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Dhital R, Guma M, Poudel DR, Chambers C, Kalunian K. Infection-related hospitalisation in young adults with systemic lupus erythematosus: data from the National Inpatient Sample. Lupus Sci Med 2023; 10:10/1/e000851. [PMID: 37019477 PMCID: PMC10083864 DOI: 10.1136/lupus-2022-000851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/07/2023] [Indexed: 04/07/2023]
Abstract
INTRODUCTION Care of young adults with SLE (YA-SLE, 18-24 years) is challenging due to major life transitions co-occurring with chronic healthcare needs. Studies have demonstrated poorer outcomes in the post-transition period. Epidemiological studies focused on serious infection-related hospitalisation (SIH) in YA-SLE are lacking. METHODS We used National Inpatient Sample from 2010 to 2019 to study the epidemiology and outcomes of SIH for five common infections in SLE, namely sepsis, pneumonia, urinary tract infections, skin and soft tissue infections, and opportunistic infections. For time trends, we extended the dataset to cover 2000-2019. The primary outcome was the rate of SIH in YA-SLE compared with adults (25-44 years) with SLE and with young adults without SLE (YA-no SLE). RESULTS From 2010 to 2019, we identified 1 720 883 hospital admissions with SLE in patients aged ≥18 years. Rates of SIH were similar in young adults and adults with SLE (15.0% vs 14.5%, p=0.12), but considerably higher than in the YA-no SLE group (4.2%, p<0.001). Among SLE with SIH, sepsis followed by pneumonia was the most common diagnosis. Significantly higher proportions of SIH among young adults than adults with SLE were comprised of non-white patients, belonged to the lowest income quartile and had Medicaid. However, only race/ethnicity was associated with SIH among YA-SLE. There was a higher prevalence of comorbid lupus nephritis and pleuritis among young adults compared with adults with SLE and SIH, and both comorbidities were associated with SIH in YA-SLE. Increasing rates of SIH, driven by sepsis, were seen over time. DISCUSSION YA- SLE had similar rates of SIH to adults with SLE. While hospitalised YA-SLE differed sociodemographically from SLE adults and YA-no SLE, only race/ethnicity was associated with SIH in the YA-SLE group. Lupus nephritis and pleuritis were associated with higher SIH in YA-SLE. Among SLE with SIH, increasing trends of sepsis deserve further study.
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Affiliation(s)
- Rashmi Dhital
- Division of Rheumatology, Department of Medicine, UCSD, La Jolla, California, USA
| | - Monica Guma
- Division of Rheumatology, Department of Medicine, UCSD, La Jolla, California, USA
- Division of Rheumatology, VA San Diego Health Care System, San Diego, California, USA
| | - Dilli R Poudel
- Department of Medicine, Indiana Regional Medical Center, Indiana, Pennsylvania, USA
| | - Christina Chambers
- Division of Environmental Science and Health, Department of Pediatrics, UCSD, La Jolla, California, USA
| | - Kenneth Kalunian
- Division of Rheumatology, Department of Medicine, UCSD, La Jolla, California, USA
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2
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Lim SC, Chan EWL, Mandal SS, Tang SP. A Preliminary Predictive Model for Proliferative Lupus Nephritis in Juvenile Systemic Lupus Erythematosus. RHEUMATO 2023; 3:86-97. [DOI: 10.3390/rheumato3010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
Abstract
Proliferative lupus nephritis, which is diagnosed by renal biopsy, has significant impact on the treatment choices and long-term prognosis of juvenile SLE (jSLE). Renal biopsies are however not always possible or available, thus leading to an ongoing search for alternative biomarkers. This study aimed to develop a clinical predictive machine learning model using routine standard parameters as an alternative tool to evaluate the probability of proliferative lupus nephritis (ISN/RPS Class III or IV). Data were collected retrospectively from jSLE patients seen at Selayang Hospital from 2004 to 2021. A total of 22 variables including demographic, clinical and laboratory features were analyzed. A recursive feature elimination technique was used to identify factors to predict pediatric proliferative lupus nephritis. Various models were then used to build predictive machine learning models and assessed for sensitivity, specificity and accuracy. There were 194 jSLE patients (165 females), of which 111 had lupus nephritis (54 proliferative pattern). A combination of 11 variables consisting of gender, ethnicity, fever, nephrotic state, hypertension, urine red blood cells (RBC), C3, C4, duration of illness, serum albumin, and proteinuria demonstrated the highest accuracy of 79.4% in predicting proliferative lupus nephritis. A decision-tree model performed the best with an AROC of 69.9%, accuracy of 73.85%, sensitivity of 78.72% and specificity of 61.11%. A potential clinically useful predictive model using a combination of 11 non-invasive variables to collectively predict pediatric proliferative lupus nephritis in daily practice was developed.
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Affiliation(s)
- Sern Chin Lim
- Department of Paediatrics, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh 47000, Malaysia
| | - Elaine Wan Ling Chan
- Institute for Research, Development and Innovation, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia
| | | | - Swee Ping Tang
- Paediatric Rheumatology Unit, Selayang Hospital, Batu Caves 68100, Malaysia
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3
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Na Nakorn K, Piyaphanee N, Sukharomana M, Pinpatanapong R, Charuvanij S. Outcomes of achieving lupus low disease activity state and damage accrual in childhood-onset systemic lupus erythematosus. Clin Rheumatol 2023; 42:1655-1664. [PMID: 36780064 DOI: 10.1007/s10067-023-06533-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 01/10/2023] [Accepted: 02/01/2023] [Indexed: 02/14/2023]
Abstract
INTRODUCTION At present, the treat-to-target approach has been proposed with the lupus low disease activity state (LLDAS) as an achievable target. OBJECTIVES To determine damage accrual and baseline clinical characteristics associated with achieving LLDAS within 12 months of treatment in patients with childhood-onset systemic lupus erythematosus (c-SLE). METHODS This retrospective cohort study was conducted at the largest university-based tertiary referral center in Thailand. Data of c-SLE patients (≤ 18 years) at diagnosis who were followed ≥ 12 months during January 2009 to December 2019 were collected. SLE disease status was categorized into LLDAS and non-optimally controlled state. SLEDAI-2K score was used to assess disease activity. Damage accrual was assessed by a pediatric version of the SLICC/ACR damage index. RESULTS A total of 232 c-SLE patients (85.8% female) were included. At 12 months of treatment, 109 (47%) patients achieved LLDAS. Damage accrual was observed in 93 (40.1%) patients at the mean follow-up time of 6.2 ± 3.7 years. Damage accrual was significantly lower in patients who achieved LLDAS within 12 months than in those non-optimally controlled (p = 0.002). The median time to achieving LLDAS was 12.6 months (95%CI: 11.19-13.97). The median time to achieving LLDAS was significantly shorter in those without renal involvement (10.8 months, 95%CI: 9.62-12.00 vs. 15.6 months, 95%CI: 13.76-17.52, respectively; p = 0.044). Multivariable logistic regression analysis revealed absence of renal involvement as the predictor of achieving LLDAS within 12 months of treatment (aOR: 2.430, 95%CI: 1.420-4.158; p = 0.001). CONCLUSIONS Achieving LLDAS within 12 months of treatment was associated with lower damage accrual. Absence of renal involvement was the predictor of achieving LLDAS within 12 months of treatment. Key Points • LLDAS is a promising and achievable treatment target in c-SLE. • Achieving LLDAS within 12 months of treatment is associated with lower damage accrual. • Absence of renal involvement is the predictor of achieving LLDAS within 12 months of treatment.
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Affiliation(s)
- Koravich Na Nakorn
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nuntawan Piyaphanee
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Maynart Sukharomana
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rattakorn Pinpatanapong
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sirirat Charuvanij
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Hamijoyo L, Sapartini G, Rahmadi AR, Wachjudi RG, Dewi S, Ghrahani R, Praptama S, Rainy NR, Usman SY, Suryajaya BS, Candrianita S, Sutedja E, Setiabudiawan B. Comparison of clinical presentation and outcome of childhood-onset and adulthood-onset of systemic lupus erythematosus among Indonesian patients. Lupus 2022; 31:759-764. [PMID: 35379039 DOI: 10.1177/09612033221093482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The clinical presentation of childhood-onset systemic lupus erythematosus (SLE) is generally perceived to differ from that of adult-onset SLE. OBJECTIVE We aimed to compare the demographic and clinical manifestation between childhood-onset vs. adult-onset SLE in a cohort of Indonesian patients at tertiary care centers. METHODS This retrospective study included patients in the Hasan Sadikin Lupus Registry from 2008 until December 2017. The demographics, clinical presentations, and outcomes were compared between childhood-onset SLE (<18 years old) (Group 1) and adult-onset SLE (≥18 years old) (Group 2). RESULTS Eight hundred seventy patients were involved into this study. The proportion of childhood-onset SLE was 20% (174 patients). The mean age of group 1 versus group 2 was 13.56 ± 3.04 vs 30.41 ± 8.54 years. The following clinical manifestations at SLE diagnosis were significantly more common in childhood-onset than in adult-onset SLE patients: hematological disorder (p = 0.033) and arthritis (p = 0.006). While discoid rash (p = 0.036) and photosensitivity (p < 0.001) were significantly found higher in adult-onset SLE. Cyclophosphamide therapy was significantly more common to be used in childhood-onset (38.5% vs 21.0%, p = <0.001). However, frequency of mortality on follow-up tended to be higher in childhood-onset group (11.5% vs 7.0%, p = 0.208). CONCLUSION Arthritis and hematologic involvements at SLE diagnosis were more prominent in childhood-onset compared to adult-onset patients, and mortality in childhood-onset SLE during follow-up relatively higher. This data may suggest the need for more aggressive management approach to childhood-onset patients with SLE.
