Pubmed; 20 papers identified, 3 relevant. Embase: 58 …