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Neuropsychiatric Involvement in Juvenile-Onset Systemic Lupus Erythematosus. Neurol Res Int 2018; 2018:2548142. [PMID: 30002929 PMCID: PMC5996412 DOI: 10.1155/2018/2548142] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/14/2018] [Accepted: 04/24/2018] [Indexed: 11/17/2022] Open
Abstract
Objective Systemic lupus erythematosus (SLE) is a complex autoimmune disorder characterized by multisystem involvement, including the nervous system. In the present study, we aimed to assess neuropsychiatric manifestations in juvenile-onset systemic lupus erythematosus (JSLE) in Iran. Methods One hundred and forty-six pediatric onset patients with SLE who had registered in our pediatric rheumatology database were evaluated prospectively and cross sectionally within 2013-2015. Data including sex, age, age at the time of diagnosis, age at the time of study, physical examination, laboratory review, and neuropsychiatric inventory were extracted from this database. Classification of neuropsychiatric JSLE was according to the 1999 American College of Rheumatology (ACR) neuropsychiatric manifestations of SLE case definitions. Result A total number of 41 patients with neuropsychiatric symptoms were selected. The patients' average age was 12.2 years. The most common neuropsychiatric symptoms were seizures, migraine, and depression. The mean age at the onset of symptoms was 10.2 ± 3 years. Mean follow-up period was 57±34 (range: 12-120) months. From 41 SLE patients, 18 (43.9) presented symptoms at the time of diagnosis. In thirteen (31.7%) patients, neurological symptoms were developed more than 1 year after SLE diagnosis. Headache was the most common feature (13%), followed by seizure (9.5%) and chorea (3.4%). Other neurological manifestations included cranial nerve involvement (0.7%), loss of consciousness (2.7%), and impaired deep tendon reflex neuropathy (2.5%). The least common neuropsychiatric JSLE manifestation was aseptic meningitis seen in only one patient (0.7%). Conclusion The presence of headache, mood disorders, psychosis, depression, and other neuropsychological manifestations in a patient with JSLE should prompt investigations into diagnosis of the primary nervous system involvement in order to reduce mortality and morbidity.
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52
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Al Rasbi A, Abdalla E, Sultan R, Abdullah N, Al Kaabi J, Al-Zakwani I, Abdwani R. Spectrum of systemic lupus erythematosus in Oman: from childhood to adulthood. Rheumatol Int 2018; 38:1691-1698. [DOI: 10.1007/s00296-018-4032-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 04/25/2018] [Indexed: 12/23/2022]
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53
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Harry O, Yasin S, Brunner H. Childhood-Onset Systemic Lupus Erythematosus: A Review and Update. J Pediatr 2018; 196:22-30.e2. [PMID: 29703361 DOI: 10.1016/j.jpeds.2018.01.045] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 10/30/2017] [Accepted: 01/12/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Onengiya Harry
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Shima Yasin
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Hermine Brunner
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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54
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Attar RZ, Ramel EI, Safdar OY, Desoky S. A case of patient with renal lupus with an initial presentation of hemolytic uremic syndrome triggered by streptococcal infection. Clin Case Rep 2018; 6:712-718. [PMID: 29636946 PMCID: PMC5889269 DOI: 10.1002/ccr3.1425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 08/30/2017] [Accepted: 01/05/2018] [Indexed: 11/23/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a systemic disease that is presented in a myriad of ways. Renal involvement is common in SLE and usually presents clinically as glomerulonephritis. We describe patients with SLE presented initially with hemolytic uremic syndrome which is a distinctive initial presentation.
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Affiliation(s)
- Rahaf Z. Attar
- College of medicineKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Enas I. Ramel
- College of medicineKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Osama Y. Safdar
- Faculty of MedicinePediatric Nephrology Center of ExcellenceKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Sherif Desoky
- Faculty of MedicinePediatric Nephrology Center of ExcellenceKing Abdulaziz UniversityJeddahSaudi Arabia
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55
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Wu CY, Li CF, Wu QJ, Xu JH, Jiang LD, Gong L, Wu FQ, Gu JR, Zhao JL, Li MT, Zhao Y, Zeng XF. Chinese Systemic Lupus Erythematosus Treatment and Research Group Registry IX: Clinical Features and Survival of Childhood-Onset Systemic Lupus Erythematosus in China. Chin Med J (Engl) 2018; 130:1276-1282. [PMID: 28524825 PMCID: PMC5455035 DOI: 10.4103/0366-6999.206346] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Approximately 15–20% cases of systemic lupus erythematosus (SLE) are diagnosed in children. There have been a few studies reporting the epidemiological data of pediatric-onset SLE (cSLE) in China, neither comparing the differences between cSLE and adult-onset SLE (aSLE). The aim of this study was to describe the impact of age of onset on clinical features and survival in cSLE patients in China based on the Chinese SLE Treatment and Research group (CSTAR) database. Methods: We made a prospective study of 225 cSLE patients (aged < 16 years) and 1759 patients aged 16–50 years based on CSTAR registry. We analyzed initial symptoms, clinical presentations, SLE disease activity, damages, and outcomes of cSLE, as well as compared with aSLE patients. Results: The mean age of cSLE patients was 12.16 ± 2.92 years, with 187 (83.1%) females. Fever (P < 0.001) as well as mucocutaneous (P < 0.001) and renal (P = 0.006) disorders were found to be significantly more frequent in cSLE patients as initial symptoms, while muscle and joint lesions were significantly less common compared to aSLE subjects (P < 0.001). The cSLE patients were found to present more frequently with malar rash (P = 0.001; odds ratio [OR], 0.624; 95% confidence interval [CI], 0.470–0.829) but less frequently with arthritis (P < 0.001; OR, 2.013; 95% CI, 1.512–2.679) and serositis (P = 0.030; OR, 1.629; 95% CI, 1.053–2.520). There was no significant difference in SLE disease activity index scores between cSLE and aSLE groups (P = 0.478). Cox regression indicated that childhood onset was the risk factor for organ damage in lupus patients (hazard ratio 0.335 [0.170–0.658], P = 0.001). The survival curves between the cSLE and aSLE groups had no significant difference as determined by the log-rank test (0.557, P = 0.455). Conclusions: cSLE in China has different clinical features and more inflammation than aSLE patients. Damage may be less in children and there is no difference in 5- year survival between cSLE and aSLE groups.
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Affiliation(s)
- Chan-Yuan Wu
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Cai-Feng Li
- Department of Rheumatology, Beijing Children Hospital Affiliated to Capital Medical University, Beijing 100045, China
| | - Qing-Jun Wu
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Jian-Hua Xu
- Department of Rheumatology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, China
| | - Lin-Di Jiang
- Department of Rheumatology, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, China
| | - Lu Gong
- Department of Rheumatology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Feng-Qi Wu
- Department of Rheumatology, Capital Institute of Pediatrics, Beijing 100102, China
| | - Jie-Ruo Gu
- Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, China
| | - Jiu-Liang Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Meng-Tao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Yan Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Xiao-Feng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
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56
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Abdel-Nabi HH, Abdel-Noor RA. Comparison between disease onset patterns of Egyptian juvenile and adult systemic lupus erythematosus (single centre experience). Lupus 2018; 27:1039-1044. [DOI: 10.1177/0961203318760208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | - R A Abdel-Noor
- Internal Medicine Department, Tanta University, Tanta, Egypt
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57
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Mohamed DF, Aziz ABEDA, Hassan SAM, Shedid NH, El-Owaidy RH, Teama MAEM. Juvenile lupus: Different clinical and serological presentations compared to adult lupus in Egypt. EGYPTIAN RHEUMATOLOGIST 2018. [DOI: 10.1016/j.ejr.2017.04.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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58
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Costagliola G, Mosca M, Migliorini P, Consolini R. Pediatric Systemic Lupus Erythematosus: Learning From Longer Follow Up to Adulthood. Front Pediatr 2018; 6:144. [PMID: 29868531 PMCID: PMC5964827 DOI: 10.3389/fped.2018.00144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/01/2018] [Indexed: 01/16/2023] Open
Abstract
Background: Pediatric systemic lupus erythematosus (pSLE) is a rare condition, representing approximately 10% of SLE cases. The aim of this study was to identify variables to improve the diagnostic awareness and management of pSLE patients. Methods: This retrospective study included 25 patients diagnosed with pSLE and followed at the University of Pisa. We collected data about clinical profile at disease onset and during a long-term follow-up, including disease activity, organ damage development, and treatments received. Results: The mean patient age at disease onset was 14.6 ± 1.6 years, and the mean follow-up period was 14.17 ± 8.04 years. The most common initial manifestations were arthritis, malar rash, and cytopenias. The median time to diagnosis since the first symptoms was 6 months, and was significantly longer in patients with hematological onset (54 months). During follow-up, the number of patients with renal involvement showed a significant increase, from 36% at diagnosis to 72.2% after 10 years of disease evolution. Patients who developed chronic organ damage maintained a higher time-averaged disease activity during follow-up and received a significantly higher dose of corticosteroids. Conclusion: Patients with immune cytopenia represent a group deserving strict clinical follow-up for the risk of evolution to SLE. Intense surveillance of renal function, early treatment and steroid-sparing strategies should be strongly considered in the management of pSLE patients.
