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Fatemi A, Matinfar M, Smiley A. Childhood versus adult-onset systemic lupus erythematosus: long-term outcome and predictors of mortality. Clin Rheumatol 2016; 36:343-350. [PMID: 28012055 DOI: 10.1007/s10067-016-3509-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/23/2016] [Accepted: 12/07/2016] [Indexed: 12/20/2022]
Abstract
The aim of this study was to compare survival of childhood-onset systemic lupus erythematosus (c-SLE) and adult-onset SLE (a-SLE) according to initial manifestations. This was a retrospective cohort study. All patients were categorized into c-SLE (≤18 years) and a-SLE (>18 years). The clinical and serological data at the time of diagnosis were recorded and compared. Kaplan-Meier curves were used to compare survival rates between the two groups. Predictors of mortality were obtained by a backward Cox regression. One hundred eighty patients with c-SLE and 394 patients with a-SLE were enrolled. The female/male ratio was higher in c-SLE (P = 0.0001). Lupus nephritis (P = 0.002) and valvular heart disease (P = 0.025) were more common in c-SLE and a-SLE, respectively. In a 23-year follow-up, 20 patients (11.1%) with c-SLE and 35 patients (8.9%) with a-SLE died. Mortality was not significantly different between them (P = 0.4). The main causes of death were nephritis (50% in c-SLE vs. 29% in a-SLE), infections (40% in c-SLE vs. 29% in a-SLE), and circulatory disease (10% in c-SLE vs. 37% in a-SLE). The difference was not significant (P = 0.08). Cumulative survival rates after 5, 10, 15, and 20 years were 91, 87, 85, and 78% in c-SLE and 93, 90, 90, and 83% in a-SLE, respectively. By multivariate analysis, seizure, proteinuria, and nephritis in c-SLE and seizure, hematuria, and pericarditis in a-SLE had negative prognostic effect on survival. Both c-SLE and a-SLE patients with seizure or renal involvement should be monitored more carefully to prevent ominous outcomes.
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Affiliation(s)
- Alimohammad Fatemi
- Department of Rheumatology, Alzahra Hospital, Sofe Street, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mohammad Matinfar
- Department of Internal Medicine, Alzahra Hospital, Sofe Street, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abbas Smiley
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, USA
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152
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Mosaad NAE, Lotfy HM, Farag YM, Mahfouz RHED, Shahin RMH. Study of serum syndecan-1 levels in a group of Egyptian juvenile systemic lupus erythematosus patients. Immunol Lett 2016; 181:16-19. [PMID: 27838471 DOI: 10.1016/j.imlet.2016.11.005] [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] [Received: 07/29/2016] [Accepted: 11/08/2016] [Indexed: 12/14/2022]
Abstract
The aim of the study was to assess the serum levels of Syndecan-1 in a group of Egyptian juvenile systemic lupus erythematosus (JSLE) patients and to study any possible associations with disease activity, renal activity and organ damage. Serum level of Syndecan-1 was assessed in 60 Egyptian JSLE patients and 30 apparently healthy age and gender matched children using ELISA. SLE Disease Activity Index-2000 (SLEDAI-2K), renal SLEDAI-2K, renal activity score and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index were assessed for all patients. Serum SDC-1 levels were higher in patients with JSLE than in healthy controls (p<0.001) and were positively correlated with SLEDAI-2K (p<0.001), with renal SLEDAI score (p=0.008) and renal activity score (p=0.04). So, Syndecan-1 might be used as a marker for disease activity and renal activity in JSLE patients.
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Affiliation(s)
| | - Hala Mohamed Lotfy
- Department of Pediatrics, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
| | - Yomna Mohamed Farag
- Department of Pediatrics, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
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153
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Lourenço B, Kozu KT, Leal GN, Silva MF, Fernandes EGC, França CMP, Souza FHC, Silva CA. Contraception for adolescents with chronic rheumatic diseases. REVISTA BRASILEIRA DE REUMATOLOGIA 2016; 57:73-81. [PMID: 28137405 DOI: 10.1016/j.rbre.2016.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 06/12/2016] [Indexed: 10/21/2022] Open
Abstract
Contraception is an important issue and should be a matter of concern in every medical visit of adolescent and young patients with chronic rheumatic diseases. This narrative review discusses contraception methods in adolescents with juvenile systemic lupus erythematosus (JSLE), antiphospholipid syndrome (APS), juvenile idiopathic arthritis (JIA) and juvenile dermatomyositis (JDM). Barrier methods are safe and their use should be encouraged for all adolescents with chronic rheumatic diseases. Combined oral contraceptives (COC) are strictly prohibited for JSLE and APS patients with positive antiphospholipid antibodies. Reversible long-acting contraception can be encouraged and offered routinely to the JSLE adolescent patient and other rheumatic diseases. Progestin-only pills are safe in the majority of rheumatic diseases, although the main concern related to its use by adolescents is poor adherence due to menstrual irregularity. Depot medroxyprogesterone acetate injections every three months is a highly effective contraception strategy, although its long-term use is associated with decreased bone mineral density. COC or other combined hormonal contraceptive may be options for JIA and JDM patients. Oral levonorgestrel should be considered as an emergency contraception method for all adolescents with chronic rheumatic diseases, including patients with contraindication to COC.
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Affiliation(s)
- Benito Lourenço
- Universidade de São Paulo (USP), Faculdade de Medicina, Unidade do Adolescente, São Paulo, SP, Brazil.
| | - Katia T Kozu
- Universidade de São Paulo (USP), Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil
| | - Gabriela N Leal
- Universidade de São Paulo (USP), Faculdade de Medicina, Unidade de Radiologia, São Paulo, SP, Brazil
| | - Marco F Silva
- Universidade de São Paulo (USP), Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil
| | - Elisabeth G C Fernandes
- Universidade de São Paulo (USP), Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil
| | - Camila M P França
- Universidade de São Paulo (USP), Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil
| | - Fernando H C Souza
- Universidade de São Paulo (USP), Faculdade de Medicina, Divisão de Reumatologia, São Paulo, SP, Brazil
| | - Clovis A Silva
- Universidade de São Paulo (USP), Faculdade de Medicina, Unidade do Adolescente, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Divisão de Reumatologia, São Paulo, SP, Brazil
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154
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Pregnancy outcomes in women with childhood-onset and adult-onset systemic lupus erythematosus: a comparative study. Rheumatol Int 2016; 36:1431-7. [DOI: 10.1007/s00296-016-3525-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 06/28/2016] [Indexed: 10/21/2022]
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155
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Smith EMD, Beresford MW. Urinary biomarkers in childhood lupus nephritis. Clin Immunol 2016; 185:21-31. [PMID: 27373868 DOI: 10.1016/j.clim.2016.06.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 06/26/2016] [Accepted: 06/27/2016] [Indexed: 12/12/2022]
Abstract
Juvenile-onset systemic lupus erythematosus (JSLE) is a rare, severe multisystem autoimmune disease affecting the kidney (Lupus Nephritis, LN) in up to 80% of children. LN is more severe in children than adults, with potential for irreversible kidney damage requiring dialysis or transplant. Renal biopsy is currently the gold standard for diagnosing and monitoring LN, however, it is invasive and associated with complications. Urine biomarkers have been shown to be better than serum biomarkers in differentiating renal disease from other organ manifestations. Over the past decade, there have been an increasing number of studies investigating specific candidate biomarkers implicated in the pathogenesis of LN or screening for urinary biomarkers using hypothesis free methods. In this review, developments in urine biomarkers for LN will be reviewed, highlighting those that are of relevance to children and have gone through validation in independent international patient cohorts, bringing them close to clinical translation.
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Affiliation(s)
- Eve M D Smith
- Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, Institute in the Park, Alder Hey Children's NHS Foundation Trust Hospital, East Prescott Road, Liverpool L14 5AB, UK.
| | - Michael W Beresford
- Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, Institute in the Park, Alder Hey Children's NHS Foundation Trust Hospital, East Prescott Road, Liverpool L14 5AB, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust in the Park, East Prescott Road, Liverpool, L14 5AB, Liverpool, UK.
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156
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Insights into the epidemiology and management of lupus nephritis from the US rheumatologist's perspective. Kidney Int 2016; 90:487-92. [PMID: 27344205 DOI: 10.1016/j.kint.2016.03.042] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 03/14/2016] [Accepted: 03/24/2016] [Indexed: 12/13/2022]
Abstract
Lupus nephritis is a common and severe manifestation of systemic lupus erythematosus that disproportionately affects nonwhites and those in lower socioeconomic groups. This review discusses recent data on the incidence, prevalence, and outcomes of patients with lupus nephritis with a focus on low-income US Medicaid patients. We also review recent guidelines on diagnosis, treatment, and screening for new onset and relapses of lupus nephritis. Finally, we discuss the management of lupus nephritis from a rheumatologist's perspective, including vigilance for the common adverse events related to disease and treatment, and we review prevention and new treatment strategies.
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157
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Abstract
Systemic lupus erythematosus (SLE) is a rare, severe, multisystem autoimmune disorder. Childhood-onset SLE (cSLE) follows a more aggressive course with greater associated morbidity and mortality than adult-onset SLE. Its aetiology is yet to be fully elucidated. It is recognised to be the archetypal systemic autoimmune disease, arising from a complex interaction between the innate and adaptive immune systems. Its complexity is reflected by the fact that there has been only one new drug licensed for use in SLE in the last 50 years. However, biologic agents that specifically target aspects of the immune system are emerging. Immunosuppression remains the cornerstone of medical management, with glucocorticoids still playing a leading role. Treatment choices are led by disease severity. Immunosuppressants, including azathioprine and methotrexate, are used in mild to moderate manifestations. Mycophenolate mofetil is widely used for lupus nephritis. Cyclophosphamide remains the first-line treatment for patients with severe organ disease. No biologic therapies have yet been approved for cSLE, although they are being used increasingly as part of routine care of patients with severe lupus nephritis or with neurological and/or haematological involvement. Drugs influencing B cell survival, including belimumab and rituximab, are currently undergoing clinical trials in cSLE. Hydroxychloroquine is indicated for disease manifestations of all severities and can be used as monotherapy in mild disease. However, the management of cSLE is hampered by the lack of a robust evidence base. To date, it has been principally guided by best-practice guidelines, retrospective case series and adapted adult protocols. In this pharmacological review, we provide an overview of current practice for the management of cSLE, together with recent advances in new therapies, including biologic agents.