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Affiliation(s)
- Laniyati Hamijoyo
- Rheumatology Division, Faculty of Medicine, Department of Internal Medicine, 61809Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia.,Lupus Study Group, Immunology Study Center, Faculty of Medicine, 4321Universitas Padjadjaran, Bandung, Indonesia
| | - Gartika Sapartini
- Allergy and Immunology Division, Faculty of Medicine, Department of Child Health, 61809Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Andri R Rahmadi
- Rheumatology Division, Faculty of Medicine, Department of Internal Medicine, 61809Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Rachmat G Wachjudi
- Rheumatology Division, Faculty of Medicine, Department of Internal Medicine, 61809Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Sumartini Dewi
- Rheumatology Division, Faculty of Medicine, Department of Internal Medicine, 61809Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Reni Ghrahani
- Allergy and Immunology Division, Faculty of Medicine, Department of Child Health, 61809Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Suhendra Praptama
- Lupus Study Group, Immunology Study Center, Faculty of Medicine, 4321Universitas Padjadjaran, Bandung, Indonesia
| | - Nisa R Rainy
- Lupus Study Group, Immunology Study Center, Faculty of Medicine, 4321Universitas Padjadjaran, Bandung, Indonesia
| | - Stefanie Y Usman
- Lupus Study Group, Immunology Study Center, Faculty of Medicine, 4321Universitas Padjadjaran, Bandung, Indonesia
| | - Bernard S Suryajaya
- Lupus Study Group, Immunology Study Center, Faculty of Medicine, 4321Universitas Padjadjaran, Bandung, Indonesia
| | - Sasfia Candrianita
- Lupus Study Group, Immunology Study Center, Faculty of Medicine, 4321Universitas Padjadjaran, Bandung, Indonesia
| | - Endang Sutedja
- Immunodermatology Division, Faculty of Medicine, Department of Dermato Venereology, 61809Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Budi Setiabudiawan
- Allergy and Immunology Division, Faculty of Medicine, Department of Child Health, 61809Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
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5
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Gamal SM, Fouad N, Yosry N, Badr W, Sobhy N. Disease characteristics in patients with juvenile- and adult-onset systemic lupus erythematosus: A multi-center comparative study. Arch Rheumatol 2021; 37:280-287. [PMID: 36017206 PMCID: PMC9377179 DOI: 10.46497/archrheumatol.2022.8888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/27/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives
This study aims to compare disease characteristics in patients with juvenile-onset systemic lupus erythematosus (JSLE) and adult-onset systemic lupus erythematosus (ASLE). Patients and methods
Between June 2010 and March 2020, a total of 186 patients with JSLE (23 males, 163 females; median age: 25 years; range, 20 to 30.3 years) and 236 patients with ASLE (23 males, 213 females; median age: 35 years; range, 29 to 40 years) were retrospectively analyzed. Clinical and laboratory data, treatment received, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborating Clinics (SLICC)/ACR Damage Index (SDI) scores, comorbidities and deaths were compared between the groups. Results
The JSLE patients showed statistically significant higher constitutional manifestations, cardiac manifestations, serositis, nephritis, end-stage renal disease, neurological manifestations, gastrointestinal manifestations, secondary vasculitis, Raynaud’s, livedo-reticularis, dry mouth, dry eye, ocular manifestations, avascular necrosis, hematological manifestations, and hypocomplementemia (p<0.001, p=0.016, p=0.005, p=0.001, p=0.04, p<0.001, p<0.001, p<0.001, p=0.002, p=0.043, p=0.004, p=0.03, p<0.001, p=0.01, p<0.001, and p=0.001, respectively). Median SLEDAI scores were statistically significant higher in the JSLE group, both at onset (p<0.001) and in the final follow-up visit (p<0.001). Median SLICC scores were also higher in the JSLE group (p<0.001). Mycophenolate mofetil and intravenous pulse steroids were more frequently used in the juvenile group (p<0.001 and p=0.03, respectively). Hypertension, dyslipidemia, and avascular necrosis were found to be statistically significantly higher in the JSLE group (p<0.001, p=0.006, and p=0.01, respectively). The mortality rate was statistically significantly higher in the JSLE group than the ASLE group (p<0.001). Conclusion
The JSLE patients showed more serious manifestations, higher disease activity, higher damage index, and mortality rate compared to ASLE patients. These results suggest the need of a regular follow-up and close surveillance of JSLE patients.
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Affiliation(s)
- Sherif M Gamal
- Rheumatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nermeen Fouad
- Rheumatology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Nora Yosry
- Rheumatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Wael Badr
- Department of Pediatric, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Nesreen Sobhy
- Rheumatology, Faculty of Medicine, Cairo University, Cairo, Egypt
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6
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Quddusi FI, Youssef MJ, Davis DMR. Dermatologic Manifestations of Systemic Diseases in Childhood. Pediatr Rev 2021; 42:655-671. [PMID: 34850179 DOI: 10.1542/pir.2020-000679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Molly J Youssef
- Department of Pediatric and Adolescent Medicine.,Department of Dermatology, Mayo Clinic, Rochester, MN
| | - Dawn Marie R Davis
- Department of Pediatric and Adolescent Medicine.,Department of Dermatology, Mayo Clinic, Rochester, MN
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7
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De Mutiis C, Wenderfer SE, Orjuela A, Bagga A, Basu B, Sar T, Aggarwal A, Jain A, Yap HK, Ito S, Ohnishi A, Iwata N, Kasapcopur O, Laurent A, Mastrangelo A, Ogura M, Shima Y, Rianthavorn P, Silva CA, Trindade V, Dormi A, Tullus K. Defining renal remission in an international cohort of 248 children and adolescents with lupus nephritis. Rheumatology (Oxford) 2021; 61:2563-2571. [PMID: 34626102 DOI: 10.1093/rheumatology/keab746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 09/20/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE We studied the rate of remission of lupus nephritis (LN) in an international cohort of 248 children and adolescents with biopsy proven LN. Five different definitions from scientific studies and the definitions recommended by the American College of Rheumatology and Kidney Disease Improving Global Outcomes (KDIGO) were used. METHODS Anonymized clinical data in patients with biopsy proven LN class ≥ III (International Society of nephrology/Royal Pathology Society-ISN/RPS) diagnosed and treated in the last 10 years in 23 international centers from 10 countries were collected. We compared the rate of patients in complete and partial remission applying the different definitions. RESULTS The mean age at diagnosis was 11 years and 4 month and 177 were females.The number of patients in complete and partial remission varied a lot between the different definitions. At 24 months, between 50% and 78.8% of the patients were in full remission as defined by the different criteria. The number of patients in partial remission was low, between 2.3% and 25%. No difference in achieved remission was found between boys and girls or between children and adolescents (P > 0.05). Patients with East Asian ethnicity reached remission more often than other ethnicities (P = 0.03-0.0008). Patients treated in high income countries showed a higher percentage of complete remission at 12 and 24 months (P = 0.002-0.000001). CONCLUSION The rate of children and adolescents with LN achieving remission varied hugely with the definition used. Our results give important information for long awaited treatment studies in children and young people.
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Affiliation(s)
| | - Scott E Wenderfer
- Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Alvaro Orjuela
- Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Arvind Bagga
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Biswanath Basu
- Division of Pediatric Nephrology, Department of Pediatrics, Nilratan Sircar Medical College and Hospital, Kolkata, India
| | - Tanmoy Sar
- Division of Pediatric Nephrology, Department of Pediatrics, Nilratan Sircar Medical College and Hospital, Kolkata, India
| | - Amita Aggarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Avinash Jain
- Department of Medicine, Sawai Man Singh Medical College, Jaipur, India
| | - Hui-Kim Yap
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shuichi Ito
- Department of Pediatrics, Yokohama City University, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, Japan
| | - Ai Ohnishi
- Department of Pediatrics, Yokohama City University, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, Japan
| | - Naomi Iwata
- Department of Infection and Immunology, Aichi Children's Health and Medical Center, Obu, Japan
| | - Ozgur Kasapcopur
- Department of Pediatric Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Audrey Laurent
- Department of Pediatric Nephrology, Rheumatology and Dermatology, Hospices Civils de Lyon, Lyon, France
| | - Antonio Mastrangelo
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Maggiore Policlinico Hospital, Milan, Italy
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Yuko Shima
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Pornpimol Rianthavorn
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Clovis A Silva
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Vitor Trindade
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ada Dormi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Kjell Tullus
- Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Ubhi M, Dubey S, Gordon C, Adizie T, Sheeran T, Allen K, Jordan R, Sadhra S, Adams J, Daji R, Reynolds JA, Kumar K. Understanding the impact of systemic lupus erythematosus on work amongst South Asian people in the UK: An explorative qualitative study. Lupus 2021; 30:1492-1501. [PMID: 34092136 PMCID: PMC8283190 DOI: 10.1177/09612033211022816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
SLE has a range of fluctuating symptoms affecting individuals and their ability to work. Although South Asian (SA) patients are at increased risk of developing SLE there is limited knowledge of the impact on employment for these patients in the UK. Understanding ethnicity and disease-specific issues are important to ensure patients are adequately supported at work. Semi-structured interviews were conducted with patients of SA origin to explore how SLE impacted on their employment. Thematic analysis was used to analyse the data which are reported following COREQ guidelines. Ten patients (8 female; 2 male) were recruited from three rheumatology centres in the UK and interviewed between November 2019 and March 2020. Patients were from Indian (n = 8) or Pakistani (n = 2) origin and worked in a range of employment sectors. Four themes emerged from the data: (1) Disease related factors; (2) Employment related factors; (3) Cultural and interpersonal factors impacting on work ability; (4) Recommendations for improvement. Patients’ ability to work was affected by variable work-related support from their hospital clinicians, low awareness of SLE and variable support from their employers, and cultural barriers in their communities that could affect levels of family support received. These findings highlight the need for additional support for SA patients with SLE in the workplace.