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Affiliation(s)
- Giorgio Costagliola
- Laboratory of Immunology, Division of Pediatrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paola Migliorini
- Clinical Immunology and Allergy Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Rita Consolini
- Laboratory of Immunology, Division of Pediatrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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59
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Sahin S, Adrovic A, Barut K, Canpolat N, Ozluk Y, Kilicaslan I, Caliskan S, Sever L, Kasapcopur O. Juvenile systemic lupus erythematosus in Turkey: demographic, clinical and laboratory features with disease activity and outcome. Lupus 2017; 27:514-519. [PMID: 29233038 DOI: 10.1177/0961203317747717] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Objectives This paper aims to assess in a retrospective fashion the clinical and laboratory features, severity and outcome of juvenile systemic lupus erythematosus (jSLE) from a referral center in Turkey. Methods We have included all jSLE patients ( n = 92) diagnosed according to the revised American College of Rheumatology 1997 criteria between January 2004 and January 2017. Results The most prevalent clinical feature in our cohort was mucocutaneous manifestations (97.8%), followed by constitutional (81.5%), hematological (59.8%) and musculoskeletal manifestations (56.5%). Renal involvement was observed in 38% ( n = 35) of the patients, whereas biopsy-proven lupus nephritis was detected in 29.3% ( n = 27) of the cohort. Neurologic involvement was seen in 15 (16.3%) individuals. Among the patients positive for anticardiolipin IgM and/or IgG ( n = 11, 12%), only three developed antiphospholipid antibody syndrome. The mean SLEDAI-2K scores at disease onset (10.5 ± 4.8) showed a substantial decrease at last visit (4.3 ± 4.6). One-quarter of the patients (26.1%, n = 24) had damage according to the PedSDI criteria with a mean score of 0.45 ± 1.0 (range 0-7). When the PedSDI damage items were evaluated individually, growth failure was the most frequent damage criterion ( n = 6), followed by seizure ( n = 5). Two patients died during the designated study period of end-stage renal disease. The five-year and 10-year survival rate of our cohort was 100% and 94.4%, respectively. Conclusions Given the lower frequency of nephritis and central nervous system disease and lower basal disease activity and damage scores, we could conclude that children with jSLE in Turkey have a more favorable course compared to Asian and African American children, as expected from Caucasian ethnicity.
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Affiliation(s)
- S Sahin
- 1 Department of Pediatric Rheumatology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - A Adrovic
- 1 Department of Pediatric Rheumatology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - K Barut
- 1 Department of Pediatric Rheumatology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - N Canpolat
- 2 Department of Pediatric Nephrology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Y Ozluk
- 3 Department of Pathology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - I Kilicaslan
- 3 Department of Pathology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - S Caliskan
- 2 Department of Pediatric Nephrology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - L Sever
- 2 Department of Pediatric Nephrology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - O Kasapcopur
- 1 Department of Pediatric Rheumatology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
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60
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Abstract
Oral ulcers are the most common mucosal sign in juvenile-onset systemic lupus erythematosus (JSLE). The ulcers are one of the key clinical features; however, the terminology of oral ulcers, especially in JSLE patients, is often vague and ill-defined. In fact, there are several clinical manifestations of oral ulcers in JSLE, and some lesions occur when the disease is active, indicating that early management of the disease should be started. Oral ulcers are classified as lupus erythematosus (LE) specific, where the lesional biopsy shows a unique pattern of mucosal change in LE, and LE nonspecific, where the ulcers and their histopathological findings can be found in other oral diseases. Here, the clinical manifestations, diagnosis and management of oral ulcers in JSLE patients are reviewed.
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61
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Groot N, de Graeff N, Marks SD, Brogan P, Avcin T, Bader-Meunier B, Dolezalova P, Feldman BM, Kone-Paut I, Lahdenne P, McCann L, Özen S, Pilkington CA, Ravelli A, Royen-Kerkhof AV, Uziel Y, Vastert BJ, Wulffraat NM, Beresford MW, Kamphuis S. European evidence-based recommendations for the diagnosis and treatment of childhood-onset lupus nephritis: the SHARE initiative. Ann Rheum Dis 2017; 76:1965-1973. [PMID: 28877866 DOI: 10.1136/annrheumdis-2017-211898] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/18/2017] [Accepted: 08/13/2017] [Indexed: 12/13/2022]
Abstract
Lupus nephritis (LN) occurs in 50%-60% of patients with childhood-onset systemic lupus erythematosus (cSLE), leading to significant morbidity. Timely recognition of renal involvement and appropriate treatment are essential to prevent renal damage. The Single Hub and Access point for paediatric Rheumatology in Europe (SHARE) initiative aimed to generate diagnostic and management regimens for children and adolescents with rheumatic diseases including cSLE. Here, we provide evidence-based recommendations for diagnosis and treatment of childhood LN. Recommendations were developed using the European League Against Rheumatism standard operating procedures. A European-wide expert committee including paediatric nephrology representation formulated recommendations using a nominal group technique. Six recommendations regarding diagnosis and 20 recommendations covering treatment choices and goals were accepted, including each class of LN, described in the International Society of Nephrology/Renal Pathology Society 2003 classification system. Treatment goal should be complete renal response. Treatment of class I LN should mainly be guided by other symptoms. Class II LN should be treated initially with low-dose prednisone, only adding a disease-modifying antirheumatic drug after 3 months of persistent proteinuria or prednisone dependency. Induction treatment of class III/IV LN should be mycophenolate mofetil (MMF) or intravenous cyclophosphamide combined with corticosteroids; maintenance treatment should be MMF or azathioprine for at least 3 years. In pure class V LN, MMF with low-dose prednisone can be used as induction and MMF as maintenance treatment. The SHARE recommendations for diagnosis and treatment of LN have been generated to support uniform and high-quality care for all children with SLE.
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Affiliation(s)
- Noortje Groot
- Wilhelmina Children's Hospital, Utrecht, The Netherlands.,Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Stephen D Marks
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Paul Brogan
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Tadej Avcin
- University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | | | - Pavla Dolezalova
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Brian M Feldman
- Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Pekka Lahdenne
- Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Liza McCann
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Seza Özen
- Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | | | - Angelo Ravelli
- Università degli Studi di Genova and Istituto Giannina Gaslini, Genoa, Italy
| | | | - Yosef Uziel
- Meir Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Bas J Vastert
- Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | | | - Michael W Beresford
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Sylvia Kamphuis
- Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
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62
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Groot N, de Graeff N, Avcin T, Bader-Meunier B, Brogan P, Dolezalova P, Feldman B, Kone-Paut I, Lahdenne P, Marks SD, McCann L, Ozen S, Pilkington C, Ravelli A, Royen-Kerkhof AV, Uziel Y, Vastert B, Wulffraat N, Kamphuis S, Beresford MW. European evidence-based recommendations for diagnosis and treatment of childhood-onset systemic lupus erythematosus: the SHARE initiative. Ann Rheum Dis 2017. [PMID: 28630236 DOI: 10.1136/annrheumdis-2016-210960] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Childhood-onset systemic lupus erythematosus (cSLE) is a rare, multisystem and potentially life-threatening autoimmune disorder with significant associated morbidity. Evidence-based guidelines are sparse and management is often based on clinical expertise. SHARE (Single Hub and Access point for paediatric Rheumatology in Europe) was launched to optimise and disseminate management regimens for children and young adults with rheumatic diseases like cSLE. Here, we provide evidence-based recommendations for diagnosis and treatment of cSLE. In view of extent and complexity of cSLE and its various manifestations, recommendations for lupus nephritis and antiphospholipid syndrome will be published separately. Recommendations were generated using the EULAR (European League Against Rheumatism) standard operating procedure. An expert committee consisting of paediatric rheumatologists and representation of paediatric nephrology from across Europe discussed evidence-based recommendations during two consensus meetings. Recommendations were accepted if >80% agreement was reached. A total of 25 recommendations regarding key approaches to diagnosis and treatment of cSLE were made. The recommendations include 11 on diagnosis, 9 on disease monitoring and 5 on general treatment. Topics included: appropriate use of SLE classification criteria, disease activity and damage indices; adequate assessment of autoantibody profiles; secondary macrophage activation syndrome; use of hydroxychloroquine and corticosteroid-sparing regimens; and the importance of addressing poor adherence. Ten recommendations were accepted regarding general diagnostic strategies and treatment indications of neuropsychiatric cSLE. The SHARE recommendations for cSLE and neuropsychiatric manifestations of cSLE have been formulated by an evidence-based consensus process to support uniform, high-quality standards of care for children with cSLE.
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Affiliation(s)
- Noortje Groot
- Wilhelmina Children's Hospital, Utrecht, Netherlands.,Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, Netherlands
| | | | - Tadej Avcin
- University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | | | - Paul Brogan
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Pavla Dolezalova
- General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Brian Feldman
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Pekka Lahdenne
- Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Stephen D Marks
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Liza McCann
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Seza Ozen
- Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | | | - Angelo Ravelli
- Università degli Studi di Genova and Istituto Giannina Gaslini, Genoa, Italy
| | | | - Yosef Uziel
- Meir Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Bas Vastert
- Wilhelmina Children's Hospital, Utrecht, Netherlands
| | | | - Sylvia Kamphuis
- Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Michael W Beresford
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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63
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Cobb M, Gorman E, Bontempo LJ, Dezman ZDW. 13-year-old Girl with Fevers. Clin Pract Cases Emerg Med 2017; 1:76-80. [PMID: 29849418 PMCID: PMC5965421 DOI: 10.5811/cpcem.2017.3.34163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 03/15/2017] [Accepted: 03/15/2017] [Indexed: 11/17/2022] Open
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64
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The impact of peer victimization and psychological symptoms on quality of life in children and adolescents with systemic lupus erythematosus. Clin Rheumatol 2017; 36:1297-1304. [PMID: 28451871 DOI: 10.1007/s10067-017-3650-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 03/31/2017] [Accepted: 04/18/2017] [Indexed: 10/19/2022]
Abstract
There is no documentation about the association between peer victimization, psychological status, and quality of life (QOL) in children and adolescents with systemic lupus erythematosus (SLE). The aim of this study was to evaluate the association between peer victimization, psychological symptoms, and QOL in a cohort of children and adolescents with SLE. Forty-one patients (aged 9-18 years) participated in this study. The control group (n = 49) was composed of healthy children and adolescents from local community. Questionnaires were used to evaluate the peer victimization, psychological status, and QOL of children and adolescents with and without SLE. No significant difference was found between the study and control groups for peer victimization, depression, state and trait anxiety, and QOL scores. The peer victimization, depression, anxiety, and self-esteem scores were negatively correlated with psychosocial and total subscale scores of QOL in the study group. According to regression analyses, trait anxiety had a negative predictive effect on the physical health domain scores of QOL, whereas trait anxiety and peer victimization had a negative effect on the psychosocial domain and total scores of QOL in the SLE patients. This study suggests that trait anxiety and peer victimization are risk factors for poor QOL in adolescents with SLE.