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158
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Joo YB, Park SY, Won S, Bae SC. Differences in Clinical Features and Mortality between Childhood-onset and Adult-onset Systemic Lupus Erythematosus: A Prospective Single-center Study. J Rheumatol 2016; 43:1490-7. [PMID: 27252431 DOI: 10.3899/jrheum.151129] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare clinical features and mortality between childhood-onset systemic lupus erythematosus (cSLE) and adult-onset SLE (aSLE) in a prospective single-center cohort. METHODS A total of 1112 patients with SLE (133 cSLE and 979 aSLE) were enrolled and followed from 1998 to 2012. The 2 groups were compared regarding American College of Rheumatology (ACR) classification criteria for SLE, autoantibodies, disease activity measured by the Adjusted Mean SLE Disease Activity Index (AMS), damage measured by the Systemic Lupus International Collaborating Clinics/ACR Damage Index (SDI), and medication. The standardized mortality ratio (SMR) was calculated. Predictors of mortality in SLE were evaluated using Cox proportional hazard models. RESULTS After a mean followup of 7.6 years, patients with cSLE had a higher number of cumulative ACR criteria and a higher AMS (p < 0.001 each), but there was no difference in SDI (p = 0.797). Immunosuppressants were used more frequently by patients with cSLE (p < 0.001). The SMR of cSLE was 18.8 (95% CI 8.6-35.6), significantly higher than that of aSLE (2.9, 95% CI 2.1-3.9). We found cSLE to be an independent predictor of mortality (HR 3.6, p = 0.008). Moreover, presence of hemolytic anemia (7.2, p = 0.034) and antiphospholipid antibody (aPL; 3.8, p = 0.041) increased the magnitude of risk of early mortality more in the patients with cSLE than in those with aSLE. CONCLUSION The clinical course of cSLE as measured by number of clinical manifestations and disease activity is worse than that of aSLE. Also, cSLE patients with hemolytic anemia and aPL are at greater risk of death than patients with aSLE who have those features.
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Affiliation(s)
- Young Bin Joo
- From the Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul; Department of Rheumatology, Myoungji Hospital, Goyang-si; Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Republic of Korea.Y.B. Joo*, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; S.Y. Park*, MD, PhD, Department of Rheumatology, Myoungji Hospital; S. Won, PhD, CRCRA; S.C. Bae, MD, PhD, MPH, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, and CRCRA
| | - So-Yeon Park
- From the Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul; Department of Rheumatology, Myoungji Hospital, Goyang-si; Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Republic of Korea.Y.B. Joo*, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; S.Y. Park*, MD, PhD, Department of Rheumatology, Myoungji Hospital; S. Won, PhD, CRCRA; S.C. Bae, MD, PhD, MPH, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, and CRCRA
| | - Soyoung Won
- From the Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul; Department of Rheumatology, Myoungji Hospital, Goyang-si; Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Republic of Korea.Y.B. Joo*, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; S.Y. Park*, MD, PhD, Department of Rheumatology, Myoungji Hospital; S. Won, PhD, CRCRA; S.C. Bae, MD, PhD, MPH, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, and CRCRA
| | - Sang-Cheol Bae
- From the Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul; Department of Rheumatology, Myoungji Hospital, Goyang-si; Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Republic of Korea.Y.B. Joo*, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; S.Y. Park*, MD, PhD, Department of Rheumatology, Myoungji Hospital; S. Won, PhD, CRCRA; S.C. Bae, MD, PhD, MPH, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, and CRCRA.
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159
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Ambrose N, Morgan TA, Galloway J, Ionnoau Y, Beresford MW, Isenberg DA. Differences in disease phenotype and severity in SLE across age groups. Lupus 2016; 25:1542-1550. [PMID: 27147622 PMCID: PMC5089221 DOI: 10.1177/0961203316644333] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/21/2016] [Indexed: 12/15/2022]
Abstract
Objectives Significant differences have been reported in disease phenotype and severity of systemic lupus erythematosus (SLE) presenting in different age groups. Most indicate a more severe phenotype in juvenile-onset SLE (JSLE). There have been limited studies in older patients and no large studies looking at SLE across all age groups. Methods We assessed the effect of age of onset of SLE on the clinical phenotype by analysing data from two large UK cohorts (the UK JSLE Cohort and the UCLH SLE cohort). Results A total of 924 individuals were compared (413 JSLE, 511 adult-onset SLE). A female preponderance was present, but less pronounced at either end of the age spectrum. Arthritis was more common with advancing age (93% vs 72%, p < 0.001), whereas renal disease (44% vs 33%, p = 0.001), alopecia (47% vs 23%, p < 0.001) and aphthous ulcerations (39% vs 26%, p = 0.001) were more common in the young. Neuropsychiatric lupus was less common in mature-onset SLE (p < 0.01). JSLE was associated more commonly with thrombocytopenia (21% vs 15%, p = 0.01), haemolytic anaemia (20% vs 3%, p < 0.001), high anti-dsDNA (71% vs 63%, p = 0.009), Sm (22% vs 16%, p = 0.02) and RNP (36% vs 29%, p < 0.04) auto-antibodies. Leucopenia increased with advancing age (p < 0.001). Mortality has been declining over recent decades. However, death rates were substantially higher than the general population. The standardized mortality ratio was 18.3 in JSLE and 3.1 in adult-onset SLE. Conclusion These data from the largest-ever direct comparison of JSLE with adult-onset SLE suggest an aggressive phenotype of disease with a worse outcome in patients with JSLE and emphasizes the importance of careful follow-up in this population.
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Affiliation(s)
- N Ambrose
- Centre for Rheumatology, University College London (UCL) Hospital NHS Foundation Trust, London, UK .,Arthritis Research UK Centre for Adolescent Rheumatology, UCL, UK
| | - T A Morgan
- 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, UK
| | - J Galloway
- Centre for Rheumatology, University College London (UCL) Hospital NHS Foundation Trust, London, UK
| | - Y Ionnoau
- Centre for Rheumatology, University College London (UCL) Hospital NHS Foundation Trust, London, UK.,Arthritis Research UK Centre for Adolescent Rheumatology, UCL, UK
| | - M 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, UK
| | - D A Isenberg
- Centre for Rheumatology, University College London (UCL) Hospital NHS Foundation Trust, London, UK.,Arthritis Research UK Centre for Adolescent Rheumatology, UCL, UK
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160
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Evaluation of cardiac functions in juvenile systemic lupus erythematosus with two-dimensional speckle tracking echocardiography. Clin Rheumatol 2016; 35:1967-1975. [PMID: 27139514 DOI: 10.1007/s10067-016-3289-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 10/21/2022]
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161
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Mahapatra A, Sharma P, Sagar R. Psychotic Symptoms in a Child with Long Standing SLE Nephritis: Neuropsychiatric Manifestation or Sequelae to Lupus? JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2016; 25:125-129. [PMID: 27274749 PMCID: PMC4879953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 12/21/2015] [Indexed: 06/06/2023]
Abstract
Systemic Lupus Erythematosus (SLE) is a prototypic autoimmune disease of unknown etiology, which affects multiple organ systems including the central nervous system (CNS). Though not common, childhood onset SLE is a known and established entity. Neuropsychiatric symptoms are common in childhood onset SLE. Of these, psychosis and behavioural symptoms are relatively rare, and there is no consensus on the proper treatment of such cases. We report a case of 13-year-old boy, diagnosed with lupus nephritis, and presented with psychosis and behavioural symptoms. The highlight of this case is that the psychiatric symptoms were present despite the primary illness being quiescent. Thus, the patient was treated with Olanzapine and lorazepam, while continuing immunosuppressive therapy as previously. Also, MRI brain revealed vasculitic changes in the right hemisphere, which might be one of the etiological factors playing role in the development of these neuropsychiatric symptoms.
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Affiliation(s)
- Ananya Mahapatra
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Pawan Sharma
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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162
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Peitz J, Tantcheva-Poór I. Kollagenosen bei Jugendlichen. Hautarzt 2016; 67:271-8. [DOI: 10.1007/s00105-016-3772-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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163
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White PH, Ardoin S. Transitioning Wisely: Improving the Connection From Pediatric to Adult Health Care. Arthritis Rheumatol 2016; 68:789-94. [DOI: 10.1002/art.39554] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 12/15/2015] [Indexed: 01/09/2023]
Affiliation(s)
- Patience H. White
- The Center for Health Care Transition Improvement and George Washington University School of Medicine and Health Sciences; Washington DC
| | - Stacy Ardoin
- Ohio State University and Nationwide Children's Hospital; Columbus Ohio
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164
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Rubinstein TB, Putterman C, Goilav B. Biomarkers for CNS involvement in pediatric lupus. Biomark Med 2016; 9:545-58. [PMID: 26079959 DOI: 10.2217/bmm.15.26] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
CNS disease, or central neuropsychiatric lupus erythematosus (cNPSLE), occurs frequently in pediatric lupus, leading to significant morbidity and poor long-term outcomes. Diagnosing cNPSLE is especially difficult in pediatrics; many current diagnostic tools are invasive and/or costly, and there are no current accepted screening mechanisms. The most complicated aspect of diagnosis is differentiating primary disease from other etiologies; research to discover new biomarkers is attempting to address this dilemma. With many mechanisms involved in the pathogenesis of cNPSLE, biomarker profiles across several modalities (molecular, psychometric and neuroimaging) will need to be used. For the care of children with lupus, the challenge will be to develop biomarkers that are accessible by noninvasive measures and reliable in a pediatric population.
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Affiliation(s)
- Tamar B Rubinstein
- Department of Pediatrics, Division of Rheumatology, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Avenue, Bronx, NY 10467, USA
| | - Chaim Putterman
- Department of Medicine, Division of Rheumatology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA
| | - Beatrice Goilav
- Department of Pediatrics, Division of Nephrology, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Avenue, Bronx, NY 10467, USA
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165
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Sousa S, Gonçalves MJ, Inês LS, Eugénio G, Jesus D, Fernandes S, Terroso G, Romão VC, Cerqueira M, Raposo A, Couto M, Nero P, Sequeira G, Nóvoa T, Melo Gomes JA, da Silva JC, Costa L, Macieira C, Silva C, Silva JAP, Canhão H, Santos MJ. Clinical features and long-term outcomes of systemic lupus erythematosus: comparative data of childhood, adult and late-onset disease in a national register. Rheumatol Int 2016; 36:955-60. [PMID: 26979603 DOI: 10.1007/s00296-016-3450-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/22/2016] [Indexed: 11/28/2022]
Abstract
Systemic lupus erythematosus (SLE) affects predominantly women at reproductive age but may present at any age. Age at disease onset has a modulating effect on presentation and course of disease, but controversies persist regarding its impact on long-term outcome. Our aims were to characterize clinical features, co-morbidities and cumulative damage in childhood-onset, adult-onset and late-onset SLE. Patients with childhood-onset SLE fulfilling ACR 1997 criteria were identified in a nationwide register-Reuma.pt/SLE (N = 89) and compared with adult-onset and late-onset counterparts matched 1:1:1 for disease duration. 267 SLE patients with mean disease duration of 11.9 ± 9.3 years were analyzed. Skin (62 %), kidney (58 %), neurological (11 %) and hematologic involvement (76 %) were significantly more common in childhood-onset SLE and disease activity was higher in this subset than in adult- and late-onset disease (SLEDAI-2K 3.4 ± 3.8 vs. 2.2 ± 2.7 vs. 1.6 ± 2.8, respectively; p = 0.004). Also, more childhood-onset patients received cyclophosphamide (10 %) and mycophenolate mofetil (34 %). A greater proportion of women (96 %), prevalence of arthritis (89 %) and anti-SSA antibodies (34 %) were noted in the adult-onset group. There was a significant delay in the diagnosis of SLE in older ages. Co-morbidities such as hypertension, diabetes and thyroid disease were significantly more frequent in late-onset SLE, as well as the presence of irreversible damage evaluated by the SLICC/ACR damage index (20 vs. 26 vs. 40 %; p < 0.001). Greater organ involvement as well as the frequent need for immunosuppressants supports the concept of childhood-onset being a more severe disease. In contrast, disease onset is more indolent but co-morbidity burden and irreversible damage are greater in late-onset SLE, which may have implications for patients' management.