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Affiliation(s)
- Mandeep Ubhi
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Shirish Dubey
- University Hospitals Coventry, Coventry, UK.,Warwickshire NHS Trust, Warwick, UK
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Sandwell and West Birmingham NHS Trust, West Bromwich, UK
| | | | - Tom Sheeran
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Kerry Allen
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Rachel Jordan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Steven Sadhra
- Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, UK
| | - Jo Adams
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | | | - John A Reynolds
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Sandwell and West Birmingham NHS Trust, West Bromwich, UK
| | - Kanta Kumar
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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9
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Bortolini MFF, Pereira VP, Gomes Dos Santos TA, Nisihara R, Skare TL. Systemic lupus erythematosus in children and adults: A retrospective study in Brazilian patients. Lupus 2021; 30:1197-1202. [PMID: 33858265 DOI: 10.1177/09612033211010330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) may have a different serological and clinical profile according to age of disease onset. AIM To compare clinical presentation and serological data from patients with SLE onset in childhood (cSLE) with disease onset in adulthood (aSLE) in a sample of Brazilian patients. METHODS Retrospective study of 614 SLE patients from a single Rheumatology Unit from Brazil: 77 (12.5%) cSLE and 537 (87.4%) aSLE. Clinical and serological data were obtained from the charts. Comparisons of cSLE with aSLE in general and according to patient's gender were made. RESULTS The comparison of whole sample showed that children had more malar rash (p = 0.04), seizures (p < 0.0001), psychosis (p = 0.02), glomerulonephritis (p = 0.001), anti-dsDNA (p = 0.008), anticardiolipin IgM (p = 0.04) but less discoid lesions (p = 0.01), anti-Ro (p < 0.0001) and anti-La antibodies (p = 0.007). When only the male sample was compared, no differences in glomerulonephritis and anti-dsDNA frequencies were found. CONCLUSION Children had a higher frequency of severe manifestations (glomerulonephritis and central nervous system) than adults. The difference in glomerulonephritis occurrence disappeared when only males were compared.
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Affiliation(s)
| | | | | | - Renato Nisihara
- Mackenzie Evangelical School of Medicine Paraná, Curitiba, Brazil
| | - Thelma L Skare
- Mackenzie Evangelical School of Medicine Paraná, Curitiba, Brazil
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10
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DeQuattro K, Trupin L, Murphy LB, Rush S, Criswell LA, Lanata CM, Dall'Era M, Katz P, Yazdany J. High Disease Severity Among Asians in a US Multiethnic Cohort of Individuals with Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2020; 74:896-903. [PMID: 33337580 DOI: 10.1002/acr.24544] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/15/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Knowledge about systemic lupus erythematosus (SLE) outcomes among US Asians is lacking. We examined SLE disease activity, severity, and damage among Asians of primarily Chinese and Filipino descent in a multiethnic cohort. METHODS California Lupus Epidemiology Study (CLUES, n=328) data were analyzed. Data were collected in English, Cantonese, Mandarin or Spanish, using validated instruments for disease activity (Systemic Lupus Erythematosus Disease Activity Index), disease severity (Lupus Severity Index [LSI]) and disease damage (Systemic Lupus International Collaborating Clinics Damage Index). We assessed differences in SLE outcomes among racial/ethnic groups using multivariable linear regression including interaction terms for age at diagnosis and race/ethnicity. RESULTS Asians were the largest racial/ethnic group (38%; [Chinese=22%; Filipino=9%; Other=7%]). Average age at diagnosis (years) was younger among Asians (27.9), particularly Filipinos (22.2), compared with Whites (29.4) and Blacks (34.0). After adjustment, disease activity and damage were not significantly different across groups. Disease severity among Asians was significantly higher than Whites (LSI 7.1 vs 6.5; p<0.05) but similar to Blacks and Hispanics. Early age at diagnosis was associated with greater organ damage among Asians, Blacks, and Hispanics, but not Whites. CONCLUSIONS SLE was more severe among US Asians compared to Whites. Filipinos were affected at strikingly young ages. Asians and non-White groups with younger age at diagnosis had greater organ damage than Whites. Such racial/ethnic distinctions suggest the need for heightened clinical awareness to improve health outcomes among Asians with SLE. Further study of SLE outcomes across a range of US Asian subgroups is important.
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Affiliation(s)
- Kimberly DeQuattro
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Laura Trupin
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Louise B Murphy
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia, USA
| | - Stephanie Rush
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Lindsey A Criswell
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Cristina M Lanata
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Maria Dall'Era
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Patricia Katz
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
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Dominguez D, Kamphuis S, Beyene J, Wither J, Harley JB, Blanco I, Vila-Inda C, Brunner H, Klein-Gitleman M, McCurdy D, Wahezi DM, Lehman T, Jelusic M, Peschken CA, Pope JE, Gladman DD, Hanly JG, Clarke AE, Bernatsky S, Pineau C, Smith CD, Barr S, Boire G, Rich E, Silverman ED. Relationship Between Genetic Risk and Age of Diagnosis in Systemic Lupus Erythematosus. J Rheumatol 2020; 48:852-858. [PMID: 33060314 DOI: 10.3899/jrheum.200002] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Specific risk alleles for childhood-onset systemic lupus erythematosus SLE (cSLE) vs adult-onset SLE (aSLE) patients have not been identified. The aims of this study were to determine if there is an association (1) between non-HLA-related genetic risk score (GRS) and age of SLE diagnosis, and (2) between HLA-related GRS and age of SLE diagnosis. METHODS Genomic DNA was obtained from 2001 multiethnic patients and genotyped using the Immunochip. Following quality control, genetic risk counting (GRCS), weighted (GRWS), standardized counting (GRSCS), and standardized weighted (GRSWS) scores were calculated based on independent single-nucleotide polymorphisms from validated SLE loci. Scores were analyzed in a regression model and adjusted by sex and ancestral population. RESULTS The analyzed cohort consisted of 1540 patients: 1351 females and 189 males (675 cSLE and 865 aSLE). There were significant negative associations between all non-HLA GRS and age of SLE diagnosis: P = 0.011 and r2 = 0.175 for GRWS; P = 0.008 and r2 = 0.178 for GRSCS; P = 0.002 and r2 = 0.176 for GRSWS (higher GRS correlated with lower age of diagnosis.) All HLA GRS showed significant positive associations with age of diagnosis: P = 0.049 and r2 = 0.176 for GRCS; P = 0.022 and r2 = 0.176 for GRWS; P = 0.022 and r2 = 0.176 for GRSCS; P = 0.011 and r2 = 0.177 for GRSWS (higher GRS correlated with higher age of diagnosis). CONCLUSION Our data suggest that there is a linear relationship between genetic risk and age of SLE diagnosis and that HLA and non-HLA GRS are associated with age of diagnosis in opposite directions.
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Affiliation(s)
- Daniela Dominguez
- D. Dominguez, MSc, Division of Rheumatology, Hospital for Sick Children, Hospital for Sick Children, Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Sylvia Kamphuis
- S. Kamphuis, MD, PhD, Division of Rheumatology Department of Pediatrics, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Joseph Beyene
- J. Beyene, PhD, Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton
| | - Joan Wither
- J. Wither, MD, PhD, Division of Genetics and Development, Krembil Research Institute, Arthritis Centre of Excellence, Division of Rheumatology, Toronto Western Hospital, University Health Network, Departments of Medicine and Immunology, University of Toronto, Toronto, Ontario, Canada
| | - John B Harley
- J.B. Harley, MD, PhD, Center for Autoimmune Genomics and Etiology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati, and US Department of Veterans Affairs Medical Center, Cincinnati, Ohio
| | - Irene Blanco
- I. Blanco, MD, C. Vila-Inda, MD, Albert Einstein College of Medicine, Division of Rheumatology, Bronx, New York
| | - Catarina Vila-Inda
- I. Blanco, MD, C. Vila-Inda, MD, Albert Einstein College of Medicine, Division of Rheumatology, Bronx, New York
| | - Hermine Brunner
- H. Brunner, MD, MSc, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Marissa Klein-Gitleman
- M. Klein-Gitleman, MD, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Deborah McCurdy
- D. McCurdy, MD, Division of Pediaitric Rheumatology, University of California Los Angeles, Los Angeles, California
| | - Dawn M Wahezi
- D.M. Wahezi, MD, Children's Hospital at Montefiore, Division of Pediatric Rheumatology, Albert Einstein College of Medicine, the Bronx, New York
| | - Thomas Lehman
- T. Lehman, MD, Division of Pediatric Rheumatology, Hospital for Special Surgery, New York, New York, USA
| | - Marija Jelusic
- M. Jelusic, MD, Department of Pediatric Rheumatology, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Christine A Peschken
- C.A. Peschken, MD, MSc, Departments of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Janet E Pope
- J.E. Pope, MD, MPH, Professor of Medicine, Department of Medicine, University of Western Ontario, London, Ontario
| | - Dafna D Gladman
- D.D. Gladman, MD, Department of Medicine, University of Toronto, Toronto, Ontario
| | - John G Hanly
- J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia
| | - Ann E Clarke
- A.E. Clarke, MD, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Sasha Bernatsky
- S. Bernatsky, MD, PhD, Department of Medicine, McGill University, Montreal, Quebec
| | - Christian Pineau
- C. Pineau, MD, Department of Medicine, McGill University Hospital, Montreal, Quebec
| | - C Douglas Smith
- C.D. Smith, MD, Department of Medicine, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario
| | - Susan Barr
- S. Barr, MD, Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Alberta
| | - Gilles Boire
- G. Boire, MD, Division of Rheumatology, Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec
| | - Eric Rich
- E. Rich, MD, Division of Rheumatology, Centre Hospitalier de l'Université de Montreal, Department of Medicine, University of Montreal School of Medicine, Montreal, Quebec
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Epidemiology and risk factors for avascular necrosis in childhood systemic lupus erythematosus in a Taiwanese population. Sci Rep 2020; 10:15563. [PMID: 32968109 PMCID: PMC7512010 DOI: 10.1038/s41598-020-71923-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/03/2020] [Indexed: 12/02/2022] Open
Abstract
Childhood-onset systemic lupus erythematosus (SLE) is associated with greater disease activity, more aggressive course, and high rates of organ damage. The prolonged use of corticosteroids in childhood SLE contributes to increased morbidity, including avascular necrosis (AVN). We conducted this retrospective study using claims data from the Taiwan National Health Insurance Research Database, enrolling 1,472 children with newly-diagnosed SLE between 2005 and 2013. The mean age at the diagnosis of SLE was 15.5 ± 3.3 years, and the female to male ratio was 6.2:1. Thirty-nine patients (2.6%) developed symptomatic AVN during a mean follow-up of 4.6 ± 2.5 years. In multivariate analysis, the risk of AVN was higher in the patients with a daily prednisolone dose between 7.5 mg and 30 mg (HR 7.435, 95% CI 2.882–19.178, p < 0.001) and over 30 mg (HR 9.366, 95% CI 2.225–39.418, p = 0.002) than in those with a dose ≤ 7.5 mg/day. In addition, AVN was inversely correlated with the use of hydroxychloroquine > 627 days (HR 0.335, 95% CI 0.162–0.694, p = 0.003). In conclusion, high daily doses of prednisolone were associated with a significant risk of AVN, whereas the use of hydroxychloroquine > 627 days conferred an advantage. We suggest that the judicious use of corticosteroids combined with hydroxychloroquine might be a promising preventive strategy for AVN.