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65
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Sinicato NA, Postal M, de Oliveira Peliçari K, Rittner L, Marini R, Appenzeller S. Prevalence and features of metabolic syndrome in childhood-onset systemic lupus erythematosus. Clin Rheumatol 2017; 36:1527-1535. [DOI: 10.1007/s10067-017-3602-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 03/06/2017] [Accepted: 03/12/2017] [Indexed: 10/19/2022]
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66
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Tanaka H, Joh K, Imaizumi T. Treatment of pediatric-onset lupus nephritis: a proposal of optimal therapy. Clin Exp Nephrol 2017; 21:755-763. [PMID: 28258497 DOI: 10.1007/s10157-017-1381-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 01/05/2017] [Indexed: 02/01/2023]
Abstract
Lupus nephritis (LN) is one of the major clinical manifestations of systemic lupus erythematosus (SLE) which occurs frequently in the early stages of pediatric-onset cases. Since SLE is a chronic disease associated with frequent disease flares and effective and safe maintenance therapy is required for achieving a favorable outcome, optimal treatment for LN in pubertal patients is a great challenge that remains to be overcome. Although its etiology remains unclear, it has been reported that the innate and adaptive immune systems have been reported to play an important role in the pathogenesis of SLE. However, studies of drugs that have been useful in controlling inflammatory pathways mediated by the innate and adaptive immune systems are now underway. In clinical practice, recent advances in the management of LN, together with earlier renal biopsy and selective use of aggressive immunosuppressive therapy, have contributed to a favorable outcome in children and adolescents with LN. However, the balance of the efficacy of treatment in terms of long-term prognosis and its adverse effects should be weighed in determining the treatment strategy.
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Affiliation(s)
- Hiroshi Tanaka
- Department of School Health Science, Faculty of Education, Hirosaki University, Hirosaki, 036-8650, Japan. .,Department of Pediatrics, Hirosaki University Hospital, Hirosaki, 036-8563, Japan.
| | - Kensuke Joh
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, 980-8575, Japan
| | - Tadaatsu Imaizumi
- Department of Vascular Biology, Graduate School of Medicine, Hirosaki University, Hirosaki, 036-8562, Japan
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Gastrointestinal system manifestations in juvenile systemic lupus erythematosus. Clin Rheumatol 2017; 36:1521-1526. [PMID: 28204893 DOI: 10.1007/s10067-017-3571-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/28/2017] [Accepted: 02/03/2017] [Indexed: 12/11/2022]
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Nightingale AL, Davidson JE, Molta CT, Kan HJ, McHugh NJ. Presentation of SLE in UK primary care using the Clinical Practice Research Datalink. Lupus Sci Med 2017; 4:e000172. [PMID: 28243454 PMCID: PMC5307373 DOI: 10.1136/lupus-2016-000172] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 12/19/2016] [Accepted: 12/30/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To describe the presenting symptoms of SLE in primary care using the Clinical Practice Research Database (CPRD) and to calculate the time from symptom presentation to SLE diagnosis. METHODS Incident cases of SLE were identified from the CPRD between 2000 and 2012. Presenting symptoms were identified from the medical records of cases in the 5 years before diagnosis and grouped using the British Isles Lupus Activity Group (BILAG) symptom domains. The time from the accumulation of one, two and three BILAG domains to SLE diagnosis was investigated, stratified by age at diagnosis (<30, 30-49 and ≥50 years). RESULTS We identified 1426 incident cases (170 males and 1256 females) of SLE. The most frequently recorded symptoms and signs prior to diagnosis were musculoskeletal, mucocutaneous and neurological. The median time from first musculoskeletal symptom to SLE diagnosis was 26.4 months (IQR 9.3-43.6). There was a significant difference in the time to diagnosis (log rank p<0.01) when stratified by age and disease severity at baseline, with younger patients <30 years and those with severe disease having the shortest times and patients aged ≥50 years and those with mild disease having the longest (6.4 years (IQR 5.8-6.8)). CONCLUSIONS The time from symptom onset to SLE diagnosis is long, especially in older patients. SLE should be considered in patients presenting with flaring or chronic musculoskeletal, mucocutaneous and neurological symptoms.
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Affiliation(s)
| | - Julie E Davidson
- Worldwide Epidemiology, GlaxoSmithKline R&D, Stockley Park , London , UK
| | - Charles T Molta
- U.S. Health Outcomes, GlaxoSmithKline, Research Triangle Park , North Carolina , USA
| | - Hong J Kan
- U.S. Medical Affairs, GlaxoSmithKline , Philadelphia, Pennsylvania , USA
| | - Neil J McHugh
- Department of Pharmacy & Pharmacology, University of Bath, Bath, UK; Royal National Hospital for Rheumatic Diseases, Bath, UK
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Otsa K, Talli S, Harding P, Parsik E, Esko M, Teepere A, Tammaru M. Prevalence and incidence of systemic lupus erythematosus in the adult population of Estonia. Lupus 2017; 26:1115-1120. [PMID: 28059020 DOI: 10.1177/0961203316686705] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Studies have demonstrated considerable variability in systemic lupus erythematosus (SLE) incidence and prevalence estimates. Lack of reliable epidemiological data may hinder evidence-based health care planning. The aim of the present study was to estimate the prevalence and incidence of SLE in the Estonian adult population. The SLE billing cases were extracted from the Estonian Health Insurance Fund database 2006-2010 and verified using health care providers' databases. The patients' life status data for January 1, 2011, were retrieved from the Estonian Population Register. The calculations for the estimates' lower limits were based on verified cases only; the upper limits calculations also accounted for the billing cases for which clinical data were unavailable. The period prevalence of SLE was between 39 and 48 per 100,000 and incidence rate between 1.5 and 1.8 per 100,000 person-years. The point prevalence on January 1, 2011, was between 37 and 40 per 100,000. The estimates are comparable with internationally published figures and can be used to enhance evidence-based health care planning. The high percentage of billing cases that could not be verified using clinical data supports the argument that epidemiological studies based solely on administrative databases are usually of low reliability.
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Affiliation(s)
- K Otsa
- 1 Ida Tallinna Keskhaigla, Department of Rheumatology, Tallinn, Estonia
| | - S Talli
- 2 East Tallinn Central Hospital, Department of Rheumatology, Tallinn, Estonia
| | - P Harding
- 2 East Tallinn Central Hospital, Department of Rheumatology, Tallinn, Estonia
| | - E Parsik
- 3 The North Estonia Medical Centre, Department of Rheumatology, Tallinn, Estonia
| | - M Esko
- 4 West Tallinn Central Hospital, Department of Rheumatology, Tallinn, Estonia
| | - A Teepere
- 2 East Tallinn Central Hospital, Department of Rheumatology, Tallinn, Estonia
| | - M Tammaru
- 2 East Tallinn Central Hospital, Department of Rheumatology, Tallinn, Estonia
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Weill O, Decramer S, Malcus C, Kassai B, Rouvet I, Ginhoux T, Crow YJ, Rieux-Laucat F, Soulas-Sprauel P, Pagnier A, Koné-Paut I, Piram M, Galeotti C, Samaille C, Reumaux H, Lanteri A, Dubois SM, Lefebvre H, Burtey S, Maurier F, Carbasse A, Lemelle I, Meinzer U, Despert V, Flodrops H, Fabien N, Ranchin B, Hachulla E, Bader-Meunier B, Belot A. Familial and syndromic lupus share the same phenotype as other early-onset forms of lupus. Joint Bone Spine 2016; 84:589-593. [PMID: 28039062 DOI: 10.1016/j.jbspin.2016.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Studies of early-onset systemic lupus erythematosus (SLE) have identified monogenic forms of the disease. The primary objective of this study was to compare the clinical and laboratory features of the first patients included in the GENIAL/LUMUGENE cohort to those reported in previous publications. The secondary objective was to determine whether subgroups with a distinctive pattern of clinical and biological features are seen in predominantly genetic forms of SLE. METHODS GENIAL/LUMUGENE is a French nationwide study of the clinical, immunological, and genetic features of juvenile-onset SLE (clinicaltrials.gov #NCT01992666). Clinical and laboratory data from the first 64 patients younger than 18 years who were included in the first part of the study were collected retrospectively. Predefined criteria were used to divide the patients into three subgroups: syndromic SLE (n=10) and familial SLE (n=12) - both presumed to have a strong genetic component - and other forms of early-onset SLE (n=42). RESULTS The predefined criteria for identifying subgroups based on knowledge of the clinical and epidemiological features of monogenic SLE showed a significantly younger age at onset in syndromic SLE (P<0.05) and a lower frequency of joint manifestations in familial SLE. CONCLUSIONS In this study, clinical and epidemiological data alone failed to identify a specific patient subgroup characterized by the same disease presentation or progression. This result may be related to the small sample size or indicate marked heterogeneity of juvenile-onset SLE. Genetic studies using new sequencing techniques in these patients might identify genetic factors responsible for marked phenotypic variability.