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Affiliation(s)
- S Sousa
- Hospital Garcia de Orta, Almada, Portugal.
| | - M J Gonçalves
- Hospital de Santa Maria, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Lisbon, Portugal
| | - L S Inês
- Hospitais da Universidade de Coimbra, Coimbra, Portugal.,School of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - G Eugénio
- Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - D Jesus
- Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - S Fernandes
- Instituto Português de Reumatologia, Lisbon, Portugal
| | - G Terroso
- Centro Hospitalar de São João, Porto, Portugal
| | - V C Romão
- Hospital de Santa Maria, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Lisbon, Portugal
| | - M Cerqueira
- Hospital Conde de Bertiandos, Ponte de Lima, Portugal
| | - A Raposo
- Hospital Conde de Bertiandos, Ponte de Lima, Portugal
| | - M Couto
- Hospital de Viseu, Viseu, Portugal
| | - P Nero
- Hospital Egas Moniz, Lisbon, Portugal
| | - G Sequeira
- Centro Hospitalar de Faro, Faro, Portugal
| | - T Nóvoa
- Hospital Divino Espírito Santo, Ponta Delgada, Portugal
| | | | | | - L Costa
- Centro Hospitalar de São João, Porto, Portugal
| | - C Macieira
- Hospital de Santa Maria, Lisbon, Portugal
| | - C Silva
- Instituto Português de Reumatologia, Lisbon, Portugal
| | - J A P Silva
- Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - H Canhão
- Hospital de Santa Maria, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Lisbon, Portugal
| | - M J Santos
- Hospital Garcia de Orta, Almada, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Lisbon, Portugal
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Srivastava P, Abujam B, Misra R, Lawrence A, Agarwal V, Aggarwal A. Outcome of lupus nephritis in childhood onset SLE in North and Central India: single-centre experience over 25 years. Lupus 2015; 25:547-57. [PMID: 26637291 DOI: 10.1177/0961203315619031] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 11/02/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Childhood SLE (cSLE) has a higher prevalence of lupus nephritis (LN), and there are ethnic variations in response to treatment as well as outcome of LN. There are limited data on long-term outcome of LN in cSLE from the Indian subcontinent. METHODS Retrospective analysis of case records of patients with cSLE (satisfying revised American College of Rheumatology (ACR) 1997 criteria for diagnosis) and age of onset <18 years was conducted from 1989 to 2013. Data on clinical features, renal involvement and biopsy findings, treatment, renal outcome, damage accrual and mortality were collected. End-stage renal disease (ESRD) was defined as the need for renal replacement therapy. Actuarial ESRD-free survival was studied as the primary outcome measure using Kaplan-Meier analysis. RESULTS Among 205 children with cSLE, 134 (121 girls) had evidence of LN. The mean age at disease onset was 13.7 ± 3.5 years and the mean disease duration at presentation was 1.9 ± 2.5 years. Kidney biopsy was available for 92 patients, and histology included: 13 (14.2%) Class II, 24 (26%) Class III, 43 (46.7%) Class IV and 12 (13.1%) Class V LN. The mean follow-up period was 6.75 ± 5.7 years. At last visit, 81 (60.4%) children were in complete remission, 28 (20.9%) were in partial remission, 15 (11.2%) still had active nephritis and 10 (7.4%) had progressed to ESRD. Almost two-thirds (62.9%) of patients experienced lupus flares, and mean flare rate was 0.09 flares/patient follow-up year. Fifty-six (43.8%) children accrued damage and the mean Systemic Lupus International Collaborating Clinics (SLICC)/ACR damage score was 0.79 ± 1.13. Actuarial ESRD-free survival at five, 10 and 15 years was 91.1%, 79% and 76.2%, and five-, 10- and 15-year renal survival was 93.8%, 87.1% and 84%, respectively. Although multiple factors individually predicted poor outcome (death/ESRD), only raised serum creatinine at onset (R square = 0.65, p ≤ 0.0001) and damage accrual (R square = 0.62, p ≤ 0.0001) remained significant on multivariate analysis. Eleven (8.2%) children died during the follow-up period, and infections were the leading cause of mortality. CONCLUSIONS Long-term outcome of LN in cSLE in our cohort was better than previous reports from India. However, a high rate of major infection still remains the leading cause of mortality.
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Affiliation(s)
- P Srivastava
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - B Abujam
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - R Misra
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Lawrence
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - V Agarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Aggarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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167
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Fatemi A, Matinfar M, Saber M, Smiley A. The association between initial manifestations of childhood-onset systemic lupus erythematosus and the survival. Int J Rheum Dis 2015; 19:974-980. [PMID: 26632491 DOI: 10.1111/1756-185x.12807] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Childhood-onset systemic lupus erythematosus (cSLE) comprises 15-20% of patients with SLE. Although several studies have reported the outcomes of adult-onset SLE, few investigations have been conducted on cSLE in the Middle East. METHODS In a retrospective study, all children with SLE admitted to our tertiary referral center between 1992 and 2011 were recruited. The clinical and laboratory data at the time of onset were recorded and analyzed. Kaplan-Meier analysis was used to calculate the survival rates. Cox regression analysis was applied to assess the predictors of mortality. RESULTS One hundred and eighty-eight children diagnosed with SLE were enrolled during the study period. Nine patients were censored due to loss to follow-up (6) and incomplete data (3 cases). Mean age of patients at the time of onset was 14.4 (3.05) years. Only 22 (11.8%) children were younger than 10 years at the time of disease onset. In total, 20 patients (11%) died, all after the first decade of life. The most common cause of death was lupus nephritis (10 patients, 50% of deaths) followed by infections (35%), cerebrovascular accidents (10%) and alveolar hemorrhage (5%). Cumulative survival rate after 5, 10, 15 and 20 years was 91, 87, 85, and 79%, respectively. Having hematuria or pleurisy at the time of SLE onset had a negative effect on survival in multivariate analysis. CONCLUSION cSLE survival in Iran was comparable to that in other developing countries. Baseline presentation with hematuria predominantly increased the mortality rate in cSLE. Prospective and larger studies in future may unfold other aspects of cSLE.
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Affiliation(s)
| | | | - Mina Saber
- Department of Dermatology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abbas Smiley
- Department of Epidemiology, School of Public Health, Indiana University, Bloomington, Indiana, USA
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168
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González-Naranjo LA, Betancur OM, Alarcón GS, Ugarte-Gil MF, Jaramillo-Arroyave D, Wojdyla D, Pons-Estel GJ, Rondón-Herrera F, Vásquez-Duque GM, Quintana-López G, Da Silva NA, Tavares Brenol JC, Reyes-Llerena G, Pascual-Ramos V, Amigo MC, Massardo L, Alfaro-Lozano J, Segami MI, Esteva-Spinetti MH, Iglesias-Gamarra A, Pons-Estel BA. Features associated with hematologic abnormalities and their impact in patients with systemic lupus erythematosus: Data from a multiethnic Latin American cohort. Semin Arthritis Rheum 2015; 45:675-83. [PMID: 26698222 DOI: 10.1016/j.semarthrit.2015.11.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/03/2015] [Accepted: 11/06/2015] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To examine hematological manifestations' correlates and their impact on damage accrual and mortality in SLE patients from the multiethnic, Latin American, GLADEL cohort. METHODS In patients with recent SLE diagnosis (≤2 years), the association between follow-up hematological manifestations (per ACR criteria) and socio-demographic and clinical variables was examined by univariable and multivariable logistic regressions; their impact on damage accrual and mortality was examined by Poisson and Cox proportional-hazards regression analyses, respectively. RESULTS Of 1437 patients, 948 (66.0%) developed ≥1 hematological manifestation [5.5% hemolytic anemia (AHA), 16.3% thrombocytopenia, and 56.4% lymphopenia] over 4.3 (3.3) follow-up years. Younger age, Mestizo ethnicity, hematologic disorder (at/or before SLE diagnosis), and first damage recorded were associated with hematological manifestations while antimalarials were negatively associated. AHA (at/or before SLE diagnosis), anti-Sm, and anti-RNP antibodies were associated with subsequent AHA occurrence while musculoskeletal involvement was negatively associated. Thrombocytopenia (at/or before SLE diagnosis), AHA, anti-phospholipid antibodies (aPLs), anti-SSA/Ro, anti-SSB/La antibodies, and first damage recorded were associated with later thrombocytopenia occurrence. Lymphopenia (at/or before SLE diagnosis), younger age at diagnosis, Mestizo ethnicity, having medical insurance, and first damage recorded were associated with subsequent lymphopenia occurrence while antimalarials and azathioprine treatment were negatively associated. AHA was associated with damage accrual and mortality after adjusting for variables known to affect these outcomes. CONCLUSIONS Mestizo ethnicity and early hematological manifestations are risk factors for their subsequent occurrence while antimalarials have a protective effect. The associations between AHA and aPLs and thrombocytopenia were corroborated. AHA contributes independently to damage accrual and diminished survival.