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13
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Lim SC, Chan EWL, Tang SP. Clinical features, disease activity and outcomes of Malaysian children with paediatric systemic lupus erythematosus: A cohort from a tertiary centre. Lupus 2020; 29:1106-1114. [PMID: 32631203 DOI: 10.1177/0961203320939185] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Paediatric systemic lupus erythematosus is a rare autoimmune disease with a wide spectrum of clinical presentation in different populations. We present a cohort of paediatric systemic lupus erythematosus in Malaysia where the disease features and outcomes are still largely unknown. METHODS A retrospective review of all paediatric systemic lupus erythematosus patients with at least 6 months follow-up at Selayang Hospital from 2004 to 2016. Epidemiological, clinical and outcome data were collected and analysed. RESULTS A total of 141 paediatric systemic lupus erythematosus patients, 87.9% females, were followed up for a median 6.3 years (interquartile range 3.6-9.0). The median age at diagnosis was 10.8 years (interquartile range 9.0-12.0 years), positive family history of systemic lupus erythematosus was present in 12.1% and the majority (61.7%) were of Malay ethnicity. Common presentations included fever (87.2%), vasculitic rash (72.3%) and lethargy (69.5%). At diagnosis, leukopenia (51.1%), thrombocytopenia (41.8%) and cutaneous lupus (56%) predominate with significant renal involvement (39.7%). Renal (45.4%), liver (26%) and the central nervous system (17%) were important major organs involved during the course of the disease. At diagnosis, almost all (99.3%) patients had high disease activity (mean Systemic Lupus Erythematosus Disease Activity Index score 20.1 ± 9.6). The majority (62.4%) achieved remission or low disease activity after 6 months, maintained over the next 10 years. Damage occurred early (39.1% at 1 year) and increased with time. Ocular damage was the most common side effect (29%) and was predominantly corticosteroid related (93%). Growth retardation was significant (38.2%) with no gonadal failure or secondary malignancies. End-stage renal disease occurred in 3.1% patients whereas 53.1% had sustained renal remission. Overall mortality was 1.4%. CONCLUSION Despite high disease activity at diagnosis, the majority had good sustained response to treatment with low overall mortality. However, there was progressive accrual of organ damage, highlighting the need for further research and refinements into therapies for paediatric systemic lupus erythematosus.
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Affiliation(s)
- Sern Chin Lim
- Department of Paediatrics, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Malaysia
| | - Elaine Wan Ling Chan
- Institute for Research, Development and Innovation, International Medical University, Bukit Jalil, Malaysia
| | - Swee Ping Tang
- Paediatric Rheumatology Unit, Selayang Hospital, Batu Caves, Malaysia
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14
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Fiorot FJ, Islabão AG, Pereira RM, Terreri MT, Saad-Magalhães C, Novak GV, Molinari BC, Sakamoto AP, Aikawa NE, Campos LM, Peracchi OA, Appenzeller S, Ferriani VP, Silva MF, Fonseca AR, Sztajnbok FR, Paim LB, Fraga MM, Okuda EM, Bica BE, Sena EG, Moraes AJ, Rolim AM, Spelling PF, Scheibel IM, Cavalcanti AS, Matos EN, Robazzi TC, Guimarães LJ, Santos FP, Ramos VC, Carneiro-Sampaio M, Bonfá E, Silva CA. Disease presentation of 1312 childhood-onset systemic lupus erythematosus: influence of ethnicity. Clin Rheumatol 2019; 38:2857-2863. [PMID: 31209708 DOI: 10.1007/s10067-019-04631-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/24/2019] [Accepted: 05/31/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate the influence of ethnicity in presentation of childhood-onset systemic lupus erythematosus (cSLE) patients. METHODS This multicenter study included cSLE patients (American College of Rheumatology criteria) followed in 27 Pediatric Rheumatology services of Brazil. Ethnicities were classified in four groups according to the parents' and all four grandparents' self-reported ethnicity. The statistical analysis was performed using the Bonferroni's correction (p < 0.0027). RESULTS According to ethnic groups, 1537 cSLE patients were classified in Caucasian (n = 786), African-Latin American (n = 526), Asian (n = 8), and others/unknown (n = 217). Comparisons between 1312 African-Latin American and Caucasian revealed similar median age at cSLE diagnosis [12.2(2.6-18) vs. 12.1(0.3-18) years, p = 0.234], time interval to diagnosis [0.25(0-12) vs. 0.3(0-10) years, p = 0.034], and SLEDAI-2K score [14(0-55) vs. 14(0-63), p = 0.781] in both groups. The mean number of diagnostic criteria according to SLICC (6.47 ± 1.911 vs. 5.81 ± 1.631, p < 0.0001) and frequencies of maculopapular lupus rash (8% vs. 3%, p < 0.0001), palate oral ulcers (17% vs. 11%, p = 0.001), tongue oral ulcers (4% vs. 1%, p = 0.001), and nonscarring alopecia (29% vs. 16%, p < 0.0001) were significantly higher in African-Latin American, whereas malar rash (45% vs. 58%, p < 0.0001) was more frequent in Caucasian. The presence of anti-phospholipid antibody (23% vs. 12%, p < 0.0001), low complement levels (58% vs. 41%, p < 0.0001), and isolated direct Coombs test (10% vs. 5%, p = 0.001) was also significantly higher in the former group. CONCLUSIONS Our study demonstrated that disease presentation severity of African-Latin American cSLE patients is comparable with Caucasian. Mucocutaneous manifestations and autoantibodies profile were the only distinctive features of the former group. The unique mixed background of Brazilian patients probably minimized race diversity spectrum of these patients. Key Points • Our study demonstrated that disease presentation severity of African-Latin American cSLE patients is comparable with Caucasian. • Mucocutaneous manifestations and autoantibodies profile were the only distinctive features of African-Latin American cSLE patients. • African-Latin American cSLE patients had more often anti-phospholipid antibodies and hypocomplementemia. • The unique mixed background of Brazilian patients probably minimized race diversity spectrum of these patients.
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Affiliation(s)
- Fernanda J Fiorot
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Aline G Islabão
- Pediatric Rheumatology Unit, Hospital Jose Alencar, Brasilia, Brazil
| | - Rosa M Pereira
- Division of Rheumatology Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Maria T Terreri
- Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Glaucia V Novak
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Beatriz C Molinari
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Ana P Sakamoto
- Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Nadia E Aikawa
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil.,Division of Rheumatology Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Lucia M Campos
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Octavio A Peracchi
- Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Simone Appenzeller
- Pediatric Rheumatology Unit, University of Campinas (UNICAMP), Campinas, Brazil
| | - Virgínia P Ferriani
- Pediatric Rheumatology Unit, Ribeirao Preto Medical School - University of Sao Paulo, Ribeirão Preto, Brazil
| | - Marco F Silva
- Pediatric Rheumatology Unit, Hospital Geral de Fortaleza, Fortaleza, Brazil
| | - Adriana R Fonseca
- Pediatric Rheumatology Unit, Rio de Janeiro Federal University (IPPMG-UFRJ), Rio de Janeiro, Brazil
| | - Flávio R Sztajnbok
- Pediatric Rheumatology Unit, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil
| | - Luciana B Paim
- Pediatric Rheumatology Unit, Albert Sabin Children's Hospital, Fortaleza, Brazil
| | - Melissa M Fraga
- Pediatric Rheumatology Unit, Hospital Darcy Vargas, Sao Paulo, Brazil
| | - Eunice M Okuda
- Pediatric Rheumatology Unit, Irmandade da Santa Casa de Misericórdia de Sao Paulo, Sao Paulo, Brazil
| | - Blanca E Bica
- Rheumatology Division - Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - Evaldo G Sena
- Pediatric Rheumatology Unit, Lauro Vanderley University Hospital, João Pessoa, Brazil
| | - Ana J Moraes
- Pediatric Rheumatology Unit, Federal University of Pará, Belém, Brazil
| | - Ana M Rolim
- Pediatric Rheumatology Unit, Obras Sociais Irmã Dulce, Salvador, Brazil
| | - Paulo F Spelling
- Pediatric Rheumatology Unit, Hospital Evangélico de Curitiba, Curitiba, Brazil
| | - Iloite M Scheibel
- Pediatric Rheumatology Unit, Hospital Criança Conceição, Porto Alegre, Brazil
| | - André S Cavalcanti
- Pediatric Rheumatology Unit, Federal University of Pernambuco, Recife, Brazil
| | - Erica N Matos
- Pediatric Rheumatology Unit, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Teresa C Robazzi
- Pediatric Rheumatology Unit, Federal University of Bahia, Salvador, Brazil
| | | | - Flávia P Santos
- Pediatric Rheumatology Unit, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Valeria C Ramos
- Pediatric Rheumatology Unit, Pontifícia Catholic University of Sorocaba, São Paulo, Brazil
| | - Magda Carneiro-Sampaio
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Eloisa Bonfá
- Division of Rheumatology Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Clovis A Silva
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil. .,Division of Rheumatology Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
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15
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Kim H, Levy DM, Silverman ED, Hitchon C, Bernatsky S, Pineau C, Smith CD, Tucker L, Petty R, Arbillaga H, Zummer M, Hudson M, Fortin P, Huber AM, Chedeville G, Peschken C, Pope JE. A comparison between childhood and adult onset systemic lupus erythematosus adjusted for ethnicity from the 1000 Canadian Faces of Lupus Cohort. Rheumatology (Oxford) 2019; 58:kez006. [PMID: 30805629 DOI: 10.1093/rheumatology/kez006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/03/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Childhood-onset SLE (cSLE) manifests differently than adult-onset SLE (aSLE). This study determined whether ethnic differences contribute to the differences in clinical presentation between the two groups. METHODS This cross-sectional study used data from a multi-centred registry from eight adult and four paediatric Canadian centres gathered at study entry. We compared the frequency of clinical manifestations and autoantibodies between aSLE and cSLE. For those with a significant difference, a multivariable logistic regression was performed, adjusting for ethnicity, SLE onset (cSLE vs aSLE), disease duration and centre. Disease activity and damage between aSLE and cSLE were compared after stratifying by disease duration. RESULTS Of 552 aSLE subjects, 502 (90.9%) were female and 381 (69.0%) were Caucasian. Mean age at diagnosis was 37.0 ± 13.6 years and disease duration 10.9 ± 9.6 years. Of 276 cSLE subjects, 231 (83.7%) were female and 101 (36.6%) were Caucasian. Mean age at diagnosis was 12.7 ± 3.3 years and disease duration 5.6 ± 8.2 years. In multivariable regression analysis, aSLE was associated with decreased odds of having a neurologic disorder (odds ratio = 0.49) and increased odds of having aCL antibodies (odds ratio = 1.85). Disease activity and damage accrual scores were higher in aSLE than cSLE within the same disease duration strata, although the differences were not clinically significant. Ethnicity was not associated with any differences in clinical manifestations or autoantibody frequency between aSLE and cSLE. CONCLUSIONS Although a crude comparison of aSLE and cSLE yielded several differences in clinical symptoms and autoantibodies, this difference was not attributable to ethnic differences between aSLE and cSLE.