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Affiliation(s)
- Olivia Weill
- Service de Médecine Interne, Néphrologie, Rhumatologie-hypertension pédiatrique, Centre de Référence des maladies Rénales Rares du Sud Ouest, SORARE, Hôpital des enfants, CHU de Toulouse, 31059 Toulouse, France
| | - Stéphane Decramer
- Service de Médecine Interne, Néphrologie, Rhumatologie-hypertension pédiatrique, Centre de Référence des maladies Rénales Rares du Sud Ouest, SORARE, Hôpital des enfants, CHU de Toulouse, 31059 Toulouse, France
| | - Christophe Malcus
- Service d'Immunologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69437 Lyon, France
| | - Behrouz Kassai
- EPICIME-CIC 1407 de Lyon, Inserm, Service de Pharmacotoxicologie, CHU-Lyon, 69677 Bron, France; Université de Lyon, Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, 69622 Villeurbanne, France
| | - Isabelle Rouvet
- Centre de biotechnologie cellulaire et Biothèque, Groupe Hospitalier Est, Hospices Civils de Lyon, 69677 Bron, France
| | - Tiphanie Ginhoux
- EPICIME-CIC 1407 de Lyon, Inserm, Service de Pharmacotoxicologie, CHU-Lyon, 69677 Bron, France
| | - Yanick J Crow
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; INSERM UMR 1163, Laboratory of Neurogenetics and Neuroinflammation Paris Descartes University, Sorbonne-Paris-Cité, Institut Imagine, Hôpital Necker-Enfants-Malades, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - Fredéric Rieux-Laucat
- INSERM UMR 1163, Laboratoire d'immunogénétique des maladies auto-immunes pédiatriques, Institut Imagine, 75015 Paris, France
| | - Pauline Soulas-Sprauel
- CNRS UPR 3572 "Immunopathology and Therapeutic Chemistry"/Laboratory of Excellence Medalis, Institute of Molecular and Cellular Biology (IBMC), Department of Clinical Immunology and Internal Medicine, National Reference Center for Autoimmune Diseases, Hôpitaux Universitaires de Strasbourg, UFR Sciences pharmaceutiques, Université de Strasbourg, 67200 Illkirch-Graffenstaden, France
| | - Anne Pagnier
- Service de rhumatologie pédiatrique, CHU de Grenoble, 38700 La Tronche, France
| | - Isabelle Koné-Paut
- Service de Rhumatologie Pédiatrique - Centre de Référence des maladies auto-inflammatoires de l'enfant (CeRéMAI), CHU de Bicêtre, APHP, Université Paris-Saclay, Université Paris Sud, 94276 Kremlin Bicêtre, France
| | - Maryam Piram
- Service de Rhumatologie Pédiatrique - Centre de Référence des maladies auto-inflammatoires de l'enfant (CeRéMAI), CHU de Bicêtre, APHP, Université Paris-Saclay, Université Paris Sud, 94276 Kremlin Bicêtre, France
| | - Caroline Galeotti
- Service de Rhumatologie Pédiatrique - Centre de Référence des maladies auto-inflammatoires de l'enfant (CeRéMAI), CHU de Bicêtre, APHP, Université Paris-Saclay, Université Paris Sud, 94276 Kremlin Bicêtre, France
| | | | - Héloïse Reumaux
- Unité de Néphrologie Pédiatriques, CHU de Lille, 59000 Lille, France
| | - Aurélia Lanteri
- Service de médecine interne, centre national de référence des maladies auto-immunes et systémiques rares, Hôpital Claude Huriez, FHU IMMNeNT, Université de Lille, 59037 Lille, France
| | - Sandrine Morell Dubois
- Service de médecine interne, centre national de référence des maladies auto-immunes et systémiques rares, Hôpital Claude Huriez, FHU IMMNeNT, Université de Lille, 59037 Lille, France
| | - Hélène Lefebvre
- Service de médecine interne, centre national de référence des maladies auto-immunes et systémiques rares, Hôpital Claude Huriez, FHU IMMNeNT, Université de Lille, 59037 Lille, France
| | - Stéphane Burtey
- Centre de néphrologie et de transplantation rénale, Aix-Marseille Université, Assistance publique-hôpitaux de Marseille, France
| | | | - Aurélia Carbasse
- Service de pédiatrie, CHU Montpellier, 34295 Montpellier, France
| | - Irène Lemelle
- Service d'Hémato-Onco Pédiatrie, CHRU Nancy, 54511 Vandoeuvre les Nancy, France
| | - Ulrich Meinzer
- Service de Pédiatrie Générale, Maladies Infectieuses et Médecine Interne Pédiatrique, Hôpital Robert Debré, APHP, INSERM, U1149, Centre de recherche sur l'inflammation, 75019 Paris, France
| | - Véronique Despert
- Service de Pédiatrie Grands Enfants-Adolescents, CHU Hôpital Sud, 35033 Rennes, France
| | - Hugues Flodrops
- Service de Pédiatrie, CHU La Réunion Site de Saint-Pierre, BP 350, 97448 Saint-Pierre, France
| | - Nicole Fabien
- Laboratoire d'autoimmunité, Service d'immunologie humorale, Hospices Civils de Lyon, CHLS, 69495 Pierre-Bénite, France
| | - Bruno Ranchin
- Immunologie et rhumatologie pédiatrique, Hôpital Necker, APHP, 75015 Paris, France
| | - Eric Hachulla
- Service de médecine interne, centre national de référence des maladies auto-immunes et systémiques rares, Hôpital Claude Huriez, FHU IMMNeNT, Université de Lille, 59037 Lille, France
| | - Brigitte Bader-Meunier
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; INSERM UMR 1163, Laboratory of Neurogenetics and Neuroinflammation Paris Descartes University, Sorbonne-Paris-Cité, Institut Imagine, Hôpital Necker-Enfants-Malades, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France; Service de néphrologie et rhumatologie pédiatrique, hôpital Femme-Mère-Enfant et université de Lyon 1, INSERM U1111, 69677 Bron, France
| | - Alexandre Belot
- Immunologie et rhumatologie pédiatrique, Hôpital Necker, APHP, 75015 Paris, France.
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Novak GV, Marques M, Balbi V, Gormezano NWS, Kozu K, Sakamoto AP, Pereira RMR, Terreri MT, Magalhães CS, Guariento A, Sallum AME, Marini R, Ferriani VPL, Barbosa CM, de Castro TCM, Ramos VC, Bonfá E, Silva CA. Anti-RO/SSA and anti-La/SSB antibodies: Association with mild lupus manifestations in 645 childhood-onset systemic lupus erythematosus. Autoimmun Rev 2016; 16:132-135. [PMID: 27988434 DOI: 10.1016/j.autrev.2016.12.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 09/10/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND To our knowledge there are no studies assessing anti-Ro/SSA and anti-La/SSB autoantibodies in a large population of childhood-systemic lupus erythematosus (cSLE) patients. METHODS This was a retrospective multicenter cohort study performed in 10 Pediatric Rheumatology services, São Paulo state, Brazil. Anti-Ro/SSA and anti-La/SSB antibodies were measured by enzyme linked immunosorbent assay (ELISA) in 645 cSLE patients. RESULTS Anti-Ro/SSA and anti-La/SSB antibodies were evidenced in 209/645 (32%) and 102/645 (16%) of cSLE patients, respectively. Analysis of cSLE patients with and without anti-Ro/SSA antibodies revealed higher frequencies of malar rash (79% vs. 71%, p=0.032), photosensitivity (73% vs. 65%, p=0.035), cutaneous vasculitis (43% vs. 35%, p=0.046) and musculoskeletal involvement (82% vs. 75%, p=0.046) in spite of long and comparable disease duration in both groups (4.25 vs. 4.58years, p=0.973). Secondary Sjögren syndrome was observed in only five patients with this antibody (2.5% vs. 0%, p=0.0035), two of them with concomitant anti-La/SSB. The presence of associated autoantibodies: anti-Sm (50% vs. 30%, p<0.0001), anti-RNP (39% vs. 21%, p<0.0001) and anti-ribossomal P protein (46% vs. 21%, p=0.002) was also significantly higher in patients with anti-Ro/SAA antibodies. Further evaluation of cSLE patients with the presence of anti-La/SSB antibodies compared to those without these autoantibodies showed that the frequency of alopecia (70% vs. 51%, p=0.0005), anti-Sm (59% vs. 31%, p<0.0001) and anti-RNP (42% vs. 23%, p<0.0001) were significantly higher in the former group. CONCLUSIONS Our large multicenter cohort study provided novel evidence in cSLE that anti-Ro/SSA and/or anti-La/SSB antibodies were associated with mild manifestations, particularly cutaneous and musculoskeletal. Secondary Sjögren syndrome was rarely observed in these patients, in spite of comparable frequencies of anti-Ro/SSA and/or anti-La/SSB reported for adult SLE.
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Affiliation(s)
- Glaucia V Novak
- Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Mariana Marques
- Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Verena Balbi
- Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Natali W S Gormezano
- Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo, Brazil; Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Kátia Kozu
- Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Ana P Sakamoto
- Pediatric Rheumatology Unit, Universidade Federal de São Paulo, Brazil
| | - Rosa M R Pereira
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Maria T Terreri
- Pediatric Rheumatology Unit, Universidade Federal de São Paulo, Brazil
| | - Claudia S Magalhães
- Pediatric Rheumatology Division, São Paulo State University (UNESP) - Faculdade de Medicina de Botucatu, Brazil
| | - Andressa Guariento
- Pediatric Rheumatology Unit, Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil
| | - Adriana M E Sallum
- Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Roberto Marini
- Pediatric Rheumatology Unit, State University of Campinas (UNICAMP), Brazil
| | | | | | | | | | - Eloisa Bonfá
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Clovis A Silva
- Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo, Brazil; Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil.
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Kolkhir P, Pogorelov D, Olisova O, Maurer M. Comorbidity and pathogenic links of chronic spontaneous urticaria and systemic lupus erythematosus--a systematic review. Clin Exp Allergy 2016; 46:275-87. [PMID: 26545308 DOI: 10.1111/cea.12673] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Chronic spontaneous urticaria (CSU) is a common mast cell-driven disease characterized by the development of wheals (hives), angioedema (AE), or both for > 6 weeks. It is thought that autoimmunity is a common cause of CSU, which is often associated with autoimmune thyroiditis, whereas the link to other autoimmune disorders such as systemic lupus erythematosus (SLE) has not been carefully explored. Here, we systematically reviewed the existing literature for information on the prevalence of CSU in SLE (and vice versa) and we examined the possible clinical and pathogenetic relationship between CSU and SLE. The prevalence of CSU and CSU-like rash in SLE was investigated by 42 independent studies and comorbidity in adult patients reportedly ranged from 0% to 21.9% and 0.4% to 27.5%, respectively (urticarial vasculitis: 0-20%). In children with SLE, CSU was reported in 0-1.2% and CSU-like rash in 4.5-12% (urticarial vasculitis: 0-2.2%). In contrast, little information is available on the prevalence of SLE in patients with CSU, and more studies are needed to determine the rate of comorbidity. Recent insights on IgG- and IgE-mediated autoreactivity suggest similarities in the pathogenesis of CSU and SLE linking inflammation and autoimmunity with the activation of the complement and coagulation system. Future studies of patients with either or both conditions could help to better define common pathomechanisms in CSU and SLE and to develop novel targeted treatment options for patients with CSU and SLE.