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Affiliation(s)
- Luis A González-Naranjo
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Universidad de Antioquia, Calle 70 No. 52-21, Medellin, Antioquia 229, Colombia.
| | | | - Graciela S Alarcón
- Department of Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL
| | - Manuel F Ugarte-Gil
- Servicio de Reumatología, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru; Universidad Científica del Sur, Lima, Peru
| | - Daniel Jaramillo-Arroyave
- Rheumatology Unit, Department of Internal Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Daniel Wojdyla
- Escuela de Estadística, Universidad Nacional de Rosario, Rosario, Argentina
| | - Guillermo J Pons-Estel
- Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Barcelona, Spain
| | - Federico Rondón-Herrera
- Rheumatology Unit, Department of Internal Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Gloria M Vásquez-Duque
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Universidad de Antioquia, Calle 70 No. 52-21, Medellin, Antioquia 229, Colombia
| | - Gerardo Quintana-López
- Rheumatology Unit, Department of Internal Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Nilzio A Da Silva
- Rheumatology Unit, Faculdade de Medicina da Universidade Federal de Goias, Goiania, Brazil
| | - João C Tavares Brenol
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gil Reyes-Llerena
- Servicio Nacional de Reumatología, Centro de Investigaciones Médico Quirúrgicas (CIMEQ), La Habana, Cuba
| | - Virginia Pascual-Ramos
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de México, Mexico
| | - Mary C Amigo
- Reumatología, Centro Médico ABC, Ciudad de México, Mexico
| | - Loreto Massardo
- Department of Clinical Immunology and Rheumatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José Alfaro-Lozano
- Servicio de Reumatología, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - María I Segami
- Hospital Nacional "Edgardo Rebagliatti Martins", Essalud, Lima, Peru
| | - María H Esteva-Spinetti
- Servicio de Reumatología, Departamento de Medicina, Hospital Central de San Cristóbal, San Cristóbal, Venezuela
| | - Antonio Iglesias-Gamarra
- Rheumatology Unit, Department of Internal Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
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Hui-Yuen JS, Reddy A, Taylor J, Li X, Eichenfield AH, Bermudez LM, Starr AJ, Imundo LF, Buyon J, Furie RA, Kamen DL, Manzi S, Petri M, Ramsey-Goldman R, van Vollenhoven RF, Wallace DJ, Askanase A. Safety and Efficacy of Belimumab to Treat Systemic Lupus Erythematosus in Academic Clinical Practices. J Rheumatol 2015; 42:2288-95. [PMID: 26523030 DOI: 10.3899/jrheum.150470] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the use and efficacy of belimumab in academic practices. Belimumab is a human monoclonal antibody that inhibits soluble B lymphocyte stimulator and has been approved for the treatment of adults with systemic lupus erythematosus (SLE). METHODS Invitations to participate and complete a 1-page questionnaire for each patient prescribed belimumab were sent to 16 physicians experienced in SLE phase III clinical trials. The outcome was defined as the physician's impression of improvement in the initial manifestation(s) being treated without worsening in other organ systems. RESULTS Of 195 patients treated with belimumab at 10 academic centers, 96% were taking background medications for SLE at initiation of belimumab, with 74% taking corticosteroids. The main indications for initiation of belimumab were arthritis, rash, and/or worsening serologic activity, with 30% of patients unable to taper corticosteroids. Of the 120 patients taking belimumab for at least 6 months, 51% responded clinically and 67% had ≥ 25% improvement in laboratory values. While numbers are limited, black patients showed improvement at 6 months. In a subset of 39 patients with childhood-onset SLE, 65% responded favorably at 6 months, and 35% discontinued corticosteroids. CONCLUSION Our data demonstrate favorable clinical and laboratory outcomes in patients with SLE at 6 months across all racial and ethnic groups, with similar improvement seen among patients with childhood-onset SLE.
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Affiliation(s)
- Joyce S Hui-Yuen
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Arthi Reddy
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Jennifer Taylor
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Xiaoqing Li
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Andrew H Eichenfield
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Liza M Bermudez
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Amy J Starr
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Lisa F Imundo
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Jill Buyon
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Richard A Furie
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Diane L Kamen
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Susan Manzi
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Michelle Petri
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Rosalind Ramsey-Goldman
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Ronald F van Vollenhoven
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Daniel J Wallace
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
| | - Anca Askanase
- From the Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; New York University Langone Medical Center; Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center, New York; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; Medical University of South Carolina, Charleston, South Carolina; Temple University School of Medicine, Philadelphia, Pennsylvania; Johns Hopkins University School of Medicine, Baltimore, Maryland; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Karolinska University Hospital, Stockholm, Sweden; Cedars-Sinai Medical Center, Los Angeles, California, USA.J.S. Hui-Yuen, MD, MSc, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A. Reddy, BSc, Research Assistant, New York University Langone Medical Center; J. Taylor, MD, Pediatric Resident, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; X. Li, BSc, Research Assistant, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; A.H. Eichenfield, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.M. Bermudez, MD, Fellow, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; A.J. Starr, MD, Assistant Professor, Division of Pediatric Rheumatology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia University Medical Center; L.F. Imundo, MD, Division of Rheumatology, New York-Presbyterian Hospital/Columbia University Medical Center; J. Buyon, MD, Professor, New York University Langone Medical
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Felsenstein S, Reiff AO, Ramanathan A. Transition of Care and Health-Related Outcomes in Pediatric-Onset Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2015; 67:1521-8. [DOI: 10.1002/acr.22611] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 04/09/2015] [Accepted: 04/09/2015] [Indexed: 11/10/2022]
Affiliation(s)
| | - Andreas O. Reiff
- Children's Hospital Los Angeles and the Keck School of Medicine of the University of Southern California; Los Angeles California
| | - Anusha Ramanathan
- Children's Hospital Los Angeles and the Keck School of Medicine of the University of Southern California; Los Angeles California
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171
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Ding Y, Liao W, Yi Z, Xiang W, He X. Association of miRNA-145 expression in vascular smooth muscle cells with vascular damages in patients with lupus nephritis. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:12646-12656. [PMID: 26722454 PMCID: PMC4680399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 08/20/2015] [Indexed: 06/05/2023]
Abstract
miRNAs have been found to contribute to the regulation of multiple cellular processes, including cell apoptosis, differentiation and proliferation. The patients with lupus nephritis (LN) exhibit thickened renal vascular membrane and highly proliferative vascular smooth muscle cells (VSMCs). Of various miRNAs discovered, miR-145 is essential to mediate the proliferation of VSMCs and the formation of atherosclerotic plaques. In this study, we studied the pathological and vascular damage of renal LN, and the correlation between miR-145 expression in VSMCs and the vascular damages. Serum, urine, and renal biopsies were obtained from 41 patients with active LN. The serum and urinary VEGF levels were examined to confirm the renal damage of each patient. Biopsies were stained to observe the glomerular segmental lesions, sclerosis, and to evaluate the vascular damages. The expression of miR-145 was also examined to determine the correlation between its expression and the vascular damages. The expression of miR-145 was mainly detected in the renal VSMCs and the epithelial cells of glomerular proximal convoluted tubule. Nevertheless, the expression of miR-145 reduced as the tunicae media vasorum ratios increased, indicating the development of LN inhibits the expression of miR-145. Furthermore, our studies revealed no significant correlation among renal interstitial vascular damage, glomerular damage and severity classification of LN. Therefore, we suggest the damage of renal interstitial vascular should be considered as one of the factors to evaluate the severity of the LN.
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Affiliation(s)
- Yan Ding
- Department of Dermatology, Hainan General HospitalHaikou 570102, China
- Department of Dermatology, Maternal and Child Health Care Hospital of Hainan ProvinceHaikou 570206, China
| | - Wang Liao
- Department of Cardiology, Hainan General HospitalHaikou 570102, China
| | - Zhuwen Yi
- Department of Nephropathy, Children’s Medical Center, The Second Xiangya Hospital, Central South UniversityChangsha 410000, China
| | - Wei Xiang
- Department of Pediatrics, Maternal and Child Health Care Hospital of Hainan ProvinceHaikou 570206, China
| | - Xiaojie He
- Department of Nephropathy, Children’s Medical Center, The Second Xiangya Hospital, Central South UniversityChangsha 410000, China
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172
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Autoantigen Microarray for High-throughput Autoantibody Profiling in Systemic Lupus Erythematosus. GENOMICS PROTEOMICS & BIOINFORMATICS 2015; 13:210-8. [PMID: 26415621 PMCID: PMC4610965 DOI: 10.1016/j.gpb.2015.09.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 09/21/2015] [Accepted: 09/23/2015] [Indexed: 12/19/2022]
Abstract
Systemic lupus erythematosus (SLE) is a complex autoimmune disease characterized by the production of autoantibodies to a broad range of self-antigens. Profiling the autoantibody repertoire using array-based technology has emerged as a powerful tool for the identification of biomarkers in SLE and other autoimmune diseases. Proteomic microarray has the capacity to hold large number of self-antigens on a solid surface and serve as a high-throughput screening method for the determination of autoantibody specificities. The autoantigen arrays carrying a wide variety of self-antigens, such as cell nuclear components (nucleic acids and associated proteins), cytoplasmic proteins, phospholipid proteins, cell matrix proteins, mucosal/secreted proteins, glomeruli, and other tissue-specific proteins, have been used for screening of autoantibody specificities associated with different manifestations of SLE. Arrays containing synthetic peptides and molecular modified proteins are also being utilized for identification of autoantibodies targeting to special antigenic epitopes. Different isotypes of autoantibodies, including IgG, IgM, IgA, and IgE, as well as other Ig subtypes, can be detected simultaneously with multi-color labeled secondary antibodies. Serum and plasma are the most common biologic materials for autoantibody detection, but other body fluids such as cerebrospinal fluid, synovial fluid, and saliva can also be a source of autoantibody detection. Proteomic microarray as a multiplexed high-throughput screening platform is playing an increasingly-important role in autoantibody diagnostics. In this article, we highlight the use of autoantigen microarrays for autoantibody exploration in SLE.