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Affiliation(s)
- Hyein Kim
- Department of Medicine, University of Western Ontario, London
| | - Deborah M Levy
- Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
- Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada
| | - Earl D Silverman
- Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
- Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada
| | - Carol Hitchon
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sasha Bernatsky
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Christian Pineau
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - C Doug Smith
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lori Tucker
- Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Ross Petty
- Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Hector Arbillaga
- Division of Rheumatology, Rheumatology Clinic, Lethbridge, Alberta, Canada
| | - Michel Zummer
- Department of Rheumatology, Hopital Maisonneuve Rosemount, Montreal, Canada
| | - Marie Hudson
- Department of Rheumatology, Jewish General Hospital, Montreal, Canada
| | - Paul Fortin
- Department of Medicine, Division of Rheumatology, Laval University, Quebec City, Quebec, Canada
| | - Adam M Huber
- Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Gaelle Chedeville
- Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Christine Peschken
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Janet E Pope
- Department of Medicine, University of Western Ontario, London
- Rheumatology Centre, Department of Medicine, Division of Rheumatology, St. Joseph's Health Care, London, Ontario, Canada
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16
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Evaluation of Dry Eye Disease in Children With Systemic Lupus Erythematosus and Healthy Controls. Cornea 2019; 38:581-586. [DOI: 10.1097/ico.0000000000001902] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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17
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Groot N, Shaikhani D, Teng YKO, de Leeuw K, Bijl M, Dolhain RJEM, Zirkzee E, Fritsch‐Stork R, Bultink IEM, Kamphuis S. Long-Term Clinical Outcomes in a Cohort of Adults With Childhood-Onset Systemic Lupus Erythematosus. Arthritis Rheumatol 2019; 71:290-301. [PMID: 30152151 PMCID: PMC6590133 DOI: 10.1002/art.40697] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 08/21/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Childhood-onset systemic lupus erythematosus (SLE) is a severe, lifelong, multisystem autoimmune disease. Long-term outcome data are limited. This study was undertaken to identify clinical characteristics and health-related quality of life (HRQoL) of adults with childhood-onset SLE. METHODS Patients participated in a single study visit comprising a structured history and physical examination. Disease activity (scored using the SLE Disease Activity Index 2000 [SLEDAI-2K]), damage (scored using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]), and HRQoL (scored using the Short Form 36 Health Survey) were assessed. Medical records were reviewed. RESULTS In total, 111 childhood-onset SLE patients were included; the median disease duration was 20 years, 91% of patients were female, and 72% were white. Disease activity was low (median SLEDAI-2K score 4), and 71% of patients received prednisone, hydroxychloroquine (HCQ), and/or other disease-modifying antirheumatic drugs. The vast majority of new childhood-onset SLE-related manifestations developed within 2 years of diagnosis. Damage such as myocardial infarctions began occurring after 5 years. Most patients (62%) experienced damage, predominantly in the musculoskeletal, neuropsychiatric, and renal systems. Cerebrovascular accidents, renal transplants, replacement arthroplasties, and myocardial infarctions typically occurred at a young age (median age 20 years, 24 years, 34 years, and 39 years, respectively). Multivariate logistic regression analysis showed that damage accrual was associated with disease duration (odds ratio [OR] 1.15, P < 0.001), antiphospholipid antibody positivity (OR 3.56, P = 0.026), and hypertension (OR 3.21, P = 0.043). Current HCQ monotherapy was associated with an SDI score of 0 (OR 0.16, P = 0.009). In this cohort, HRQoL was impaired compared to the overall Dutch population. The presence of damage reduced HRQoL scores in 1 domain. High disease activity (SLEDAI-2K score ≥8) and changes in physical appearance strongly reduced HRQoL scores (in 4 of 8 domains and 7 of 8 domains, respectively). CONCLUSION The majority of adults with childhood-onset SLE in this large cohort developed significant damage at a young age and had impaired HRQoL without achieving drug-free remission, illustrating the substantial impact of childhood-onset SLE on future life.
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Affiliation(s)
- N. Groot
- Sophia Children’s HospitalErasmus University Medical Center, Rotterdam, The Netherlands, and Wilhelmina Children’s HospitalUniversity Medical CenterUtrechtThe Netherlands
| | - D. Shaikhani
- Sophia Children’s HospitalErasmus University Medical CenterRotterdamThe Netherlands
| | - Y. K. O. Teng
- Leiden University Medical CenterLeidenThe Netherlands
| | - K. de Leeuw
- University Medical CenterGroningenThe Netherlands
| | - M. Bijl
- Martini HospitalGroningenThe Netherlands
| | | | - E. Zirkzee
- Maasstad HospitalRotterdamThe Netherlands
| | - R. Fritsch‐Stork
- University Medical Center, Utrecht, The Netherlands, Hanusch Hospital of WGKK and AUVA Trauma Center, Vienna, Austria, and Sigmund Freud UniversityViennaAustria
| | - I. E. M. Bultink
- Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - S. Kamphuis
- Sophia Children’s HospitalErasmus University Medical CenterRotterdamThe Netherlands
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Lin CY, Loyola-Sanchez A, Hurd K, Ferucci ED, Crane L, Healy B, Barnabe C. Characterization of indigenous community engagement in arthritis studies conducted in Canada, United States of America, Australia and New Zealand. Semin Arthritis Rheum 2019; 49:145-155. [PMID: 30598333 DOI: 10.1016/j.semarthrit.2018.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 10/21/2018] [Accepted: 11/20/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Research adhering to community engagement processes leads to improved outcomes. The level of Indigenous communities' engagement in rheumatology research is unknown. OBJECTIVE To characterize the frequency and level of community engagement reporting in arthritis studies conducted in Australia (AUS), Canada (CAN), New Zealand (NZ) and the United States of America (USA). METHODS Studies identified through systematic reviews on topics of arthritis epidemiology, disease phenotypes and outcomes, health service utilization and mortality in Indigenous populations of AUS, CAN, NZ and USA, were evaluated for their descriptions of community engagement. The level of community engagement during inception, data collection and results interpretation/dissemination stages of research was evaluated using a custom-made instrument, which ranked studies along the community engagement spectrum (i.e. inform-consult-involve-collaborate-empower). Meaningful community engagement was defined as involving, collaborating or empowering communities. Descriptive analyses for community engagement were performed and secondary non-parametric inferential analyses were conducted to evaluate the possible associations between year of publication, origin of the research idea, publication type and region of study; and meaningful community engagement. RESULTS Only 34% (n = 69) of the 205 studies identified reported community engagement at ≥ 1 stage of research. Nearly all studies that engaged communities (99% (n = 68)) did so during data collection, while only 10% (n = 7) did so at the inception of research and 16% (n = 11) described community engagement at the results' interpretation/dissemination stage. Most studies provided community engagement descriptions that were assessed to be at the lower end of the spectrum. At the inception of research stage, 3 studies reported consulting communities, while 42 studies reported community consultation at data collection stage and 4 studies reported informing or consulting communities at the interpretation/dissemination of results stage. Only 4 studies described meaningful community engagement through all stages of the research. Inferential statistics identified that studies with research ideas that originated from the Indigenous communities involved were significantly more associated with achieving meaningful community engagement. CONCLUSIONS The reporting of Indigenous community engagement in published arthritis studies is limited in frequency and is most frequently described at the lower end of the community engagement spectrum. Processes that support meaningful community engagement are to be promoted.
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Affiliation(s)
- Chu Yang Lin
- Faculty of Medicine & Dentistry, University of Alberta, Canada.
| | | | - Kelle Hurd
- Cumming School of Medicine, University of Calgary, Canada.
| | | | | | - Bonnie Healy
- Alberta First Nations Information Governance Center, Canada.
| | - Cheryl Barnabe
- Departments of Medicine and Community Health Sciences, University of Calgary and Rheumatologist, Alberta Health Services, 3330 Hospital Drive NW, T2N 4N1, Calgary, Alberta, Canada.
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Chottawornsak N, Rodsaward P, Suwannachote S, Rachayon M, Rattananupong T, Deekajorndech T, Asawanonda P, Chiewchengchol D, Rerknimitr P. Skin signs in juvenile- and adult-onset systemic lupus erythematosus: clues to different systemic involvement. Lupus 2018; 27:2069-2075. [PMID: 30336755 DOI: 10.1177/0961203318805851] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We aim to explore the differences of skin signs between juvenile- and adult-onset systemic lupus erythematosus and to identify their associations to the development of systemic involvement. METHODS A retrospective chart review of 377 systemic lupus erythematosus patients was performed. RESULTS In total, 171 patients with juvenile systemic lupus erythematosus and 206 with adult systemic lupus erythematosus were studied. All patients were of Southeast Asian descent. The mean duration of follow up was 8.18 ± 6.19 and 9.36 ± 7.68 years for juvenile systemic lupus erythematosus and adult systemic lupus erythematosus, respectively. At diagnosis, most patients presented with acute cutaneous lupus erythematosus, whereas chronic cutaneous lupus erythematosus was twice as common in adult systemic lupus erythematosus ( p < 0.001). The mean Systemic Lupus Erythematosus Disease Activity Index of juvenile systemic lupus erythematosus was significantly higher than that of adult systemic lupus erythematosus (14.29 ± 7.13 vs 11.27 ± 6.53). Multivariate analysis revealed the following associations in juvenile systemic lupus erythematosus: acute cutaneous lupus erythematosus and non-scarring alopecia with increased risk of arthralgia, mucosal ulcers with leukopenia, cutaneous vasculitis with seizure, and finding of granular casts. On the contrary, the associations for adult systemic lupus erythematosus were oral ulcers with arthralgia and cutaneous vasculitis with myositis. CONCLUSIONS Cutaneous signs in systemic lupus erythematosus may signal prognostic implication. Interestingly, despite similar cutaneous lesions in systemic lupus erythematosus, different ages of onset are associated with different systemic involvement.