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Affiliation(s)
- P Kolkhir
- Department of Dermatology and Venereology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - D Pogorelov
- Department of Dermatology and Venereology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - O Olisova
- Department of Dermatology and Venereology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - M Maurer
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Gomes RC, Silva MF, Kozu K, Bonfá E, Pereira RM, Terreri MT, Magalhães CS, Sacchetti SB, Marini R, Fraga M, Carvalho LM, Barbosa CM, Carneiro-Sampaio M, Silva CA. Features of 847 Childhood-Onset Systemic Lupus Erythematosus Patients in Three Age Groups at Diagnosis: A Brazilian Multicenter Study. Arthritis Care Res (Hoboken) 2016; 68:1736-1741. [PMID: 27014968 DOI: 10.1002/acr.22881] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 01/14/2016] [Accepted: 03/01/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate demographic data and clinical and laboratory features at disease diagnosis in 3 different age groups of childhood-onset systemic lupus erythematosus (SLE): group A, early-onset (<6 years); group B, school age (≥6 to <12 years); and group C, adolescent (≥12 to <18 years). METHODS This was a Brazilian multicenter cohort retrospective study in 10 pediatric rheumatology centers, including 847 childhood-onset SLE patients. RESULTS Patients were divided into 3 groups: group A with 39 patients (4%), group B with 395 patients (47%), and group C with 413 patients (49%). Of 39 childhood-onset SLE patients in group A, 3 (8%) were ages <2 years, 4 (10%) were ≥2 to <3 years, and 32 (82%) were ≥3 and <6 years. A total of 74 childhood-onset SLE patients were analyzed for C1q levels, and complete C1q deficiency was observed in 3 of 74 patients (4%), all in group A. Groups were similar regarding high frequencies of female sex, nephritis, neuropsychiatric involvement, Systemic Lupus Erythematosus Disease Activity Index 2000 score ≥8, autoantibody profile, elevated acute phase proteins, and low complement levels (P > 0.05). However, the frequency of fever (78% versus 61% versus 47%; P < 0.0001), hepatomegaly (42% versus 29% versus 14%; P < 0.0001), splenomegaly (28% versus 12% versus 4%; P < 0.0001), and discoid lupus (13% versus 4% versus 4%; P = 0.020) was significantly higher in group A compared to groups B and C. The frequency of weight loss >2 kg (19% versus 28% versus 36%; P = 0.017), photosensitivity (34% versus 41% versus 51%; P = 0.006), leukopenia <4,000/mm3 (14% versus 25% versus 30%; P = 0.048), and lymphopenia <1,500/mm3 (22% versus 41% versus 47%; P = 0.011) was significantly lower in group A. CONCLUSION Our large multicenter study identified the finding that the initial appearance of childhood-onset SLE is characterized by comparable high frequency of internal organ involvement and some distinct clinical and laboratory features in early-onset and adolescent groups.
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Affiliation(s)
- Roberta C Gomes
- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marco F Silva
- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Katia Kozu
- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Eloisa Bonfá
- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rosa M Pereira
- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | | | - Roberto Marini
- State University of Campinas (UNICAMP), Sao Paulo, Brazil
| | - Melissa Fraga
- Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | | | | | - Clovis A Silva
- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
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Boneparth A, Wenderfer SE, Moorthy LN, Radhakrishna SM, Sagcal-Gironella ACP, von Scheven E. Clinical characteristics of children with membranous lupus nephritis: the Childhood Arthritis and Rheumatology Research Alliance Legacy Registry. Lupus 2016; 26:299-306. [PMID: 27510603 DOI: 10.1177/0961203316662720] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective The objective of this article is to describe and compare clinical features, treatment, and renal outcomes of children with membranous lupus nephritis (MLN), through analysis of a national multicenter registry. Methods Patients with pediatric systemic lupus erythematosus (SLE) and MLN from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Legacy Registry were included. Demographic, disease and medication-related data were collected between 2010 and 2014 from 59 CARRA Legacy Registry sites. Results A total of 132 individuals had MLN, either in isolation or in combination with proliferative LN. Seventy-four patients had pure MLN. The proportion of patients with daily corticosteroid treatment was similar among groups (96%, 91%, and 96%, for class III+V, IV+V, and V, respectively, p = 0.67). Proportion of individuals exposed to any disease-modifying antirheumatic drug (DMARD) or biologic was similar among the three groups (83%, 91%, 95% for class III+V, IV+V, and V, respectively, p = 0.189). Proportion of patients with decreased glomerular filtration rate (less than 90 ml/min/1.73 m2) was significantly different among groups (4%, 38%, and 4%, for class III+V, IV+V, and V, respectively, p < 0.0001). Conclusion This is the largest reported cohort of children with MLN. More research is needed to understand treatment practices for pediatric MLN, particularly decisions related to pharmacologic treatment of pure MLN. More work is also needed to identify prognostic factors and predictors of outcome for pediatric MLN. Future observational studies will be a first step toward understanding and formulating a standardized approach to treatment of pediatric membranous LN and allowing for the initiation of prospective comparative effectiveness studies and interventional trials.
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Affiliation(s)
- A Boneparth
- 1 Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - L Nandini Moorthy
- 1 Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | | | - E von Scheven
- 4 University of California at San Francisco, San Francisco, CA, USA
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Abstract
Juvenile systemic lupus erythematosus (JSLE) represents 15—20% of all SLE cases. The leading presenting symptoms of JSLE are constitutional and not specific such as fatigue, headache, weight loss or mood swings. They are also encountered in healthy adolescents, which explains frequent diagnosis delay. The frequency of irreversible damage is high in JSLE and involves especially the renal, musculoskeletal and neuropsychiatric systems. Although the overall prognosis has markedly improved, thanks to earlier diagnosis and new therapeutic approaches, cardiovascular, hematological events and chronic renal failure remain severe, and constitute the main disease-related causes of death. Treatment is based on hydroxycloroquine and corticosteroids. Immunosuppressive agents must be discussed to decrease the duration of corticosteroids use. New drugs and monoclonal antibodies targeting B-cells and B-cell related cytokines are being evaluated with encouraging results. Management of JSLE has to challenge three objectives: controlling disease progression, obtaining patient's adherence to treatment, and preventing consequences of medication side effects on growth, puberty, development and fertility. Patients' quality of life and psychosocial development have also to be taken into account, as well as the organization of a successful transition from paediatric to adult care. Lupus (2007) 16, 606—612.
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Affiliation(s)
- I Kone-Paut
- Department of Pediatrics and Pediatric Rheumatology, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
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Silva CA. Childhood-onset systemic lupus erythematosus: early disease manifestations that the paediatrician must know. Expert Rev Clin Immunol 2016; 12:907-10. [DOI: 10.1080/1744666x.2016.1195685] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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77
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Huggins JL, Holland MJ, Brunner HI. Organ involvement other than lupus nephritis in childhood-onset systemic lupus erythematosus. Lupus 2016; 25:857-63. [DOI: 10.1177/0961203316644339] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In this review we critically analyze pulmonary, gastrointestinal and cardiac manifestations of childhood-onset systemic lupus erythematosus (cSLE). Clinical manifestations of these organ systems may be the initial manifestation of cSLE; frequently occur with very active cSLE; and are potential life-threatening manifestations often presenting to the emergency department and requiring admission to the intensive care unit. Early recognition and treatment of the pulmonary, gastrointestinal and cardiac manifestations of cSLE will result in improved prognosis and better outcomes.
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Affiliation(s)
- J L Huggins
- Cincinnati Children’s Hospital Medical Center, Cincinnati, USA
| | - M J Holland
- Cincinnati Children’s Hospital Medical Center, Cincinnati, USA
| | - H I Brunner
- Cincinnati Children’s Hospital Medical Center, Cincinnati, USA
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78
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Sarda G, Harvey R. Severe transaminitis in a paediatric patient with systemic lupus erythaematosus and a discussion of the literature. BMJ Case Rep 2016; 2016:10.1136/bcr-2015-214159. [PMID: 27090540 DOI: 10.1136/bcr-2015-214159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
A 15-year-old African-American girl with known systemic lupus erythaematosus (SLE) presented to the emergency room with fever, abdominal distension, pain and vomiting. She was found to have severe transaminitis on laboratory examination, which prompted further work up including imaging and liver biopsy. Although complete diagnostic criteria were not met, histology was suggestive of autoimmune hepatitis (AIH). She was treated with steroids and azathioprine with good response and resolution of liver function tests. Availability of the literature discussing patients of any age with SLE and AIH is minimal, and consists mostly of small case series and some case reports. The juvenile literature on SLE and AIH occurring in the same patient is even scarcer and should be further studied at a multicentre level.
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Affiliation(s)
- Garima Sarda
- Baystate Medical Center Children's Hospital, Springfield, Massachusetts, USA
| | - Rohini Harvey
- Baystate Medical Center Children's Hospital, Springfield, Massachusetts, USA
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79
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Arathi N, Sasidharan PK, Geetha P. Kozhikode criteria for diagnosing systemic lupus erythematosus as a hematological disorder. J Blood Med 2016; 7:13-8. [PMID: 27022308 PMCID: PMC4792217 DOI: 10.2147/jbm.s95839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease in which cells and tissues undergo damage mediated by tissue-binding autoantibodies. At its onset, it may involve one organ alone or more than one organ simultaneously; over a time, additional manifestations due to the involvement of other organs may occur. Our observations have confirmed that hematological manifestations are the commonest initial presentation in SLE. The criteria used till 2012 was the American College of Rheumatology (ACR) criteria, which is only a classification criterion and not really for diagnosis; if we rely on ACR criteria, the diagnosis is often delayed. Time required for satisfying all four of the eleven criteria is variable and prolonged. Moreover, hematological manifestations are underrepresented in the ACR criteria. Based on the clinical observations made on patients evaluated in a tertiary center in North Kerala, an alternate diagnostic criterion named the Kozhikode criteria was proposed, especially for the diagnosis of SLE when it presents with hematological manifestations alone. The present study was an attempt to validate the same and to look for any association of diet and lifestyle with the disease.
