<p><strong>BACKGROUND: </strong>PROMIS Pediatric patient-reported outcome measures were developed with children from the general population, and their content validity has not been established in children with chronic disease. This study was done to evaluate the content validity of the PROMIS Pediatric Pain Interference and Fatigue measures in children 8-17 years-old with Crohn's disease and the PROMIS Pediatric Fatigue, Sleep Disturbance, and Sleep-related Impairment measures for children 8-17 years-old with chronic kidney disease.</p>

<p><strong>METHODS: </strong>We conducted semi-structured interviews with individuals affected by Crohn's disease and chronic kidney disease. The interviews were done to elicit children's lived experiences of the PROMIS outcomes of interest. We used deductive content analysis to contrast the participants' reports of their symptoms and impacts on daily life with existing conceptual frameworks for the PROMIS measures, each of which was developed with input from children in the general population.</p>

<p><strong>RESULTS: </strong>On average, we elicited an average of 7 pain interference and 7 fatigue concepts from Crohn's disease participants (n = 37), while chronic kidney disease participants (n = 26) provided 9 concepts for fatigue, 4 for sleep disturbance, and 7 for sleep-related impairment. Concept saturation was achieved after 16-19 interviews across the four PROMIS measures. Children with these two chronic health conditions reported the same breadth and types of lived experiences as children from the development samples drawn from the general population.</p>

<p><strong>CONCLUSION: </strong>The study supports the content validity of several PROMIS Pediatric measures for children with Crohn's disease and chronic kidney disease. These findings provide evidence that PROMIS Pediatric measures, developed as universally relevant patient-reported outcomes, may be more broadly applicable to children with chronic disease.</p>

<p><strong>OBJECTIVE: </strong>We aimed to estimate the incidence rate (IR) of psoriasis in children with inflammatory bowel disease (IBD), juvenile idiopathic arthritis (JIA), and chronic noninfectious osteomyelitis (CNO) with tumor necrosis factor-alpha inhibitor (TNFi) exposure as compared to those without TNFi exposure and to the general pediatric population.</p>

<p><strong>METHODS: </strong>This was a single-center retrospective cohort study of children with IBD, JIA, or CNO from 2008 to 2018. TNFi exposure was defined as a prescription for adalimumab, etanercept, infliximab, certolizumab, or golimumab, and the primary outcome was incident psoriasis. IRs and standardized incidence ratios (SIRs) were calculated. Cox proportional hazards models were used to assess the association of psoriasis with TNFi exposure and other risk factors.</p>

<p><strong>RESULTS: </strong>Of the 4111 children who met inclusion criteria, 1614 (39%) had TNFi exposure and 2497 (61%) did not with 4705 and 6604 person-years of follow-up, respectively. There were 58 (IR 12.3 per 1000 person-years) and 25 (IR 3.8 per 1000 person-years) cases of psoriasis in children with and without TNFi exposure, respectively. The SIR was 18 (95% confidence interval [CI] 15, 22) overall, 30 (95% CI 23, 39) for children with TNFi exposure, and 9.3 (95% CI 6.3, 14) for children without TNFi exposure. The hazard ratio (HR) of psoriasis comparing TNFi exposure to no TNFi exposure was 3.84 (95% CI 2.28, 6.47, p&lt;0.001).</p>

<p><strong>CONCLUSION: </strong>Children with IBD, JIA, and CNO had an increased rate of psoriasis compared to the general pediatric population, with the highest rate in those with TNFi exposure.</p>

<p><strong>OBJECTIVE: </strong>To assess preventive care measure prescribing in children exposed to glucocorticoids and identify prescribing variation according to subspecialty and patient characteristics.</p>

<p><strong>STUDY DESIGN: </strong>Retrospective cohort study of children initiating chronic glucocorticoids in the gastroenterology, nephrology, and rheumatology divisions at a pediatric tertiary care center. Outcomes included 25-hydroxyvitamin D (25OHD) and lipid testing, pneumococcal polysaccharide (PPV) and influenza vaccination, and stress dose hydrocortisone prescriptions.</p>

<p><strong>RESULTS: </strong>A total of 701 children were followed for a median of 589 days. 25OHD testing was performed in 73%, lipid screening in 29%, and PPV and influenza vaccination in 16% and 78%, respectively. Hydrocortisone was prescribed in 2%. Across specialties, 25OHD, lipid screening, and PPV prescribing varied significantly (all P &lt; .001). Using logistic regression adjusting for specialty, 25OHD testing was associated with older age, female sex, non-Hispanic ethnicity, and lower baseline height and body mass index z-scores (all P &lt; .03). Lipid screening was associated with older age, higher baseline body mass index z-score, and lower baseline height z-score (all P &lt; .01). Vaccinations were associated with lower age (P &lt; .02), and PPV completion was associated with non-White race (P = .04).</p>

<p><strong>CONCLUSIONS: </strong>Among children chronically exposed to glucocorticoids, 25OHD testing and influenza vaccination were common, but lipid screening, pneumococcal vaccination, and stress dose hydrocortisone prescribing were infrequent. Except for influenza vaccination, preventive care measure use varied significantly across specialties. Quality improvement efforts are needed to optimize preventive care in this high-risk population.</p>