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Affiliation(s)
- N Chottawornsak
- 1 Division of Dermatology, Chulalongkorn University, Bangkok, Thailand
| | - P Rodsaward
- 2 Center of Excellence in Immunology and Immune-mediated Diseases, Chulalongkorn University, Bangkok, Thailand
| | - S Suwannachote
- 2 Center of Excellence in Immunology and Immune-mediated Diseases, Chulalongkorn University, Bangkok, Thailand
| | - M Rachayon
- 2 Center of Excellence in Immunology and Immune-mediated Diseases, Chulalongkorn University, Bangkok, Thailand
| | - T Rattananupong
- 3 Department of Preventive and Social Medicine, Chulalongkorn University, Bangkok, Thailand
| | - T Deekajorndech
- 4 Division of Pediatric Nephrology, Chulalongkorn University, Bangkok, Thailand
| | - P Asawanonda
- 1 Division of Dermatology, Chulalongkorn University, Bangkok, Thailand
| | - D Chiewchengchol
- 2 Center of Excellence in Immunology and Immune-mediated Diseases, Chulalongkorn University, Bangkok, Thailand
| | - P Rerknimitr
- 1 Division of Dermatology, Chulalongkorn University, Bangkok, Thailand
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Aggarwal A, Phatak S, Srivastava P, Lawrence A, Agarwal V, Misra R. Outcomes in juvenile onset lupus: single center cohort from a developing country. Lupus 2018; 27:1867-1875. [DOI: 10.1177/0961203318791046] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction About 10–20% of systemic lupus erythematosus (SLE) patients have onset in childhood and have more severe organ involvement. Survival of juvenile SLE patients is improving worldwide. Long-term data of childhood onset SLE from developing countries is scarce. Methods Clinical and laboratory data at initial presentation and follow-up visits were retrieved from clinic files, hospital information system and personal interviews. Treatment received, complications, flares, outcomes and death were recorded. Survival was calculated using Kaplan–Meier survival curves and regression analysis was done for predictors of mortality. Results Children with SLE ( n = 273, 250 girls) had a median age at onset of 14 years and duration of illness prior to diagnosis at our hospital of 1 year. Fever and arthritis were the most common presenting manifestations. Renal disease was seen in 60.5% and central nervous system (CNS) disease in 29%. The median follow-up period in 248 patients was 3.5 years. Fourteen children died, and 10 of these had active disease at the time of death. The mean actuarial survival was 24.5 years and survival rates at 1, 5 and 10 years were 97.9%, 95% and 89% respectively. Fever, CNS disease, anti-dsDNA levels and serious infections predicted death on univariate and multivariate analysis. Infections were seen in 72 children (26.3%), and 38 of these infections were serious. One-third of the patients had damage on the last follow-up. Flares were seen in 120 children, the majority being major flares. Conclusion Outcomes of pediatric SLE in North Indian children are similar to those seen in developed countries. Infections pose a major challenge in these patients.
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Affiliation(s)
- A Aggarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - S Phatak
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - P Srivastava
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - A Lawrence
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - V Agarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - R Misra
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Gergianaki I, Bertsias G. Systemic Lupus Erythematosus in Primary Care: An Update and Practical Messages for the General Practitioner. Front Med (Lausanne) 2018; 5:161. [PMID: 29896474 PMCID: PMC5986957 DOI: 10.3389/fmed.2018.00161] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 05/08/2018] [Indexed: 12/29/2022] Open
Abstract
Systemic Lupus Erythematosus (SLE) is a complex chronic autoimmune disease that manifests a wide range of organ involvement. Traditionally, the diagnosis and management of SLE is provided at secondary and tertiary centers to ensure prompt initiation of treatment, adequate control of flares and prevention of irreversible organ damage. Notwithstanding, the role of primary care in SLE is also emerging as there are still significant unmet needs such as the diagnostic delay at the community level and the high burden of therapy- and disease-related comorbidities. In the present review, we summarize practical messages for primary care physicians and general practitioners (GPs) concerning early diagnosis and proper referral of patients with SLE. In addition, we discuss the main comorbidities complicating the disease course and the recommended preventative measures, and we also provide an update on the role and current educational needs of GPs regarding the disease.
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Affiliation(s)
- Irini Gergianaki
- Rheumatology, Clinical Immunology and Allergy, University of Crete Faculty of Medicine, Iraklio, Greece
| | - George Bertsias
- Rheumatology, Clinical Immunology and Allergy, University of Crete Faculty of Medicine, Iraklio, Greece
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Lim LSH, Pullenayegum E, Feldman BM, Lim L, Gladman DD, Silverman ED. From Childhood to Adulthood: Disease Activity Trajectories in Childhood-Onset Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2018; 70:750-757. [DOI: 10.1002/acr.23319] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 07/11/2017] [Indexed: 01/13/2023]
Affiliation(s)
- Lily Siok Hoon Lim
- University of Manitoba, Winnipeg, Manitoba, Canada; and Institute of Health Policy Management & Evaluation; Toronto Ontario Canada
| | | | - Brian M. Feldman
- The Hospital for Sick Children (SickKids); Toronto Ontario Canada
| | - Lillian Lim
- The Hospital for Sick Children (SickKids); Toronto Ontario Canada
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Mohamed DF, Aziz ABEDA, Hassan SAM, Shedid NH, El-Owaidy RH, Teama MAEM. Juvenile lupus: Different clinical and serological presentations compared to adult lupus in Egypt. EGYPTIAN RHEUMATOLOGIST 2018. [DOI: 10.1016/j.ejr.2017.04.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Tian SY, Silverman ED, Pullenayegum E, Brown PE, Beyene J, Feldman BM. Comparative Effectiveness of Mycophenolate Mofetil for the Treatment of Juvenile-Onset Proliferative Lupus Nephritis. Arthritis Care Res (Hoboken) 2017; 69:1887-1894. [PMID: 28182833 DOI: 10.1002/acr.23215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 01/31/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Although juvenile-onset proliferative lupus nephritis (PLN) leads to significant morbidity and mortality, there is no clinical trials-based evidence to support the treatment effectiveness of any therapy for juvenile-onset PLN. Marginal structural models enable us to estimate treatment effectiveness using observational data while accounting for confounding by indication. METHODS We used prospectively collected data to examine the effect of mycophenolate mofetil (MMF), compared to the use of other therapies, on the long-term outcome of a juvenile-onset PLN cohort (age at PLN onset <18 years). The major outcome variable was the estimated glomerular filtration rate (GFR) using the revised Schwartz formula. Confounding by indication was corrected for marginal structural model. RESULTS A total of 172 subjects with juvenile-onset PLN, with a mean followup duration of approximately 4 years, were included. Overall, MMF was superior to other therapies, with a relative effect estimate for MMF of 1.06, i.e., 6% better estimated GFR on average (95% confidence interval 0.7, 11.3), corrected for potential confounding by indication. We found that beginning in year 4 there was a significant improvement in estimated GFR in the patients who were treated with MMF versus other therapies. This improvement was maintained until the end of the study. CONCLUSION MMF was more beneficial than other therapies in improving/maintaining long-term renal function in patients with juvenile-onset PLN up to a maximum followup of 7 years. This finding is consistent with evidence from adult PLN clinical trials.
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Affiliation(s)
- Simon Y Tian
- Program of Child Health Evaluative Sciences, The Hospital for Sick Children and The Hospital for Sick Children Research Institute, and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Earl D Silverman
- Program of Child Health Evaluative Sciences, The Hospital for Sick Children and The Hospital for Sick Children Research Institute, and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Eleanor Pullenayegum
- Program of Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, and Dalla Lana School of Public Health, University of Toronto, Toronto, and McMaster University, Hamilton, Ontario, Canada
| | - Patrick E Brown
- University of Toronto and Cancer Care Ontario, Toronto, Ontario, Canada
| | - Joseph Beyene
- McMaster University, Hamilton, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Brian M Feldman
- The Hospital for Sick Children, The Hospital for Sick Children Research Institute, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Lim LSH, Pullenayegum E, Lim L, Gladman D, Feldman B, Silverman E. From Childhood to Adulthood: The Trajectory of Damage in Patients With Juvenile-Onset Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2017; 69:1627-1635. [DOI: 10.1002/acr.23199] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 01/17/2017] [Indexed: 12/14/2022]
Affiliation(s)
| | | | - Lillian Lim
- SickKids Child Health Evaluative Services; Toronto Ontario Canada
| | - Dafna Gladman
- University of Toronto and Toronto Western Hospital; Toronto Ontario Canada
| | - Brian Feldman
- The Hospital for Sick Children; Toronto Ontario Canada
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Abstract
INTRODUCTION Systemic lupus erythematosus (SLE) is a disease distributed worldwide, which occurs in both genders, and across racial/ethnic and age groups; however, higher rates are observed in adults, in women and in non-Caucasians. Genetic, environmental, sociodemographic and methodological issues are responsible not only for these differences but for the variable course and outcome of the disease. Non-Caucasians have a more severe disease with a higher risk for early mortality and damage accrual. Males also have a more severe disease; however, a negative impact of male gender on lupus outcomes has not been firmly established. Childhood-onset is associated with a more severe disease; moreover, it is also associated with higher damage and diminished survival; finally, late-onset lupus is mild but it is associated with higher damage accrual and a diminished survival. Areas covered: In this review, we discuss the incidence and prevalence of SLE, the impact of age, gender and race/ethnicity in SLE and in the survival of those affected. Expert commentary: Age, gender and race/ethnicity impact disease expression in SLE patients; despite improvements in survival, mortality in SLE remains almost three times higher than in the general population.