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Affiliation(s)
- N Arathi
- Department of Medicine, Government Medical College, Kozhikode, Kerala, India
| | - P K Sasidharan
- Department of Medicine, Government Medical College, Kozhikode, Kerala, India; Department of Haematology, Government Medical College, Kozhikode, Kerala, India
| | - P Geetha
- Department of Medicine, Government Medical College, Kozhikode, Kerala, India
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80
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AlKharafi NNAH, Alsaeid K, AlSumait A, Al-Sabah H, Al-Ajmi H, Rahim JA, Al-Enezi H, Nanda A. Cutaneous Lupus Erythematosus in Children: Experience from a Tertiary Care Pediatric Dermatology Clinic. Pediatr Dermatol 2016; 33:200-8. [PMID: 27001318 DOI: 10.1111/pde.12788] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND/OBJECTIVES The manifestations of cutaneous lupus erythematosus (CLE) and their relevance to systemic disease are well characterized in adults, but data are limited in children. The objective of the current study was to examine the spectrum of CLE and its relationship to systemic disease in children from a tertiary care pediatric dermatology clinic. MATERIALS AND METHODS An analysis of 26 children with CLE registered consecutively over 14 years was performed. RESULTS Ninety-six percent of the patients were of Arab ethnicity. They included seven (27%) cases with neonatal lupus erythematosus (LE) (71% females and 29% males). Of the other 19 children with CLE, 95% were female. The mean and median age at diagnosis was 11 years. Eighty-nine percent of the patients fulfilled the criteria for systemic LE. All patients had LE-specific lesions and 83% had LE-nonspecific manifestations. Atypical initial presentations were recorded in 28% of the patients, and 22% of the patients had the rare LE variants. Of the LE-specific manifestations, acute CLE was seen in 83%, subacute in 44%, and chronic in 22%. Autoimmune associations were recorded in 44% and a positive family history of autoimmune diseases in 61%. CONCLUSION This study highlights a striking female predominance, higher risk of systemic disease in children presenting with CLE, higher prevalence of atypical presentation and rare CLE variants, and underrepresentation of discoid LE in children and signifies the need for more surveys to delineate the spectrum of pediatric CLE in different parts of the world.
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Affiliation(s)
| | - Khaled Alsaeid
- Department of Pediatrics, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Anwar AlSumait
- As'ad Al-Hamad Dermatology Center, Al-Sabah Hospital, Kuwait City, Kuwait
| | - Humoud Al-Sabah
- As'ad Al-Hamad Dermatology Center, Al-Sabah Hospital, Kuwait City, Kuwait
| | - Hejab Al-Ajmi
- As'ad Al-Hamad Dermatology Center, Al-Sabah Hospital, Kuwait City, Kuwait
| | - Jasim Abdul Rahim
- Pediatric Rheumatology Unit, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Hamid Al-Enezi
- Pediatric Rheumatology Unit, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Arti Nanda
- As'ad Al-Hamad Dermatology Center, Al-Sabah Hospital, Kuwait City, Kuwait
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81
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Kawasaki Y, Ohara S, Miyazaki K, Kanno S, Ono A, Suyama K, Sato M, Suzuki S, Maeda R, Nagasawa K, Hosoya M. Incidence and prognosis of systemic lupus erythematosus in a 35 year period in Fukushima, Japan. Pediatr Int 2015; 57:650-5. [PMID: 25615939 DOI: 10.1111/ped.12588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/11/2014] [Accepted: 12/26/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND We examined the epidemiology, clinical manifestations, and prognosis of pediatric systemic lupus erythematosus (SLE) in Fukushima Prefecture, Japan over a 35 year period. METHODS We collected the medical records of 37 patients diagnosed with SLE between 1977 and 2013. These children were divided into two groups. group 1 consisted of 19 patients who were diagnosed between 1977 and 1995, and group 2 consisted of 18 patients diagnosed between 1996 and 2013. The epidemiology, clinical features, and prognosis were retrospectively compared between the two groups. RESULTS The mean number of patients per 100,000 children per year for group 1 and group 2 was 0.33 ± 0.25 and 0.35 ± 0.30, respectively. The duration from onset of symptoms to treatment in group 2 was shorter than that in group 1, but the clinical and laboratory findings at onset did not differ between the two groups. All patients were treated with prednisolone, and 17 patients in group 1 and 18 in group 2 were treated with methylprednisolone pulse therapy. The frequency of cyclophosphamide treatment decreased whereas the frequency of cyclosporine, tacrolimus and mizoribine pulse therapy increased in group 2. SLE disease activity index (SLEDAI) score at the latest follow up in group 2 was lower in group 1. The survival rate was 84% in group 1 and 100% in group 2. CONCLUSION The frequency and severity of SLE in group 1 were similar to those in group 2, and the prognosis of SLE in group 2 was better than that in group 1.
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Affiliation(s)
- Yukihiko Kawasaki
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shinichiro Ohara
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kyohei Miyazaki
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shuto Kanno
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Atsushi Ono
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kazuhide Suyama
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Masatoki Sato
- Department of Pediatrics, Some General Hospital, Fukushima, Japan
| | - Shigeo Suzuki
- Department of Pediatrics, Ohara General Hospital, Fukushima, Japan
| | - Ryo Maeda
- Department of Pediatrics, Hoshi General Hospital, Fukushima, Japan
| | | | - Mitsuaki Hosoya
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
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82
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Maharaj SS, Chang SM. Cardiac tamponade as the initial presentation of systemic lupus erythematosus: a case report and review of the literature. Pediatr Rheumatol Online J 2015; 13:9. [PMID: 25802493 PMCID: PMC4369869 DOI: 10.1186/s12969-015-0005-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 03/07/2015] [Indexed: 11/10/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease that can involve any organ system, exhibiting great diversity in presentation. Cardiac tamponade as the initial presentation of childhood onset SLE (cSLE) is rare. We report the case of a 10 year old Afro-Caribbean female who presented with complaints of chest pain, shortness of breath and fever over 4 days. Clinical examination strongly suggested cardiac tamponade which was confirmed by investigations and treated with pericardiocentesis. After a thorough investigation, the underlying diagnosis of SLE was confirmed using the Systemic Lupus International Collaborating Clinics (SLICC) criteria and high dose corticosteroid therapy initiated. A review of recent studies shows that common initial presentations of cSLE include constitutional symptoms, renal disease, musculoskeletal and cutaneous involvement. In presenting this case and reviewing the literature we emphasize the importance of cSLE as a differential diagnosis when presented with pericarditis in the presence or absence of cardiac tamponade. In these patients early diagnosis and treatment is desired and in this regard we also discuss the sensitivity of the SLICC criteria in cSLE.
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Affiliation(s)
- Satish S Maharaj
- Eric Williams Medical Sciences Complex, The University of the West Indies, Champs Fleurs, Trinidad and Tobago
| | - Simone M Chang
- Eric Williams Medical Sciences Complex, The University of the West Indies, Champs Fleurs, Trinidad and Tobago
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83
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Mesenteric vasculitis in children with systemic lupus erythematosus. Clin Rheumatol 2015; 35:785-93. [DOI: 10.1007/s10067-015-2892-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 01/26/2015] [Accepted: 01/31/2015] [Indexed: 01/25/2023]
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84
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Chiba Y, Katsuse O, Fujishiro H, Kamada A, Saito T, Ikura T, Takahashi Y, Kunii M, Takeno M, Hirayasu Y. Lymphopenia Helps Early Diagnosis of Systemic Lupus Erythematosus for Patients With Psychosis as an Initial Symptom. PSYCHOSOMATICS 2015; 56:85-8. [DOI: 10.1016/j.psym.2013.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 06/26/2013] [Accepted: 06/27/2013] [Indexed: 12/01/2022]
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85
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Yang YS, Cheon BR, Shim JW, Kim DS, Jung HL, Park MS, Shim JY. Pulmonary hemorrhage as an unusual initial manifestation of systemic lupus erythematosus. ALLERGY ASTHMA & RESPIRATORY DISEASE 2015. [DOI: 10.4168/aard.2015.3.5.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Yun Seok Yang
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Bo Ram Cheon
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Won Shim
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Deok Soo Kim
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Lim Jung
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Moon Soo Park
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Yeon Shim
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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86
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Tarr T, Dérfalvi B, Győri N, Szántó A, Siminszky Z, Malik A, Szabó AJ, Szegedi G, Zeher M. Similarities and differences between pediatric and adult patients with systemic lupus erythematosus. Lupus 2014; 24:796-803. [PMID: 25516474 DOI: 10.1177/0961203314563817] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 11/20/2014] [Indexed: 12/16/2022]
Abstract
Systemic lupus erythematosus (SLE) is a multifactorial autoimmune disease with highest prevalence among women of childbearing age. However, children younger than 16 years also can develop SLE (childhood-onset lupus/juvenile-type SLE). The aim of our study was to compare the clinical course of adult and pediatric-onset SLE. Data from 342 adult patients followed at the University of Debrecen, Hungary, and 79 children documented in the Hungarian National Pediatric SLE registry were analyzed using hospital medical records. Organ manifestations, laboratory parameters, and immunoserological characteristics were reviewed and the results were evaluated using SPSS for Windows software.Gender distribution was not significantly different between groups with disease starting in childhood vs adulthood. The prevalence of the following manifestations was significantly higher for pediatric than for adult-onset disease including: lupus nephritis (43% pediatric vs 26.4% for adult-onset), hematological disorders (57% vs 36.4%), photosensitivity (20% vs 9%), butterfly rash (61% vs 35.5%) and mucosal ulceration (11.4% vs 4%). For adult-onset SLE, neurological symptoms (30% vs 6%) and polyarthritis (86% vs 68%) occurred significantly more frequently than in children. Anti-SSA, anti-SSB and antiphospholipid antibodies were detected at significantly higher levels in adult-onset patients compared to those in pediatrics. Children were more commonly given high-dose intravenous immunoglobulin treatment (6.3% vs 0.6%) and mycophenolate mofetil (15.2% vs 5.3%) than adults.These results suggest that pediatric and adult-onset SLE differ in multiple aspects, and it is important to recognize these differences for optimal treatment and prognosis of these patients.