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Leal GN, Silva KF, Lianza AC, Giacomin MF, Andrade JL, Kozu K, Bonfá E, Silva CA. Subclinical left ventricular dysfunction in childhood-onset systemic lupus erythematosus: a two-dimensional speckle-tracking echocardiographic study. Scand J Rheumatol 2015; 45:202-9. [DOI: 10.3109/03009742.2015.1063686] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- GN Leal
- Department of Radiology, Children’s Institute, Hospital das Clínicas, São Paulo University Medical School
| | - KF Silva
- Department of Radiology, Children’s Institute, Hospital das Clínicas, São Paulo University Medical School
| | - AC Lianza
- Department of Radiology, Children’s Institute, Hospital das Clínicas, São Paulo University Medical School
| | - MF Giacomin
- Rheumatology Unit, Children’s Institute, Hospital das Clínicas, Faculty of Medicine, University of São Paulo
| | - JL Andrade
- Institute of Radiology, Hospital das Clínicas, São Paulo University Medical School
| | - K Kozu
- Rheumatology Unit, Children’s Institute, Hospital das Clínicas, Faculty of Medicine, University of São Paulo
| | - E Bonfá
- Department of Rheumatology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - CA Silva
- Rheumatology Unit, Children’s Institute, Hospital das Clínicas, Faculty of Medicine, University of São Paulo
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174
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Choi JH, Park DJ, Kang JH, Yim YR, Lee KE, Lee JW, Wen L, Kim TJ, Park YW, Lee JK, Lee SS. Comparison of clinical and serological differences among juvenile-, adult-, and late-onset systemic lupus erythematosus in Korean patients. Lupus 2015; 24:1342-9. [PMID: 26085595 DOI: 10.1177/0961203315591024] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 05/12/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We investigated whether systemic lupus erythematosus (SLE) patients could be distinguished based on the time of disease onset and, if so, whether the groups differed in their clinical and laboratory features in ethnically homogeneous Korean patients. METHODS We enrolled 201 SLE patients with available clinical data at the time of onset of SLE from the lupus cohort at Chonnam National University Hospital. Sociodemographic, clinical, and laboratory data, including autoantibodies, and concomitant diseases were found at the time of diagnosis of SLE by reviewing patient charts. We divided SLE patients according to age at SLE diagnosis into three groups: juvenile-onset SLE (JSLE, diagnosed at ≤ 18 years), adult-onset SLE (ASLE, diagnosed at 19-50 years), and late-onset SLE (LSLE, diagnosed at >50 years), and compared baseline demographic, clinical, and relevant laboratory findings. RESULTS Of the 201 patients, 27 (14.4%), 149 (74.1%), and 25 (12.4%) were JSLE, ASLE, and LSLE patients, respectively. Fever, oral ulcers, nephritis, anemia, and thrombocytopenia were more common in JSLE patients than ASLE or LSLE patients (p < 0.05, < 0.05, 0.001, < 0.05, and < 0.05, respectively). However, Sjögren's syndrome was more frequent in LSLE patients than JSLE or ASLE patients (p < 0.05). Disease activity was significantly higher in JSLE patients than in ASLE or LSLE patients (p < 0.001). Anti-dsDNA and anti-nucleosome antibodies were found more frequently in JSLE patients and less frequently in LSLE patients (p < 0.05 and 0.005, respectively) and decreased complement levels were more common in JSLE patients and less common in LSLE patients (p < 0.001, 0.001, and < 0.05, respectively). CONCLUSIONS Our results indicate that SLE patients present with different clinical and serological manifestations according to age at disease onset. JSLE patients have more severe disease activity and more frequent renal involvement and LSLE patients have milder disease activity, more commonly accompanied by Sjögren's syndrome, at disease onset.
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Affiliation(s)
- J H Choi
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - D J Park
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - J H Kang
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Y R Yim
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - K E Lee
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - J W Lee
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - L Wen
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - T J Kim
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Y W Park
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - J K Lee
- Department of Neurosurgery, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - S S Lee
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
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Haddon DJ, Diep VK, Price JV, Limb C, Utz PJ, Balboni I. Autoantigen microarrays reveal autoantibodies associated with proliferative nephritis and active disease in pediatric systemic lupus erythematosus. Arthritis Res Ther 2015; 17:162. [PMID: 26081107 PMCID: PMC4493823 DOI: 10.1186/s13075-015-0682-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 06/11/2015] [Indexed: 12/31/2022] Open
Abstract
Introduction Pediatric systemic lupus erythematosus (pSLE) patients often initially present with more active and severe disease than adults, including a higher frequency of lupus nephritis. Specific autoantibodies, including anti-C1q, anti-DNA and anti-alpha-actinin, have been associated with kidney involvement in SLE, and DNA antibodies are capable of initiating early-stage lupus nephritis in severe combined immunodeficiency (SCID) mice. Over 100 different autoantibodies have been described in SLE patients, highlighting the need for comprehensive autoantibody profiling. Knowledge of the antibodies associated with pSLE and proliferative nephritis will increase the understanding of SLE pathogenesis, and may aid in monitoring patients for renal flare. Methods We used autoantigen microarrays composed of 140 recombinant or purified antigens to compare the serum autoantibody profiles of new-onset pSLE patients (n = 45) to healthy controls (n = 17). We also compared pSLE patients with biopsy-confirmed class III or IV proliferative nephritis (n = 23) and without significant renal involvement (n = 18). We performed ELISA with selected autoantigens to validate the microarray findings. We created a multiple logistic regression model, based on the ELISA and clinical information, to predict whether a patient had proliferative nephritis, and used a validation cohort (n = 23) and longitudinal samples (88 patient visits) to test its accuracy. Results Fifty autoantibodies were at significantly higher levels in the sera of pSLE patients compared to healthy controls, including anti-B cell-activating factor (BAFF). High levels of anti-BAFF were associated with active disease. Thirteen serum autoantibodies were present at significantly higher levels in pSLE patients with proliferative nephritis than those without, and we confirmed five autoantigens (dsDNA, C1q, collagens IV and X and aggrecan) by ELISA. Our model, based on ELISA measurements and clinical variables, correctly identified patients with proliferative nephritis with 91 % accuracy. Conclusions Autoantigen microarrays are an ideal platform for identifying autoantibodies associated with both pSLE and specific clinical manifestations of pSLE. Using multiple regression analysis to integrate autoantibody and clinical data permits accurate prediction of clinical manifestations with complex etiologies in pSLE. Electronic supplementary material The online version of this article (doi:10.1186/s13075-015-0682-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- D James Haddon
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA.
| | - Vivian K Diep
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA.
| | - Jordan V Price
- Department of Molecular and Cell Biology, Division of Immunology and Pathogenesis, University of California at Berkeley, 142 Life Sciences Addition #3200, Berkeley, CA, 94720, USA.
| | - Cindy Limb
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA.
| | - Paul J Utz
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA.
| | - Imelda Balboni
- Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA.
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Tan JHT, Hoh SF, Win MTM, Chan YH, Das L, Arkachaisri T. Childhood-onset systemic lupus erythematosus in Singapore: clinical phenotypes, disease activity, damage, and autoantibody profiles. Lupus 2015; 24:998-1005. [DOI: 10.1177/0961203315584413] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 04/07/2015] [Indexed: 01/01/2023]
Abstract
Childhood-onset systemic lupus erythematosus (cSLE) is a multisystem autoimmune disease characterized by immune dysregulation affecting patients less than 18 years old. One-fifth of SLE cases are diagnosed during childhood. cSLE presents differently from adults and has a more severe and aggressive course. We describe the clinical and antibody profiles in our cSLE Singapore cohort. All cSLE patients who satisfied the 1997 American College of Rheumatology diagnostic criteria were captured in our lupus registry from January 2009 to January 2014. Data including demographic, cumulative clinical, serologic data, and damage indices were collected. Adjusted mean SLEDAI-2K (AMS) was used to summarize disease activity over multiple visits. Cluster analysis using non-hierarchical K-means procedure was performed on eight selected antibodies. The 64 patients (female:male ratio 5:1; Chinese 45.3%, Malay 28.1%, Indian 9.4%, and other races 17.2%) had a mean onset age of 11.5 years (range 2.1–16.7) and mean age at diagnosis was 11.9 years (range 2.6–18.0). Our study demonstrated differences in clinical manifestations for which hematologic involvement was the most common manifestation with less renal disease and uncommon neurologic manifestation as compared to other cSLE cohorts reported in our region. Antibody clusters were identified in our cohort but their clinical association/discrimination and outcome prediction required further validation study. Outcomes of our cohort in regard to disease activity after therapy and organ damages were comparable if not better to other cSLE cohorts elsewhere. Steroid-related damage, including symptomatic multifocal avascular necrosis and cataract, were not uncommon locally. Infection remains the major cause of death for the continent. Nevertheless, the five year survival rate of our cohort (98.4%) was high.
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Affiliation(s)
- J H T Tan
- Rheumatology and Immunology Service, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore
| | - S F Hoh
- Department of Nursing, KK Women’s and Children’s Hospital, Singapore
| | - M T M Win
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Y H Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - L Das
- Rheumatology and Immunology Service, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore
| | - T Arkachaisri
- Rheumatology and Immunology Service, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore
- Duke-NUS Graduate Medical School, Singapore
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177
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Ru JL, Zhao Y, Xie XX, Che GZ, Cheng CF, Zhao HM, Jin ZY, Sun HP, Li XF. Clinical applications of the indirect immunofluorescence assay for detection of anticell membrane-associated DNA antibodies in juvenile systemic lupus erythematosus. Pediatr Res 2015; 77:376-80. [PMID: 25406901 DOI: 10.1038/pr.2014.182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 08/15/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Juvenile-onset systemic lupus erythematosus (JSLE) has a higher mortality risk compared to adult-onset SLE. We compared the diagnostic value of anti-cmDNA antibodies with that of antinucleosome antibodies (AnuA), anti-Sm antibodies, and anti-dsDNA antibodies and human B lymphocyte Raji cells with that of human promyelocytic leukemia HL60 cells as substrates in an indirect immunofluorescence assay to detect anti-cmDNA antibodies in JSLE patients. METHODS We recruited 92 JSLE patients and 71 patients with other juvenile-onset rheumatic diseases. Anti-cmDNA antibodies and antinuclear antibodies (ANA) were detected in patient sera using indirect immunofluorescence assays. Anti-dsDNA antibodies were detected by combining ELISA and indirect immunofluorescence. Anti-Sm antibodies were detected by double immunodiffusion assay and immunoblotting, while AnuA were detected by ELISA. RESULTS The JSLE group had a significantly higher percentage of patients positive for anti-cmDNA compared to patients with other rheumatoid diseases. Using one antibody for diagnosis, anti-cm DNA antibodies had the highest accuracy at 84.0%; using two antibodies, the combination of anti-cm DNA and anti-dsDNA antibodies had 90.8% accuracy. Raji cells used as substrate demonstrated a stronger intensity of fluorescent patterns compared to HL60 cells. CONCLUSION The high sensitivity, specificity, and accuracy of detection of anti-cmDNA antibodies make it a valuable diagnostic tool for JSLE.