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Affiliation(s)
- Guillermo J Pons-Estel
- a Department of Autoimmune Diseases , Institut Clinic de Medicina I Dermatologia, Hospital Clinic , Barcelona , Catalonia , Spain.,b Division of Rheumatology and Autoimmune Diseases , Sanatorio Parque, Grupo Oroño , Rosario , Argentina
| | - Manuel F Ugarte-Gil
- c Servicio de Reumatología , Hospital Nacional Guillermo Almenara Irigoyen, EsSalud , Lima , Perú.,d School of Medicine , Universidad Científica del Sur , Lima , Perú
| | - Graciela S Alarcón
- e Division of Clinical Immunology and Rheumatology, School of Medicine , The University of Alabama at Birmingham , Birmingham , AL , USA.,f Department of Medicine, School of Medicine , Universidad Peruana Cayetano Heredia , Lima , Perú
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Hurd K, Barnabe C. Systematic review of rheumatic disease phenotypes and outcomes in the Indigenous populations of Canada, the USA, Australia and New Zealand. Rheumatol Int 2017; 37:503-521. [PMID: 27988789 PMCID: PMC5357284 DOI: 10.1007/s00296-016-3623-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/30/2016] [Indexed: 01/17/2023]
Abstract
We performed a systematic review designed to characterize clinical phenotypes and outcomes in Indigenous populations with rheumatic disease to enhance the understanding of how rheumatic disease presents in Indigenous populations and allow for better projection of the healthcare needs of the communities affected. A systematic search was performed in medical (Medline, EMBASE, CINAHL), Indigenous and conference abstract databases (to June 2015). Search terms for Indigenous populations were combined with terms for inflammatory arthritis conditions, connective tissue disorders, crystal arthritis and osteoarthritis. Studies were included if they reported on disease features, disease activity measures, or patient-reported outcomes in Canadian, American, Australian or New Zealand Indigenous populations. Data were extracted in duplicate, and a narrative summary was prepared. A total of 5269 titles and abstracts were reviewed, of which 504 underwent full-text review and 85 met inclusion criteria. Nearly all the studies described outcomes in the North American populations (n = 77), with only four studies from Australia and four studies from New Zealand. The majority of studies were in rheumatoid arthritis (n = 31) and systemic lupus erythematosus (n = 19). Indigenous patients with rheumatoid arthritis had higher disease activity and reported more significant impact on patient-reported outcomes and quality of life than non-Indigenous patients. Spondyloarthropathy features were described in North American populations, with most patients having advanced manifestations. In systemic lupus erythematosus, nephritis was more frequent in Indigenous populations. Gout and osteoarthritis were more severe in New Zealand Maori populations. The existing literature supports differences in disease phenotype and severity in Indigenous populations of Canada, America, Australia and New Zealand. We encourage investigators in this area of research to undertake contemporary studies that disentangle differences between phenotype and severity that are biologic in etiology or merely reflecting differences in access to care and that provide a longitudinal assessment of outcomes in more diverse populations.
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Affiliation(s)
- Kelle Hurd
- Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Cheryl Barnabe
- Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.
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Wright TB, Punaro M. Paediatric systemic lupus erythematosus: insights from translational research. Rheumatology (Oxford) 2017; 56:i24-i31. [DOI: 10.1093/rheumatology/kew447] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Indexed: 01/06/2023] Open
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Artim-Esen B, Şahin S, Çene E, Şahinkaya Y, Barut K, Adrovic A, Özlük Y, Kılıçaslan I, Omma A, Gül A, Öcal L, Kasapçopur Ö, İnanç M. Comparison of Disease Characteristics, Organ Damage, and Survival in Patients with Juvenile-onset and Adult-onset Systemic Lupus Erythematosus in a Combined Cohort from 2 Tertiary Centers in Turkey. J Rheumatol 2017; 44:619-625. [PMID: 28298568 DOI: 10.3899/jrheum.160340] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2017] [Indexed: 12/22/2022]
Abstract
Objective.Age at onset has been shown to affect the clinical course and outcome of systemic lupus erythematosus (SLE). Herein, we aimed to define the differences in clinical characteristics, organ damage, and survival between patients with juvenile-onset (jSLE) and adult-onset SLE (aSLE).Methods.For the study, 719 patients (76.9%) with aSLE and 216 (23.1%) with jSLE were examined. Comparisons between the groups were made for demographic characteristics, clinical features, auto-antibody profiles, damage, and survival rates.Results.These results were significantly more frequent in jSLE: photosensitivity, malar rash, oral ulcers, renal involvement, neuropsychiatric (NP) manifestations, and autoimmune hemolytic anemia (AIHA). Of the autoantibodies, a higher frequency of anti-dsDNA and anticardiolipin IgG and IgM were observed in the jSLE group. A significant proportion of patients with aSLE had anti-Sm positivity and pleuritis. The proportion of patients with jSLE who developed organ damage was comparable to that of patients with aSLE (53% vs 47%) and the mean damage scores were similar in both groups. Renal damage was significantly more frequent in jSLE while musculoskeletal and cardiovascular system damage and diabetes mellitus were more prominent in aSLE. Comparison of survival rates of the 2 groups did not reveal any significant differences.Conclusion.We report a higher frequency in the jSLE group of renal involvement, cutaneous symptoms, oral ulcers, NP manifestations, AIHA, and anti-dsDNA positivity. A significant proportion of patients in the jSLE group had damage, most prominently in the renal domain. Our findings might support different genetic/environmental backgrounds for these 2 subgroups.
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Advances in the care of children with lupus nephritis. Pediatr Res 2017; 81:406-414. [PMID: 27855151 DOI: 10.1038/pr.2016.247] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 10/07/2016] [Indexed: 12/27/2022]
Abstract
The care of children with lupus nephritis (LN) has changed dramatically over the past 50 y. The majority of patients with childhood-onset systemic lupus erythematosus (cSLE) develop LN. In the 1960's, prognosis in children was worse than in adults; therapies were limited and toxic. Nearly half of cases resulted in death within 2 y. Since this time, several diagnostic recommendations and disease-specific indices have been developed to assist physicians caring for patients with LN. Pediatric researchers are validating and adapting these indices and guidelines for the treatment of LN in cSLE. Classification systems, activity, and chronicity indices for kidney biopsy have been validated in pediatric cohorts in several countries. Implementation of contemporary immunosuppressive agents has reduced treatment toxicity and improved outcomes. Biomarkers sensitive to LN in children have been identified in the kidney, urine, and blood. Multi-institutional collaborative networks have formed to address the challenges of pediatric LN research. Considerable variation in evaluation and treatment has been addressed for proliferative forms of LN by development of consensus treatment practices. Patient survival at 5 y is now 95-97% and renal survival exceeds 90%. Moreover, international consensus exists for quality indicators for cSLE that consider the unique aspects of chronic disease in childhood.
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Olaosebikan BH, Adelowo OO, Animashaun BA, Akintayo RO. Spectrum of paediatric rheumatic diseases in Nigeria. Pediatr Rheumatol Online J 2017; 15:7. [PMID: 28143550 PMCID: PMC5282742 DOI: 10.1186/s12969-017-0139-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/23/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Paediatric rheumatology service in Sub-Sahara African is virtually not available as there is a shortage of paediatric rheumatologists and other rheumatology health professionals. We aim to describe the clinical spectrum and the frequencies of paediatric rheumatic diseases (PRDs) in Lagos State University Teaching Hospital (LASUTH), Lagos, Nigeria. METHODS This is a retrospective review of patients with PRDs seen over a five year period (March 2010 to February 2016) at the rheumatology clinic and children ward of LASUTH. We reviewed the folders of 57 patients from our records. The demographics, baseline laboratory features, clinical diagnosis, treatment patterns and patient outcomes were extracted and analyzed. Clinical and laboratory characteristics between patients with Juvenile idiopathic arthritis (JIA) and patients with juvenile connective tissue diseases (JCTD) were compared using Fisher's exact test. RESULTS Fifty seven patients were studied with a female to male ratio of 3 to 1 (Female: 43; M: 14). The mean age at presentation in years was 14 ± 4.4 years (range: 1.5-22 years). The mean duration of symptoms before diagnosis was 18.4 ± .9 months (range: 2-60 months). The diagnostic types of PRDs included 28(49.1%) cases of JIA. These were made up of 14 cases of polyarticular JIA, nine cases of oligoarticular JIA and 5 cases of systemic onset JIA. Others were 18 (24.6%) cases of juvenile systemic lupus erythematosus (JSLE), 3 (5.3%) cases of joint hypermobility syndrome, 2 (3.5%) cases of juvenile systemic sclerosis, 2 (3.5%) cases of fibromyalgia, 2 (3.5%) cases of plantar fasciitis, 1 (1.6%) case of juvenile dermatomyositis (JDM), 1 (1.6%) case of juvenile polymyositis-systemic lupus erythematosus (PM-SLE) overlap, 1 (1.6%) case of secondary bilateral knee osteoarthritis from Blount disease, 1 (1.6%) case of secondary osteoporosis from childhood leukemia and 1 (1.6%) case of Osgood-Schlatter's disease. Constitutional symptoms and extra-articular diseases were significantly more frequent among JCTD cases than among the JIA cases (Constitutional symptoms: 100% vs 83.3%, p = 0.003; extra-articular disease: 100% vs 10.7%, p = 0.001). The percentage mortality in this study was 10.5% while 20 (35.1%) of the patients were lost to clinic follow up. CONCLUSION The pattern of PRDs observed in this study is similar to that described in South African and North American series but it differs from patterns reported in Asian series. Although hitherto largely unrecognized, PRDs may constitute a substantial cause of morbidity and mortality in black Africans.