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Affiliation(s)
- T Tarr
- Department of Clinical Immunology, University of Debrecen, Hungary
| | - B Dérfalvi
- 2nd. Department of Pediatrics, Semmelweis University Budapest, Hungary Department of Pediatrics, Dalhousie University-IWK Health Centre, Halifax, Canada
| | - N Győri
- Department of Clinical Immunology, University of Debrecen, Hungary
| | - A Szántó
- Department of Clinical Immunology, University of Debrecen, Hungary
| | - Z Siminszky
- Department of Clinical Immunology, University of Debrecen, Hungary
| | - A Malik
- 1st. Department of Pediatrics and Research Laboratory of Hungarian Academy of Science, Semmelweis University Budapest, Hungary
| | - A J Szabó
- 1st. Department of Pediatrics and Research Laboratory of Hungarian Academy of Science, Semmelweis University Budapest, Hungary
| | - G Szegedi
- Department of Clinical Immunology, University of Debrecen, Hungary
| | - M Zeher
- Department of Clinical Immunology, University of Debrecen, Hungary
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87
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Lupus nephritis in Egyptian children: a 16-year experience. J Nephrol 2014; 28:557-62. [DOI: 10.1007/s40620-014-0157-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 11/05/2014] [Indexed: 11/25/2022]
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88
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Dandolo A, Prajs N, Lizop M. [Nephropathy due to Puumala hantavirus]. Arch Pediatr 2014; 21:1334-8. [PMID: 25449445 DOI: 10.1016/j.arcped.2014.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 01/30/2014] [Accepted: 09/21/2014] [Indexed: 11/18/2022]
Abstract
Hemorrhagic fever with renal syndrome (HFRS) is due to an infection by the virus of the Hantavirus genus. Rodent hosts of Hantavirus are present in restricted areas in France; consequently, there are ecological niches and microepidemics of human Hantavirus infections. A HFRS case was diagnosed in the Paris region. The 11-year-old child had an acute debut fever-persistent despite antipyretic medication-asthenia, headache, abdominal pain, myalgia, thrombocytopenia, as well as renal failure with proteinuria. The diagnosis was made with a relevant clinical history and the specific serology of Puumala hantavirus. Therefore, a kidney biopsy was not necessary. What was interesting was the diagnostic approach because of the difference between the place and time of contamination and where the child became ill and developed the symptoms. The child was infected by Puumala hantavirus in Les Ardennes, a high-risk area, but became ill in the Paris region, an area with no prevalence. We review Hantavirus infections in France and its differential diagnosis.
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Affiliation(s)
- A Dandolo
- Service des urgences, institut hospitalier Franco-Britannique, 92300 Levallois-Perret, France.
| | - N Prajs
- Service de pédiatrie, institut hospitalier Franco-Britannique, 92300 Levallois-Perret, France
| | - M Lizop
- Service de pédiatrie, institut hospitalier Franco-Britannique, 92300 Levallois-Perret, France
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89
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Bakr A, Laimon W, El-Ziny MA, Hammad A, El-Hawary AK, Elsharkawy AA, El-Refaey AM, Salem NA, El-Mougy A, Zedan MM, Aboelenin HM, Eid R, Sarhan A. The emergence of systemic lupus erythematosus in hypothyroid patients: two case reports and mini review. Lupus 2014; 23:825-8. [DOI: 10.1177/0961203314525866] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 02/04/2014] [Indexed: 11/16/2022]
Abstract
Systemic lupus erythematosus (SLE) is a multi-systemic autoimmune disease that involves almost all the organs in the human body and is characterized by auto antibodies formation. Autoimmune thyroid diseases (AITD) are organ-specific diseases that are associated with a production of a variety of antibodies such as antinuclear antibodies, anti-double-stranded DNA, anti-Ro antibodies, anti-cardiolipin antibodies, and others. The diagnosis of AITD in patients with SLE is well known, but the reverse is rarely reported. We present two cases of adolescent girls in whom SLE evolved one year after being diagnosed with hypothyroidism.
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Affiliation(s)
- A Bakr
- Faculty of Medicine, Mansoura University Children Hospital, Mansoura, Egypt
| | - W Laimon
- Faculty of Medicine, Mansoura University Children Hospital, Mansoura, Egypt
| | - MA El-Ziny
- Faculty of Medicine, Mansoura University Children Hospital, Mansoura, Egypt
| | - A Hammad
- Faculty of Medicine, Mansoura University Children Hospital, Mansoura, Egypt
| | - AK El-Hawary
- Faculty of Medicine, Mansoura University Children Hospital, Mansoura, Egypt
| | - AA Elsharkawy
- Faculty of Medicine, Mansoura University Children Hospital, Mansoura, Egypt
| | - AM El-Refaey
- Faculty of Medicine, Mansoura University Children Hospital, Mansoura, Egypt
| | - NA Salem
- Faculty of Medicine, Mansoura University Children Hospital, Mansoura, Egypt
| | - A El-Mougy
- Faculty of Medicine, Mansoura University Children Hospital, Mansoura, Egypt
| | - MM Zedan
- Faculty of Medicine, Mansoura University Children Hospital, Mansoura, Egypt
| | - HM Aboelenin
- Faculty of Medicine, Mansoura University Children Hospital, Mansoura, Egypt
| | - R Eid
- Faculty of Medicine, Mansoura University Children Hospital, Mansoura, Egypt
| | - A Sarhan
- Faculty of Medicine, Mansoura University Children Hospital, Mansoura, Egypt
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90
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Slettedal IÖ, Dahl HM, Sandvig I, Dalmau J, Strømme P. Young girl with psychosis, cognitive failure and seizures. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2013; 132:2073-6. [PMID: 23038201 DOI: 10.4045/tidsskr.12.0092] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Imer Önder Slettedal
- Department of Adolescent Mental Health, Centre for Child and Adolescent Mental Health, Oslo University Hospital, Ullevål, Norway
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91
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Brown RT, Shaftman SR, Tilley BC, Anthony KK, Kral MC, Maxson B, Mee L, Bonner MJ, Vogler LB, Schanberg LE, Connelly MA, Wagner JL, Silver RM, Nietert PJ. The health education for lupus study: a randomized controlled cognitive-behavioral intervention targeting psychosocial adjustment and quality of life in adolescent females with systemic lupus erythematosus. Am J Med Sci 2013; 344:274-82. [PMID: 22996139 DOI: 10.1097/maj.0b013e3182449be9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION To examine in a randomize controlled feasibility clinical trial the efficacy of a cognitive-behavioral intervention designed to manage pain, enhance disease adjustment and adaptation and improve quality of life among female adolescents with systemic lupus erythematosus. METHODS Female adolescents (n = 53) ranging in age from 12 to 18 years were randomly assigned to 1 of 3 groups including a cognitive-behavioral intervention, an education-only arm and a no-contact control group. Participants were assessed at baseline, postintervention and at 3- and 6-month intervals after completion of the intervention. RESULTS No significant differences were revealed among the 3 treatment arms for any of the dependent measures at any of the assessment points. For the mediator variables, a posthoc secondary analysis did reveal increases in coping skills from baseline to postintervention among the participants in the cognitive-behavioral intervention group compared with both the no-contact control group and the education-only group. CONCLUSION Although no differences were detected in the primary outcome, a possible effect on coping of female adolescents with systemic lupus erythematosus was detected in this feasibility study. Whether the impact of training in the area of coping was of sufficient magnitude to generalize to other areas of functioning, such as adjustment and adaptation, is unclear. Future phase III randomized trials will be needed to assess additional coping models and to evaluate the dose of training and its influence on pain management, adjustment and health-related quality of life.
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Affiliation(s)
- Ronald T Brown
- Department of Psychology, Wayne State University, Detroit, MI 48202, USA.
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92
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Silva CA, Avcin T, Brunner HI. Taxonomy for systemic lupus erythematosus with onset before adulthood. Arthritis Care Res (Hoboken) 2013; 64:1787-93. [PMID: 22730317 DOI: 10.1002/acr.21757] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 05/29/2012] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To propose a common nomenclature to refer to individuals who fulfill the American College of Rheumatology classification criteria for systemic lupus erythematosus (SLE) during childhood or adolescence. METHODS The medical literature was reviewed for studies conducted in the target population between 1960 and December 2011 to obtain information about the terms used to refer to such children and adolescents. We reviewed the threshold ages used and disease features considered to discriminate these individuals from patients with onset of SLE during adulthood. Furthermore, the nomenclature used in other chronic diseases with onset during both childhood and adulthood was assessed. RESULTS There was an astonishing variability in the age cutoffs used to define SLE onset prior to adulthood, ranging from 14-21 years, but most studies used age 18 years. The principal synonyms in the medical literature were SLE without reference to the age at onset of disease, childhood-onset SLE, juvenile SLE, and pediatric (or paediatric) SLE. CONCLUSION Based on the definition of childhood, in analogy with other complex chronic diseases commencing prior to adulthood, and given the current absence of definite genetic variations that discriminate adults from children, the term childhood-onset SLE is proposed when referring to individuals with onset of SLE prior to age 18 years.