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Affiliation(s)
- Jin-li Ru
- Department of Rheumatology and Immunology, The 264th Hospital of Chinese People's Liberation Army, Taiyuan, China
| | - Yue Zhao
- Department of Rheumatology and Immunology, The 264th Hospital of Chinese People's Liberation Army, Taiyuan, China
| | - Xiao-xiang Xie
- Department of Rheumatology and Immunology, The 264th Hospital of Chinese People's Liberation Army, Taiyuan, China
| | - Guo-zhu Che
- Department of Rheumatology and Immunology, The 264th Hospital of Chinese People's Liberation Army, Taiyuan, China
| | - Chuan-fang Cheng
- Department of Rheumatology and Immunology, The 264th Hospital of Chinese People's Liberation Army, Taiyuan, China
| | - Hua-ming Zhao
- Department of Rheumatology and Immunology, The 264th Hospital of Chinese People's Liberation Army, Taiyuan, China
| | - Zhi-yong Jin
- Department of Rheumatology and Immunology, The 264th Hospital of Chinese People's Liberation Army, Taiyuan, China
| | - Hui-ping Sun
- Department of Rheumatology and Immunology, The 264th Hospital of Chinese People's Liberation Army, Taiyuan, China
| | - Xiao-feng Li
- Department of Rheumatology and Immunology, The Second Hospital of Shanxi Medical University, Taiyuan, China
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178
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Arkin LM, Ansell L, Rademaker A, Curran ML, Miller ML, Wagner A, Kenner-Bell BM, Chamlin SL, Mancini AJ, Klein-Gitelman M, Paller AS. The natural history of pediatric-onset discoid lupus erythematosus. J Am Acad Dermatol 2015; 72:628-33. [PMID: 25648823 DOI: 10.1016/j.jaad.2014.12.028] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 12/18/2014] [Accepted: 12/21/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pediatric discoid lupus erythematosus (DLE) is rare. The risk of progression to systemic lupus erythematosus (SLE) is uncertain. OBJECTIVE We sought to determine the risk of progression of pediatric DLE to SLE and to characterize its phenotype. METHODS This was a retrospective review of 40 patients with DLE. RESULTS Six (15%) of 40 patients presented with DLE as a manifestation of concurrent SLE. Of the remaining 34, 9 (26%) eventually met SLE criteria and 15 (44%) developed laboratory abnormalities without meeting SLE criteria. Only 10 (29%) maintained skin-limited disease. The average age at progression to SLE was 11 years, with greatest risk in the first year after DLE diagnosis. Most (89%) patients with SLE met diagnostic criteria with mucocutaneous disease (discoid lesions, malar rash, oral and nasal ulcers, photosensitivity), positive antibodies, and/or cytopenia without developing end-organ damage over 5 years of median follow-up. LIMITATIONS The study was retrospective. CONCLUSIONS In pediatric patients, DLE carries a significant risk of progression to SLE but may predict a milder phenotype of systemic disease. All patients require careful monitoring for SLE, particularly within the first year of diagnosis.
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Affiliation(s)
- Lisa M Arkin
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Leah Ansell
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alfred Rademaker
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Megan L Curran
- Division of Rheumatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael L Miller
- Division of Rheumatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Annette Wagner
- Division of Dermatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Brandi M Kenner-Bell
- Division of Dermatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sarah L Chamlin
- Division of Dermatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anthony J Mancini
- Division of Dermatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Marisa Klein-Gitelman
- Division of Rheumatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Dermatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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179
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Levy DM, Peschken CA, Tucker LB, Chédeville G, Huber AM, Pope JE, Silverman ED. Association of health-related quality of life in childhood-onset systemic lupus erythematosus with ethnicity: results from a multiethnic multicenter Canadian cohort. Arthritis Care Res (Hoboken) 2015; 66:1767-74. [PMID: 24821613 DOI: 10.1002/acr.22363] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 04/29/2014] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To evaluate the influence of ethnicity on self-reported health-related quality of life (HRQOL) in the Canadian childhood-onset systemic lupus erythematosus (cSLE) population. METHODS Patients with cSLE at 4 pediatric centers were consecutively enrolled. Sociodemographics and multiple disease activity measures were collected. The Child Health Questionnaire (CHQ) was administered and analyzed by ethnicity. RESULTS We enrolled 213 cSLE patients, and complete data from 196 patients with the following ethnicities were analyzed: white (33%), Asian (32%), South Asian (16%), African American (11%), Latino/Hispanic (5%), and Aboriginal (4%). Compared to healthy children, cSLE patients rated their HRQOL significantly more poorly in 9 of 10 individual domains, and in 4 of 10 domains when compared to a cohort of juvenile arthritis patients. Within the cSLE cohort, CHQ scores were lower in 5 of 10 domains in white patients versus nonwhite ethnicities (P < 0.05 for each). Physical summary scores were lower for white patients compared to the other ethnicities aggregated together (mean ± SD 46.0 ± 11.9 versus 50.4 ± 10.1; P = 0.009); however, psychosocial summary scores were similar among the groups (mean ± SD 40.5 ± 14.6 versus 42.8 ± 12.7; P = 0.26). Disease activity measures, including the Systemic Lupus Erythematosus Disease Activity Index 2000, the Systemic Lupus Activity Measure, Revised, and physician global visual analog scale, were similar across ethnicities. However, patient-reported Systemic Lupus Erythematosus Activity Questionnaire symptom scores were greater in patients of white ethnicity compared to those of Asian ethnicity (mean ± SD 8.2 ± 5.8 versus 4.5 ± 4.7; P = 0.004). CONCLUSION The self- and parent-reported health status of Canadian cSLE patients differed across ethnicities, with white patients reporting lower HRQOL despite similar and overall low disease activity.
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Affiliation(s)
- Deborah M Levy
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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180
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Epidemiology and classification of systemic lupus erythematosus. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00124-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
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181
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182
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Vijay Y, Parveen B. Clinical and immunological profile of systemic lupus erythematosus in a pediatric population in North India. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2014. [DOI: 10.4103/1110-161x.147354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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183
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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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184
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Shiff NJ, Lix LM, Joseph L, Duffy C, Tucker LB, Svenson LW, Belisle P, Bernatsky S. The prevalence of systemic autoimmune rheumatic diseases in Canadian pediatric populations: administrative database estimates. Rheumatol Int 2014; 35:569-73. [DOI: 10.1007/s00296-014-3136-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 09/15/2014] [Indexed: 11/24/2022]
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185
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Alpert O, Marwaha R, Huang H. Psychosis in children with systemic lupus erythematosus: the role of steroids as both treatment and cause. Gen Hosp Psychiatry 2014; 36:549.e1-2. [PMID: 24929259 DOI: 10.1016/j.genhosppsych.2014.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 04/23/2014] [Accepted: 05/01/2014] [Indexed: 11/18/2022]
Abstract
Steroids may both be a cause of and treatment for pediatric patients with systemic lupus erythematosus (SLE) presenting with psychotic symptoms. We present two cases demonstrating that careful histories (including prior steroid exposure) and the use of biomarkers can help guide the management of children with SLE presenting with psychosis.
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Affiliation(s)
- Orna Alpert
- Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia, Philadelphia, PA.
| | - Raman Marwaha
- Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA
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186
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Watson L, Beresford MW, Maynes C, Pilkington C, Marks SD, Glackin Y, Tullus K. The indications, efficacy and adverse events of rituximab in a large cohort of patients with juvenile-onset SLE. Lupus 2014; 24:10-7. [DOI: 10.1177/0961203314547793] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background B cells drive antibody formation and T cell activation. This study aimed to describe the clinical indications, efficacy and adverse events (AEs) for the B-cell depleting agent, rituximab, in a large cohort of children with lupus. Methods Prescribing records and the UK JSLE Cohort Study database identified rituximab use. Results Sixty-three patients received 104 courses of intravenous rituximab over a 10-year period. Patients were aged 12.2 (IQR 9.0–13.9) years at diagnosis and 50 (79%) were female. They had disease for 1.4 (0.2–3.0) years at the time of rituximab. Lupus nephritis was the most common indication (36% of first courses). Clinical biomarkers, 2.5 (1.6–4.3) months after treatment, demonstrated a statistically significant improvement in ESR, C3, C4, creatinine, albumin, haemoglobin, anti-dsDNA titres and urine albumin:creatinine ratio. IgG, IgA and IgM levels decreased ( p < 0.01). Oral corticosteroid dose significantly reduced after rituximab (dose before 0.26 (0.09–0.44) mg/kg, after 0.17 (0.09–0.30) mg/kg; p = 0.01)). AEs occurred in 19 (18%) of all courses including; delayed second dose (8%), Ig replacement (2%) and infusion reactions (6%; anaphylaxis 2%). The global BILAG score showed a trend toward improvement (before 4.5 (2.0–9.0), after 3.0 (2.0–5.0); p = 0.16). Conclusion Rituximab improves disease activity in children with lupus and serious AEs are infrequent. Controlled studies are required.
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Affiliation(s)
- L Watson
- Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, UK
- Department of Paediatric Nephrology, Alder Hey Children’s NHS Foundation Trust Hospital, Liverpool, UK
| | - M W Beresford
- Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, UK
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust Hospital, Liverpool, UK
| | - C Maynes
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London UK
| | - C Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London UK
| | - S D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London UK
| | - Y Glackin
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London UK
| | - K Tullus
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London UK
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187
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Wei CC, Lin CL, Tsai JD, Shen TC, Sung FC. Increased Incidence of juvenile onset systemic lupus erythematosus in children with atopic dermatitis. Lupus 2014; 23:1494-9. [PMID: 25057040 DOI: 10.1177/0961203314543920] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Herein, we investigated the risk of juvenile-onset systemic lupus erythematosus (JSLE) in children with atopic dermatitis (AD). From 2000 to 2007, 192,357 children with newly diagnosed AD and 769,428 matched non-AD controls were identified. By the end of 2008, incidences and hazard ratios (HRs) of JSLE were measured. JSLE incidence in the AD cohort was 2.90-fold greater than that in the non-AD cohort (3.25 vs. 1.12 per 100,000 person-years), with a Cox model-measured adjusted HR of 2.92 (95% CI: 1.85-4.60); the risk of JSLE was greater for older children and girls. The AD-to-non-AD cohort HR was 6.6 (95% CI: 2.88-13.1) for children aged >12 years compared with 1.81 (95% CI: 0.98-3.32) for children aged ≤ 12 years. The HR of JSLE in AD children increased from 1.55 (95% CI: 0.88-2.76) for those with ≤ 3 clinical visits to 66.3 (95% CI: 33.1-132.8) for those with >6 visits (p < 0.0001, by trend test). The risk of developing SLE in the AD cohort was the highest within five years after AD diagnosis (HR: 4.02; 95% CI: 2.83-7.08). Children with AD are at a high risk of developing JSLE during their growth period.