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Affiliation(s)
- Babatunde Hakeem Olaosebikan
- 0000 0004 0481 2583grid.411278.9Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos State Nigeria
| | - Olufemi Oladipo Adelowo
- 0000 0004 0481 2583grid.411278.9Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos State Nigeria
| | - Barakat Adeola Animashaun
- 0000 0004 0481 2583grid.411278.9Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Lagos State Nigeria
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Adelowo OO, Olaosebikan BH, Animashaun BA, Akintayo RO. Juvenile systemic lupus erythematosus in Nigeria. Lupus 2016; 26:329-333. [DOI: 10.1177/0961203316672927] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Juvenile systemic lupus erythematosus (JSLE) is a complex multisystemic autoimmune disorder of unknown cause. It accounts for about one in five cases of SLE. The tendency for SLE to run a fulminant course when it starts in childhood has made JSLE a potentially more severe disease than adult SLE. Reports of JSLE from sub-Saharan Africa are scanty in spite of the increasing reports of adult SLE. We conducted a 4-year retrospective study of JSLE cases seen at the Lagos State University Teaching Hospital between January 2010 and December 2014. Out of the 12 patients studied, eight were girls and four were boys. All patients had positive antinuclear antibody and extractable nuclear antibody tests. Anti-dsDNA antibody was positive in 10 patients. Eight patients had renal disease while four patients had neuropsychiatric manifestations. Haematological abnormalities and constitutional symptoms were present in all patients. Patients were treated with pulse methylprednisolone, oral prednisolone, hydroxychloroquine and azathioprine. Three patients also received rituximab. In conclusion, JSLE exists in Nigeria and exhibits clinical and immunological characteristics similar to its pattern in other parts of the world. It is, however, diagnosed late and is possibly being underdiagnosed as there is no paediatric rheumatologist in the country.
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Affiliation(s)
- O O Adelowo
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Nigeria
| | - B H Olaosebikan
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Nigeria
| | - B A Animashaun
- Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Nigeria
| | - R O Akintayo
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
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Moorthy LN, Baldino ME, Kurra V, Puwar D, Llanos A, Peterson MGE, Hassett AL, Lehman TJA. Relationship between health-related quality of life, disease activity and disease damage in a prospective international multicenter cohort of childhood onset systemic lupus erythematosus patients. Lupus 2016; 26:255-265. [DOI: 10.1177/0961203316659546] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Previously, we described associations between health-related quality of life (HRQOL) and disease-related factors among childhood onset systemic lupus erythematosus (cSLE) patients. Here we determined the relationship between HRQOL, disease activity and damage in a large prospective international cohort of cSLE. We compared HRQOL, disease activity and disease damage across different continents and examined the relationship between children's and parents' assessments of HRQOL. Patients with cSLE and their parents completed HRQOL measures at enrollment and ≥4 follow-up visits. Physicians assessed disease activity and damage. The multinational cohort ( n = 467) had relatively low disease activity and damage. Patient and parent HRQOL scores were significantly correlated. Asian and European patients had the highest HRQOL, while South and North American patients had lower HRQOL scores. Renal, CNS, skin and musculoskeletal systems exhibited the highest levels of damage. North and South American and Asian patients were more likely to have disease damage and activity scores above median values, compared with Europeans. Asians were more likely to use cyclophosphamide/rituximab. Female gender, high disease activity and damage, non-White ethnicity, and use of cyclophosphamide and/rituximab were related to lower HRQOL. HRQOL domain scores continue to emphasize that SLE has widespread impact on all aspects of children's and parents' lives.
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Affiliation(s)
- L N Moorthy
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, USA
| | - M E Baldino
- Rutgers School of Public Health, Piscataway, USA
| | - V Kurra
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, USA
| | - D Puwar
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, USA
| | - A Llanos
- Rutgers School of Public Health, Piscataway, USA
| | | | - A L Hassett
- University of Michigan, Department of Anesthesiology, USA
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Morais SA, Isenberg DA. A study of the influence of ethnicity on serology and clinical features in lupus. Lupus 2016; 26:17-26. [PMID: 27216418 DOI: 10.1177/0961203316645204] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/24/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The objective of this study was to review the links between ethnicity, serology and clinical expression in systemic lupus erythematosus (SLE) in a single cohort that was followed over a 36-year period. PATIENTS AND METHODS Patients with SLE treated at the University College London Hospitals (UCLHs) between January 1978 and December 2013 formed the cohort. We assessed the demographic, clinical and serological data. Standard methods were used for laboratory testing. The Student t test and Mann-Whitney U test were used for the continuous variables; the Fisher's exact test was used for the categorical variables. RESULTS We studied 624 SLE patients: There were 571 women (91.5%), with a mean age at diagnosis of 29.0 ± 6.5 years; and 53 men (8.5%), with a mean age at diagnosis of 29.4 ± 15.3 years. Ethnically, 369 of the patients were European, 100 were Afro-Caribbean, 77 were East Asian, 56 were South Asian and 21 were of mixed ethnicity. The East Asian patients developed the disease at a younger age than the other ethnic groups (p < 0.0001). The Afro-Caribbean patients were less frequently associated with the presence of rash and photosensitivity, and the non-European patients were more likely to have alopecia and renal involvement. The South Asian patients were significantly associated with musculoskeletal and neurological involvement, serositis, Sicca syndrome and hematological features. The Afro-Caribbean patients had the highest prevalence of anti-Smith, anti-RNP, anti-Ro and anti-La antibodies. Anti-IgG anticardiolipin (aCL) antibodies were significantly associated with the non-East Asian groups; and hypocomplementemia was common in the East Asians. Rash, alopecia, mouth ulcers, serositis, neurological, joint and renal involvement were significantly associated with the presence of anti-Smith and anti-RNP antibodies in the Afro-Caribbean group. We also observed an association of joint involvement and the presence of anti-Ro and anti-La antibodies in this group. CONCLUSIONS The East Asian patients developed their SLE disease at a younger age than the other ethnic groups. Cutaneous involvement was more frequent in those who were not Afro-Caribbean. Serositis, joint and neurological involvement were more frequently diagnosed in the South Asian patients. Anti-ENA antibodies were frequently associated with the Afro-Caribbean patients.
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Affiliation(s)
- S A Morais
- Internal Medicine Department, Hospital Pedro Hispano, Matosinhos, Portugal
| | - D A Isenberg
- Centre for Rheumatology, University College London Hospitals, London, UK
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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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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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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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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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Terao C, Yamada R, Mimori T, Yamamoto K, Sumida T. A nationwide study of SLE in Japanese identified subgroups of patients with clear signs patterns and associations between signs and age or sex. Lupus 2014; 23:1435-42. [DOI: 10.1177/0961203314547790] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
We performed a nationwide study to determine the distributions of the signs and clinical markers of systemic lupus erythematosus (SLE) and identify any patterns in their distributions to allow patient subclassification. We obtained 256,999 patient-year records describing the disease status of SLE patients from 2003 to 2010. Of these, 14,779 involved patients diagnosed within the last year, and 242,220 involved patients being followed up. Along with basic descriptive statistics, we analyzed the effects of sex, age and disease duration on the frequencies of signs in the first year and follow-up years. The patients and major signs were clustered using the Ward method. The female patients were younger at onset. Renal involvement and discoid eczema were more frequent in males, whereas arthritis, photosensitivity and cytopenia were less. Autoantibody production and malar rash were positively associated with young age, and serositis and arthritis were negatively associated. Photosensitivity was positively associated with a long disease duration, and autoantibody production, serositis and cytopenia were negatively associated. The SLE patients were clustered into subgroups, as were the major signs. We identified differences in SLE clinical features according to sex, age and disease duration. Subgroups of SLE patients and the major signs of SLE exist.
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Affiliation(s)
- C Terao
- Center for Genomic Medicine
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - T Mimori
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - K Yamamoto
- Department of Allergy and Rheumatology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - T Sumida
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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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: 57] [Impact Index Per Article: 5.7] [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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Impact of race and ethnicity in the course and outcome of systemic lupus erythematosus. Rheum Dis Clin North Am 2014; 40:433-54, vii-viii. [PMID: 25034155 DOI: 10.1016/j.rdc.2014.04.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Genetic factors seem to play a more important role early in the course of systemic lupus erythematosus (SLE), whereas nongenetic factors seem to play a more important role over the course of the disease. SLE is more frequent with less favorable outcomes in nonwhite populations. To overcome these differences and reduce the immediate-term, mediate-term, and long-term impact of SLE among disadvantaged populations, it is essential to increase disease awareness, to improve access to health care and to provide care to these patients in a consistent manner regardless of the severity of their disease.
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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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Knight AM, Weiss PF, Morales KH, Keren R. National trends in pediatric systemic lupus erythematosus hospitalization in the United States: 2000-2009. J Rheumatol 2014; 41:539-46. [PMID: 24488419 DOI: 10.3899/jrheum.130592] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE In the setting of recent healthcare advances and emphasis on reduced spending, we aimed to characterize US trends in inpatient healthcare use and mortality for pediatric systemic lupus erythematosus (SLE). METHODS We performed a retrospective, serial, cross-sectional analysis of the national Kids' Inpatient Database (for 2000, 2003, 2006, and 2009). We identified patients with SLE aged 2 to 21 years using an International Classification of Diseases, 9th revision (ICD-9) code of 710.0 listed as a discharge diagnosis. Using sampling weights, we estimated trends in hospitalization, inpatient mortality, procedure rates, and length of stay (LOS). We analyzed patient and hospital-specific risk factors for mortality and LOS, and compared those outcomes to those without SLE. RESULTS We identified 26,903 estimated pediatric SLE hospitalizations. The hospitalization rate of 8.6 (95% CI 7.6-9.6) per 100,000 population and mean LOS of 5.9 days (95% CI 5.6-6.2) were stable over time. We found a significant downward trend in mortality, decreasing from 1% to 0.6% (p = 0.04), which paralleled a less pronounced trend for those without SLE. The rate of dialysis, blood transfusions, and vascular catheterization procedures increased. Patients with SLE nephritis and non-white race were at risk for increased healthcare use and death. CONCLUSION Pediatric SLE hospitalization rate and LOS remained stable, but inpatient mortality decreased as the rate of common therapeutic procedures increased. More research is needed to understand the drivers of these relationships.
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Affiliation(s)
- Andrea M Knight
- From the Division of Rheumatology, the Division of General Pediatrics, and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia; the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Barsalou J, Levy DM, Silverman ED. An update on childhood-onset systemic lupus erythematosus. Curr Opin Rheumatol 2013; 25:616-22. [DOI: 10.1097/bor.0b013e328363e868] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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