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93
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Manaboriboon B, Silverman ED, Homsanit M, Chui H, Kaufman M. Weight change associated with corticosteroid therapy in adolescents with systemic lupus erythematosus. Lupus 2012; 22:164-70. [DOI: 10.1177/0961203312469260] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Physical appearance is very important to adolescents and weight gain secondary to corticosteroid (CS) treatment may have a direct impact on adolescent development. Understanding weight gain in adolescents with SLE who are being treated with CS will help clinicians develop strategies for prevention of nonadherence, obesity and eating disorders in this population. Methods: Patients aged 11–18 years old with newly diagnosed SLE between January,1995 and December, 2006 were identified through the Rheumatology database at the Sickkids hospital, Canada. All charts were reviewed. Patients were categorized based on final BMI status as normal, overweight and obese. Risk factors for being obese were examined by logistic regression model analysis. Results: Of 236 patients, 78% fulfilled the criteria. 85% were female with mean age at onset of diagnosis was 14 ± 1.7 years. Mean duration of CS treatment was 50 ± 31 months and mean cumulative CS dosage was 34.11 ± 32.7 g of prednisone. At baseline, 10% had BMI >25 kg/m2 while at the end of the study, 20% were overweight and 10.4% were obese. In addition, 61% gained <10 kg while 15% gained ≥20 kg. Initial BMI was a significant predictors for final BMI (OR = 27.59, 95%CI = 6.04–126.09, p < .001) while male (OR = 8.50, 95%CI = 2.95–24.5, p < 0.000) and cumulative CS dosage (OR = 1.53, 95%CI = 1.05–2.23, p < .05) were the significant predictors for weight gain >10 kg. Duration of CS treatment did not correlate with obesity. Conclusion: Although a significant number of patients became overweight or obese after being treated with CS, most gained <10 kg. Obesity secondary to CS treatment in SLE patients was significantly correlated with baseline BMI, gender and cumulative CS dosage.
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Affiliation(s)
- B Manaboriboon
- Department of Pediatrics, Siriraj Hospital, Mahidol University, Thailand
| | - ED Silverman
- Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, The Hospital for Sick Children Research Institute, University of Toronto, Canada
| | - M Homsanit
- Department of Preventive and Social Medicine, Siriraj Hospital, Mahidol University, Thailand
| | - H Chui
- Department of Psychology, University of Maryland, USA
| | - M Kaufman
- Division of Adolescent Medicine, Department of Paediatrics,The Hospital for Sick Children, University of Toronto, Canada
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94
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Hiraki LT, Feldman CH, Liu J, Alarcón GS, Fischer MA, Winkelmayer WC, Costenbader KH. Prevalence, incidence, and demographics of systemic lupus erythematosus and lupus nephritis from 2000 to 2004 among children in the US Medicaid beneficiary population. ACTA ACUST UNITED AC 2012; 64:2669-76. [PMID: 22847366 DOI: 10.1002/art.34472] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate the nationwide prevalence, incidence, and sociodemographics of systemic lupus erythematosus (SLE) and lupus nephritis among children in the US Medicaid beneficiary population. METHODS Children ages 3 years to <18 years with a diagnosis of SLE (defined as ≥3 claims with an International Classification of Diseases, Ninth Revision [ICD-9] code of 710.0 for SLE, each >30 days apart) were identified from the US Medicaid Analytic eXtract database from 2000 to 2004. This database contains all inpatient and outpatient Medicaid claims for 47 US states and the District of Columbia. Lupus nephritis was identified from ≥2 ICD-9 billing codes for glomerulonephritis, proteinuria, or renal failure, each recorded >30 days apart. The prevalence and incidence of SLE and lupus nephritis were calculated among Medicaid-enrolled children overall and within sociodemographic groups. RESULTS Of the 30,420,597 Medicaid-enrolled children during these years, 2,959 were identified as having SLE. The prevalence of SLE was 9.73 (95% confidence interval [95% CI] 9.38-10.08) per 100,000 Medicaid-enrolled children. Among the children with SLE, 84% were female, 40% were African American, 25% were Hispanic, 21% were White, and 42% resided in the South region of the US. Moreover, of the children with SLE, 1,106 (37%) had lupus nephritis, representing a prevalence of 3.64 (95% CI 3.43-3.86) per 100,000 children. The average annual incidence of SLE was 2.22 cases (95% CI 2.05-2.40) and that of lupus nephritis was 0.72 cases (95% CI 0.63-0.83) per 100,000 Medicaid enrollees per year. The prevalence and incidence rates of SLE and lupus nephritis increased with age, were higher in girls than in boys, and were higher in all non-White racial/ethnic groups. CONCLUSION In the current study, the prevalence and incidence rates of SLE among Medicaid-enrolled children in the US are high compared to studies in other populations. In addition, these data represent the first population-based estimates of the prevalence and incidence of lupus nephritis in the US to date.
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Affiliation(s)
- Linda T Hiraki
- Harvard School of Public Health and Brigham and Women's Hospital, Boston, Massachusetts, USA.
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95
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Sasidharan PK, Bindya M, Sajeeth Kumar KG. Hematological Manifestations of SLE at Initial Presentation: Is It Underestimated? ISRN HEMATOLOGY 2012; 2012:961872. [PMID: 22830038 PMCID: PMC3399342 DOI: 10.5402/2012/961872] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 05/28/2012] [Indexed: 11/29/2022]
Abstract
SLE can present with hematological manifestations alone or along with features of other system involvement. With a low index of clinical suspicion or inadequate follow up the diagnosis may be delayed or missed at the time of presentation, in those with hematological abnormalities as the initial manifestation. An observational study was conducted among patients of SLE, in a tertiary referral centre of North Kerala, with the purpose of estimating the proportion of patients with hematological manifestations as the initial presentation of the disease and to study their nature. It was observed that 82% of the patients had hematological manifestations at presentation. It is the most common presenting manifestation of SLE in people of North Kerala. Autoimmune hypothyroidism was one of the common coexisting abnormalities in these patients, which is not included in the American College of Rheumatology (ACR) criteria for diagnosis. Arthritis was uncommon among those who presented with hematological manifestations. A significant number of patients do not satisfy the ACR criteria at the time of diagnosis but do so on follow up. The ACR criteria are weak to diagnose such patients and therefore need revision. We therefore propose an alternative to ACR criteria as “Kozhikode criteria for SLE”.
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Affiliation(s)
- P K Sasidharan
- Department of Medicine, Calicut Medical College, Kozhikode, Kerala 673008, India
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96
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Patel A, Rangaraj S, Wright B, Murphy R. An unusual presentation of juvenile systemic lupus erythematosus. Clin Exp Dermatol 2012; 37:249-51. [DOI: 10.1111/j.1365-2230.2011.04206.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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97
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Huang CF, Wang WM, Chiang CP. Scaly ear rash as the herald of a young girl with juvenile systemic lupus erythematosus. Ann Dermatol 2012; 23:S333-7. [PMID: 22346271 PMCID: PMC3276790 DOI: 10.5021/ad.2011.23.s3.s333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 04/08/2011] [Accepted: 04/11/2011] [Indexed: 11/15/2022] Open
Abstract
Juvenile systemic lupus erythematosus (JSLE) is an autoimmune-mediated multiorgan disease. The cutaneous manifestation is one of the most common initial presentations in JSLE. A typical lesion is a facial malar rash, but a patient may sometimes present with nonclassical lesions. Herein, we report two cases of JSLE with similar persistent scaly ear rashes as the heralding cutaneous symptom preceding systemic symptoms. Identifying this atypical and underestimated cutaneous rash in juvenile patients might help the clinician make the correct diagnosis and provide earlier intervention, which may help prevent disease progression.
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Affiliation(s)
- Ching-Fu Huang
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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98
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99
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Grimbly C, Rennebohm R, Fruitman DS. Case 2: Chest pain in an adolescent. Paediatr Child Health 2012; 17:21-3. [DOI: 10.1093/pch/17.1.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2011] [Indexed: 11/13/2022] Open
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100
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Hui-Yuen JS, Imundo LF, Avitabile C, Kahn PJ, Eichenfield AH, Levy DM. Early versus later onset childhood-onset systemic lupus erythematosus: Clinical features, treatment and outcome. Lupus 2011; 20:952-9. [DOI: 10.1177/0961203311403022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The objective of the study was to compare clinical features, treatment and disease outcome in patients with early versus later onset of childhood-onset systemic lupus erythematosus (cSLE). A retrospective matched cohort study of cSLE patients diagnosed between 1988 and 2008 and followed for a minimum of one year was conducted. Thirty-four pre-pubertal cSLE patients with disease onset prior to their 12th birthday were matched by ethnicity and year of diagnosis to 34 pubertal cSLE patients. The most common criteria at diagnosis in both groups were malar rash, arthritis, hematologic manifestations, and renal disease. After a mean follow-up of more than six years, a similar proportion of patients in the two groups were still prescribed corticosteroids (47% and 41%); patients in the early onset group required a significantly higher daily dose (0.6 mg/kg prednisone-equivalent versus 0.2 mg/kg, p < 0.05). There were no significant differences in organ involvement, disease activity and disease damage between the two groups, and severe complications occurred at similar rates. There were a greater number of admissions to the pediatric intensive care unit (PICU) in the early onset group (18 versus 5, p = 0.01), with time-to-event analysis demonstrating a significantly shorter disease duration from diagnosis to first PICU admission in the early onset group ( p < 0.001). While a similar proportion of patients in the early and later onset groups required treatment with cyclophosphamide, patients in the early onset group received treatment earlier in their disease course (mean 13.7 versus 19.9 months, p < 0.001). Early onset cSLE leads to earlier and more frequent PICU admission, earlier use of cyclophosphamide, and higher corticosteroid dose at long-term follow-up.
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Affiliation(s)
- JS Hui-Yuen
- Department of Pediatrics, Stonybrook University, USA
| | - LF Imundo
- Pediatric Rheumatology, Morgan Stanley Children’s Hospital of New York Presbyterian, Columbia University Medical Center, New York, USA
| | - C Avitabile
- Pediatric Cardiology, Children’s Hospital of Philadelphia, Philadelphia, USA
| | - PJ Kahn
- Pediatric Rheumatology, New York University, New York, USA
| | - AH Eichenfield
- Pediatric Rheumatology, Morgan Stanley Children’s Hospital of New York Presbyterian, Columbia University Medical Center, New York, USA
| | - DM Levy
- Paediatric Rheumatology, Hospital for Sick Children and University of Toronto, Toronto, Canada
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