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Affiliation(s)
- C-C Wei
- Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan College of Medicine, China Medical University, Taichung, Taiwan
| | - C-L Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - J-D Tsai
- Institute of Medicine, Chung Shan Medical University Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - T-C Shen
- College of Medicine, China Medical University, Taichung, Taiwan Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - F-C Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
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188
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Aggarwal A, Srivastava P. Childhood onset systemic lupus erythematosus: how is it different from adult SLE? Int J Rheum Dis 2014; 18:182-91. [PMID: 24965742 DOI: 10.1111/1756-185x.12419] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
About 20% of systemic lupus erythematosus (SLE) starts in childhood and children have less gender bias in favor of females as compared to adults. Systemic manifestations, nephritis, neuro-psychiatric disease and cytopenias are more common in children at presentation than adults. Since most children develop lupus in their early adolescence, dealing with the diagnosis of an unpredictable lifelong disease during this phase of life is challenging. Physicians must recognise specific medical and social needs of this age group, for optimal long-term outcome. Steroids and immunosuppressive drugs are the cornerstone for treatment in children as with adults with lupus. The outcome has improved considerably with these drugs and 10-year survival is nearly 90%. Due to longer life spans more damage accrues in children as compared to adults. Most of the drugs are associated with significant toxicity and the goal of having a drug which reduces disease activity and damage without hampering normal growth, development and fertility is still an elusive one. The current review focuses on clinical and immunological aspects of childhood SLE and how it differs from adulthood SLE.
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Affiliation(s)
- Amita Aggarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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189
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Lawson EF, Hersh AO, Trupin L, von Scheven E, Okumura MJ, Yazdany J, Yelin EH. Educational and vocational outcomes of adults with childhood- and adult-onset systemic lupus erythematosus: nine years of followup. Arthritis Care Res (Hoboken) 2014; 66:717-24. [PMID: 24877200 DOI: 10.1002/acr.22228] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To compare educational and vocational outcomes among adults with childhood-onset systemic lupus erythematosus (SLE) and adult-onset SLE. METHODS We used data derived from the 2002–2010 cycles of the Lupus Outcomes Study, a longitudinal cohort of 1,204 adult subjects with SLE. Subjects ages 18–60 years living in the US (n = 929) were included in the analysis and were classified as childhood-onset SLE if age at diagnosis was <18 years (n = 115). Logistic regression was used to assess the unadjusted and adjusted effect of childhood-onset SLE, sex, race/ethnicity, baseline age, urban or rural location, and US region on the likelihood of completing a bachelor's degree. Generalized estimating equations were used to assess the effect of childhood-onset SLE, demographics, education, and disease-related factors on the odds of employment, accounting for multiple observations over the study period. RESULTS Subjects with childhood-onset SLE were on average younger (mean ± SD 29 ± 10 years versus 44 ± 9 years), with longer disease duration (mean ± SD 15 ± 10 years versus 11 ± 8 years). Subjects with adult-onset SLE and childhood-onset SLE subjects were equally likely to complete a bachelor's degree. However, subjects with childhood-onset SLE were significantly less likely to be employed, independent of demographic and disease characteristics (odds ratio 0.62, 95% confidence interval 0.42–0.91). CONCLUSION While subjects with SLE are just as likely as those with adult-onset SLE to complete college education, childhood-onset SLE significantly increases the risk of not working in adulthood, even when controlling for disease and demographic factors. Exploring reasons for low rates of employment and providing vocational support may be important to maximize long-term functional outcomes in patients with childhood-onset SLE.
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190
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Wei CC, Lin CL, Shen TC, Tsai JD, Chung CJ, Li TC. Increased incidence of juvenile-onset systemic lupus erythematosus among children with asthma. Pediatr Allergy Immunol 2014; 25:374-9. [PMID: 24953297 DOI: 10.1111/pai.12228] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2014] [Indexed: 01/28/2023]
Abstract
BACKGROUND Children with systemic lupus erythematosus (SLE) have an especially aggressive disease course and poor outcomes. Previous studies demonstrated a possible association between SLE and allergies, but the relationship between these disorders remains unclear. This population-based cohort study aimed to investigate the incidence and risk of juvenile-onset SLE (JSLE) among children with asthma. METHODS From 2000 to 2003, 120,939 children with newly diagnosed asthma and 483,756 randomly selected non-asthma controls were enrolled. We used a multivariable Cox proportional hazard regression model to measure and compare the incidence rate and risk of JSLE in the asthma and non-asthma cohorts. RESULTS The overall incidence of JSLE was 2.52 times greater in the asthma cohort than that in the non-asthma cohort [3.49 vs. 1.53 per 100,000 person-years; 95% confidence interval (CI): 1.59-3.99]. The risk of JSLE was greatest among boys [hazard ratio (HR) 3.02, 95% CI: 1.21-7.52] and children aged 6-10 yr (HR 3.50, 95% CI: 1.75-7.02). The HR of JSLE increased with greater frequency of asthma-related medical visits from 1.22 (95% CI: 0.67-1.41) for those with ≤2 visits/yr to 5.88 (95% CI: 3.43-10.1) for subjects with >2 visits/yr (trend test p < 0.001). However, the risk of JSLE declined over time. CONCLUSION We found an increased incidence of JSLE among children with asthma. The mechanism of asthma on JSLE development should be elucidated to establish innovative disease intervention programs.
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Affiliation(s)
- Chang-Ching Wei
- Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
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191
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Feng M, Lv J, Fu S, Liu B, Tang Y, Wan X, Liang P, Zeng Y, Li J, Lu Y, Li X, Xu A. Clinical features and mortality in Chinese with lupus nephritis and neuropsychiatric lupus: A 124-patient study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2014; 19:414-9. [PMID: 25097623 PMCID: PMC4116572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 03/05/2014] [Accepted: 04/16/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Few investigation has focused on the patients with lupus nephritis (LN) and neuropsychiatric systemic lupus erythematosus (NPSLE). This study was aimed to investigate the clinical features, mortality, and the predictors for mortality of this group of patients. MATERIALS AND METHODS Medical records were retrospectively reviewed in Sun Yat-sen Memorial Hospital from 1996 to 2012. Data of demographic information, clinical manifestations, laboratory tests, SLE disease activity index 2000 (SLEDAI-2K) score, diagnosis, complications, treatment, and mortality was collected. RESULTS A total of 124 patients were included in our study. Thirty-five (29.1%) patients had glomerular filtration rate <60 ml/min/1.73 m(2), while 24 (19.4%) experienced acute kidney injury (AKI). Thirteen of the 19 American College of Rheumatology defined NPSLE syndromes were identified. The most frequent manifestation was seizure disorder (56/124, 45.2%), followed by psychosis (37/124, 29.8%) and cerebrovascular disease (35/124, 28.2%). One hundred and five (84.7%) patients had SLEDAI-2K scores ≥15, the mean of which was 21.5 ± 6.2. The mortality during hospitalization was 12.9% (16/124) with NP involvement itself being the leading cause of death (7/16, 43.8%). Multivariate logistic regression confirmed that age <14 years at onset of NPSLE (odds ratios [OR]: 9.95, 95% confidence intervals [CI]: 1.43-69.36, P = 0.020), AKI (OR: 10.40, 95% CI: 2.33-46.48, P = 0.002) and pneumonia (OR: 4.52, 95% CI: 1.14-17.96, P = 0.032) were risk factors for mortality, while cyclophosphamide (CYC) treatment (OR: 0.09, 95% CI: 0.02-0.54, P = 0.008) was a protective factor. CONCLUSION Most of SLE patients with LN and new-onset NPSLE are in an active disease state. NP manifestation itself was the leading cause of death during hospitalization. Childhood-onset NPSLE, AKI and pneumonia might be predictors of mortality, whereas CYC treatment might improve the prognosis.
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Affiliation(s)
- Min Feng
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun Lv
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Sha Fu
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bo Liu
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ying Tang
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xia Wan
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Peifen Liang
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuchun Zeng
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jingao Li
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanying Lu
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaomei Li
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Anping Xu
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China,Address for correspondence: Prof. Anping Xu, Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou - 510 120, China. E-mail:
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HERSH AIMEE. Growing Up and Moving On — Transition of Care for Patients with Childhood-onset Rheumatic Disease. J Rheumatol 2014; 41:829-31. [DOI: 10.3899/jrheum.140140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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193
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Chiewchengchol D, Murphy R, Morgan T, Edwards SW, Leone V, Friswell M, Pilkington C, Tullus K, Rangaraj S, McDonagh JE, Gardner-Medwin J, Wilkinson N, Riley P, Tizard J, Armon K, Sinha MD, Ioannou Y, Mann R, Bailey K, Davidson J, Baildam EM, Pain CE, Cleary G, McCann LJ, Beresford MW. Mucocutaneous manifestations in a UK national cohort of juvenile-onset systemic lupus erythematosus patients. Rheumatology (Oxford) 2014; 53:1504-12. [PMID: 24692572 DOI: 10.1093/rheumatology/keu137] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To determine whether mucocutaneous manifestations are associated with major organ involvement in a UK national cohort of juvenile-onset SLE (JSLE) patients. METHODS JSLE patients (n = 241) from 15 different centres whose diagnosis fulfilled four or more of the ACR criteria were divided into two groups: those with at least one ACR mucocutaneous criterion (ACR skin feature positive) and those without (ACR skin feature negative) at diagnosis. The relative frequency of skin involvement was described by the paediatric adaptation of the 2004 British Isles Lupus Assessment Group (pBILAG-2004) index. RESULTS One hundred and seventy-nine patients (74%) had ACR-defined skin involvement with no significant demographic differences compared with those without. ACR skin feature negative patients showed greater haematological (84% vs 67%), renal (43% vs 26%) (P < 0.05) and neurological (16% vs 4%) involvement (P = 0.001). Forty-two per cent of ACR skin feature negative patients had skin involvement using pBILAG-2004, which included maculopapular rash (17%), non-scaring alopecia (15%), cutaneous vasculitis (12%) and RP (12%). ACR skin feature negative patients with moderate to severe skin involvement by pBILAG-2004 showed greater renal and haematological involvement at diagnosis and over the follow-up period (P < 0.05). Higher immunosuppressive drug use in the skin feature negative group was demonstrated. CONCLUSION Patients who fulfil the ACR criteria but without any of the mucocutaneous criteria at diagnosis have an increased risk of major organ involvement. The pBILAG-2004 index has shown that other skin lesions may go undetected using the ACR criteria alone, and these lesions show a strong correlation with disease severity and major organ involvement.
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Affiliation(s)
- Direkrit Chiewchengchol
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Ruth Murphy
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Thomas Morgan
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Steven W Edwards
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Valentina Leone
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Mark Friswell
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Clarissa Pilkington
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Kjell Tullus
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Satyapal Rangaraj
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Janet E McDonagh
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Janet Gardner-Medwin
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Nick Wilkinson
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Phil Riley
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Jane Tizard
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Kate Armon
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Manish D Sinha
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Yiannis Ioannou
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Rebecca Mann
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Kathryn Bailey
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK. Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, Universi
| | - Joyce Davidson
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Eileen M Baildam
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Clare E Pain
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Gavin Cleary
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Liza J McCann
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Michael W Beresford
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK.
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194
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Merola JF, Bermas B, Lu B, Karlson EW, Massarotti E, Schur PH, Costenbader KH. Clinical manifestations and survival among adults with (SLE) according to age at diagnosis. Lupus 2014; 23:778-84. [PMID: 24608964 DOI: 10.1177/0961203314526291] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 02/10/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The objective of this paper is to determine the effect of clinical and laboratory manifestations, and medication prescribing, on survival according to patient age at diagnosis in a large academic systemic lupus erythematosus (SLE) cohort. METHODS We identified SLE patients with a diagnosis at age ≥18, seen between 1970 through 2011, and with more than two visits to our lupus center. Data collection included SLE manifestations, serologies, other laboratory tests, medications, dates, and causes of death. We examined characteristics of those diagnosed before age 50 (adult onset) compared to those diagnosed at or after age 50 (late onset) using descriptive statistics. We used Kaplan-Meier curves with log rank tests to estimate five- and 10-year survival in age-stratified cohorts. Predictors of 10-year survival were assessed using Cox regression models, adjusted for calendar year, race/ethnicity, sex, lupus nephritis, and medication use. RESULTS Of 928 SLE patients, the mean age at diagnosis was 35. Among the adult-onset group, there was significantly higher prevalence of malar rashes and lupus nephritis. Glucocorticoids, azathioprine, mycophenolate, and cyclophosphamide use were also more frequent in the adult-onset group compared to the late-onset group. Five-year survival rates were 99.5% and 94.9% and 10-year survival rates were 97.8% and 89.5%, among those diagnosed before and at or after age 50. In the entire cohort, increasing age at diagnosis, male sex, and black race were statistically significant predictors of reduced 10-year survival. Compared to those diagnosed before age 50, the late-onset group had a multivariable-adjusted hazard ratio for 10-year risk of death of 4.96 (95% CI 1.75-14.08). The most frequent cause of known death was a lupus manifestation, followed by cardiovascular disease and infection. CONCLUSIONS In our cohort, several demographic features, SLE manifestations, and medication prescribing differed between those with adult-onset and late-onset SLE. Ten-year survival rates were high for both groups, but relatively lower among late-onset patients. A lupus manifestation as the cause of death was more common among adult-onset compared with late-onset patients.
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Affiliation(s)
- J F Merola
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - B Bermas
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - B Lu
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - E W Karlson
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - E Massarotti
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - P H Schur
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - K H Costenbader
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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195
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Yavuz S, Ece A. Mean platelet volume as an indicator of disease activity in juvenile SLE. Clin Rheumatol 2014; 33:637-41. [DOI: 10.1007/s10067-014-2540-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 02/10/2014] [Accepted: 02/12/2014] [Indexed: 02/04/2023]
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196
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Amaral B, Murphy G, Ioannou Y, Isenberg DA. A comparison of the outcome of adolescent and adult-onset systemic lupus erythematosus. Rheumatology (Oxford) 2014; 53:1130-5. [DOI: 10.1093/rheumatology/ket488] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Abstract
Paediatric-onset systemic lupus erythematosus (SLE) is usually more severe than its adult counterpart. In particular, there is a higher incidence of renal and central nervous system involvement. Specific measures to assess disease activity and damage have been implemented. The disease is very rare before the fifth birthday and therefore the onset of an SLE picture in the first years of life should lead to the suspicion of the presence of one of the rare monogenic diseases that causes SLE or of one of those congenital diseases that has been showed to be closely associated with the SLE.
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Affiliation(s)
- Clara Malattia
- Department of Pediatrics, University of Genoa and Pediatria e Reumatologia, G. Gaslini Institute, Genoa, Italy.
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198
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Villa-Blanco I, Calvo-Alén J. Utilizing registries in systemic lupus erythematosus clinical research. Expert Rev Clin Immunol 2014; 8:353-60. [DOI: 10.1586/eci.12.20] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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199
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Cervera R, Doria A, Amoura Z, Khamashta M, Schneider M, Guillemin F, Maurel F, Garofano A, Roset M, Perna A, Murray M, Schmitt C, Boucot I. Patterns of systemic lupus erythematosus expression in Europe. Autoimmun Rev 2014; 13:621-9. [PMID: 24418306 DOI: 10.1016/j.autrev.2013.11.007] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 11/13/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To analyse the differences in disease expression of European SLE patients based on gender, age at diagnosis, and ethnicity. METHODS A two-year, retrospective, multicentre, observational study was carried out in five countries (France, Germany, Italy, Spain and the UK). Patients' clinical manifestations including disease activity, organ involvement, organ damage and flares were analysed. RESULTS Thirty-one centres enrolled 412 consecutive eligible patients (90.5% of women), with active disease, stratified by disease severity (half severe and half non-severe). Baseline characteristics included; mean (SD) age: 43.3 (13.6) years, SLE duration: 10.7 (8.0) years and age at disease diagnosis: 32.6 (13.0) years old. The mean (SD) SELENA-SLEDAI and SLICC/ACR scores were: 8.1 (6.7) and 0.82 (1.36), respectively. Over half of patients experienced flares (54.9%). The average number of annual flares was 1.01 (0.71) flares/year. In males compared to females, the renal system was more frequently active (53.8% vs 30.0%, p=0.002), the mean SLICC/ACR score was higher (1.15 vs 0.79, p=0.039) and the pulmonary system was more likely to be damaged (12.8% vs 3.8%, p=0.010). Furthermore, patients diagnosed at younger age displayed more renal system activity (young: 56.3% vs adult: 33.4% vs elder: 8.9%, p<0.001) and renal damage (25.0% vs 6.9% vs 2.2%, p=0.018) compared to the others. The annual number of flares (1.13 vs 1.05 vs 0.81 flares/year, p<0.0001), including the occurrence of severe flares (0.58 vs 0.51 vs 0.20, p<0.0001), was also higher in these patients. Conversely, greater organ damage was observed in patients diagnosed at an older age compared to the others. The mean SLICC/ACR score was higher (1.31 vs young: 0.88 and adult: 0.78, p<0.001) in patients diagnosed in the older age groups. The pulmonary (13.3% vs younger: 0% vs adult: 3.7%, p=0.030) and cardiovascular (17.8% vs younger: 0% vs adult: 2.9%, p<0.001) systems were more frequently damaged in these patients. Black African descents showed greater disease activity compared to Caucasian patients. They flared more often (77.1% vs 48.6%, p=0.001) and experienced a greater number of annual flares (1.57 vs 0.89 flares/year, p<0.0001), mainly more severe flares (0.89 vs 0.38/year, p<0.0001). They also were more likely to experience renal system damage. CONCLUSION The study showed clearly two patient subsets. The disease was the most active in Black African descents, and this phenomenon has never been described before in continental Europe. The disease was also more active in patients diagnosed at a younger or adult. Greater disease damage was observed in males and in patients diagnosed at an older age.
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Affiliation(s)
- R Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain, Carrer Villarroel, 170, 08036 Barcelona, Catalonia, Spain.
| | - A Doria
- Division of Rheumatology, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Z Amoura
- Internal Medecine Department 2, La Pitié Salpétrière Hospital, 47-83 Bd. de l'Hôpital, 75651 Paris cedex 13, France
| | - M Khamashta
- Lupus Research Unit, The Rayne Institute Lambeth Wing, St Thomas' Hospital, London SE1 7EH, England, United Kingdom
| | - M Schneider
- Policlinic of Rheumatology, Heinrich-Heine-University, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - F Guillemin
- Inserm CIC-EC, University Hospital, CHU of Nancy, 54505 Nancy, France
| | - F Maurel
- Health Economics & Outcomes Research, IMS Real-World Evidence Solutions, Tour Ariane 5-7, place de la Pyramide, 92088 Paris La défense cedex, France
| | - A Garofano
- Health Economics & Outcomes Research, IMS Real-World Evidence Solutions, Tour Ariane 5-7, place de la Pyramide, 92088 Paris La défense cedex, France
| | - M Roset
- Health Economics & Outcomes Research, IMS Real-World Evidence Solutions, C/Doctor Ferran 25-27, Barcelona 08034, Catalonia, Spain
| | - A Perna
- Immuno Inflammation & Infectious Diseases Global Franchise, GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, England, United Kingdom
| | - M Murray
- Access to Medicine Centre of Excellence, GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex, TW8 9GS England, United Kingdom
| | - C Schmitt
- Global Health Outcomes, GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, England, United Kingdom
| | - I Boucot
- Medical Department, GlaxoSmithKline, 100 route de Versailles, 78163 Marly-le-Roi Cedex, France
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200
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Son MBF, Johnson VM, Hersh AO, Lo MS, Costenbader KH. Outcomes in hospitalized pediatric patients with systemic lupus erythematosus. Pediatrics 2014; 133:e106-13. [PMID: 24379234 PMCID: PMC9923530 DOI: 10.1542/peds.2013-1640] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Disparities in outcomes among adults with systemic lupus erythematosus (SLE) have been documented. We investigated associations between sociodemographic factors and volume of annual inpatient hospital admissions with hospitalization characteristics and poor outcomes among patients with childhood-onset SLE. METHODS By using the Pediatric Health Information System, we analyzed admissions for patients aged 3 to <18 years at index admission with ≥ 1 International Classification of Diseases, Ninth Revision code for SLE from January 2006 to September 2011. Summary statistics and univariable analyses were used to examine demographic characteristics of hospital admissions, readmissions, and lengths of stay. We used multivariable logistic regression analyses, controlling for patient gender, age, race, ethnicity, insurance type, hospital volume, US census region, and severity of illness, to examine risk factors for poor outcomes. RESULTS A total of 10,724 admissions occurred among 2775 patients over the study period. Hispanic patients had longer lengths of stay, more readmissions, and higher in-hospital mortality. In multivariable analysis, African American race was significantly associated with ICU admission. African American race and Hispanic ethnicity were associated with end-stage renal disease and death. Volume of patients with SLE per hospital and hospital location were not significantly associated with outcomes. CONCLUSIONS In this cohort of hospitalized children with SLE, race and ethnicity were associated with outcomes. Further studies are needed to elucidate the relationship between sociodemographic factors and poor outcomes in patients with childhood-onset SLE.
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Affiliation(s)
- Mary Beth F. Son
- Division of Immunology and,Departments of Pediatrics and,Address correspondence to Mary Beth F. Son, MD, Division of Immunology, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115. E-mail:
| | - Victor M. Johnson
- Department of Anesthesiology, Boston Children’s Hospital, Boston, Massachusetts
| | - Aimee O. Hersh
- Department of Pediatrics, University of Utah, Salt Lake City, Utah; and
| | - Mindy S. Lo
- Division of Immunology and,Departments of Pediatrics and
| | - Karen H. Costenbader
- Medicine, Harvard Medical School, Boston, Massachusetts;,Department of Rheumatology, Brigham & Women’s Hospital, Boston, Massachusetts
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