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Terminiello A, Marrani E, Pagnini I, Maccora I, Maniscalco V, Rumeileh SA, Mastrolia MV, Simonini G. Childhood mixed connective tissue disease at disease onset: Evidence from a systematic review. Autoimmun Rev 2024; 23:103513. [PMID: 38191065 DOI: 10.1016/j.autrev.2023.103513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 12/30/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE Childhood Mixed Connective Tissue Disease (cMCTD) is the rarest pediatric connective tissue disease that includes features of systemic lupus erythematosus, polymyositis/dermatomyositis, juvenile idiopathic arthritis, and systemic sclerosis, identified by Sharp in 1972 and whose diagnosis remains challenging. This systematic review aims to identify clinical features at the onset of cMCTD and manifestations not currently included into the available diagnostic criteria. METHODS A systematic literature review was performed in accordance with PRISMA guidelines 2020 using bibliographic databases: MEDLINE via PubMed and EMBASE. ELIGIBILITY CRITERIA patients diagnosed with MCTD with onset before 18 years. STUDIES INCLUDED registries, retrospective and prospective cohort studies, case series and reports with analysis of data on signs and symptoms of presentation. RESULTS 39 articles were included (215 subjects, 82.5% female), mean age of 141 months (± 41 months DS, range 2.5-204). The most used criteria for the diagnosis of MCTD were the Kasukawa criteria (54.5%). The clinical manifestations described at onset were Raynaud's phenomenon (69.7%), arthritis (60.9%), muscular involvement (53.5%), dermatological signs (39.5%), swollen fingers or hands (29.3%), arthralgias (25.6%), fever (22.3%), lung involvement (14.4%), sclerodactily (13.5%), lymphadenopathy (10.7%) serositis (10.2%), esophageal involvement (6.9%), nervous system involvement (6.9%), xeroftalmia (3.7%), xerostomia (3.7%), hepatosplenomegaly (2.8%), cardiac involvement (2.8%), hepatitis (2.3%), parotiditis (2.3%), Hashimoto's thyroiditis (0.9%), ocular involvement (0.9%). CONCLUSIONS The data from this systematic review suggest great heterogeneity of the clinical presentation of cMCTD for which there are no validated diagnostic criteria that may suggest a new diagnostic approach to allow earlier or more accurate diagnosis in the future.
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Affiliation(s)
| | - Edoardo Marrani
- Rheumatology Unit, ERN-ReCONNET Center, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Ilaria Pagnini
- Rheumatology Unit, ERN-ReCONNET Center, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Ilaria Maccora
- Rheumatology Unit, ERN-ReCONNET Center, Meyer Children's Hospital IRCCS, Florence, Italy; NEUROFARBA Department, University of Florence, Florence, Italy
| | - Valerio Maniscalco
- Rheumatology Unit, ERN-ReCONNET Center, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Sarah Abu Rumeileh
- Rheumatology Unit, ERN-ReCONNET Center, Meyer Children's Hospital IRCCS, Florence, Italy
| | | | - Gabriele Simonini
- Rheumatology Unit, ERN-ReCONNET Center, Meyer Children's Hospital IRCCS, Florence, Italy; NEUROFARBA Department, University of Florence, Florence, Italy
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Batu ED, Günalp A, Şahin S, Özdel S, Kızıldağ Z, Pac Kısaarslan A, Bağrul İ, Kasap Cuceoglu M, Tanatar A, Sonmez HE, Sag E, Demir S, Çelikel E, Cağlayan S, Çelikel Acar B, Sözeri B, Aktay Ayaz N, Bilginer Y, Poyrazoğlu MH, Ünsal E, Kasapçopur Ö, Özen S. Pediatric mixed connective tissue disease versus other overlap syndromes: a retrospective multicenter cohort study. Rheumatol Int 2023; 43:1485-1495. [PMID: 36906866 DOI: 10.1007/s00296-023-05300-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/27/2023] [Indexed: 03/13/2023]
Abstract
Pediatric mixed connective tissue disease (MCTD) is a subgroup of overlap syndromes. We aimed to compare the characteristics and outcomes in children with MCTD and other overlap syndromes. All MCTD patients met either Kasukawa or Alarcon-Segovia and Villareal criteria. The patients with other overlap syndromes had the features of ≥ 2 autoimmune rheumatic diseases but did not meet MCTD diagnostic criteria. Thirty MCTD (F/M = 28/2) and thirty (F/M = 29/1) overlap patients were included (disease onset < 18 years). The most prominent phenotype at disease onset and the last visit was systemic lupus erythematosus (SLE) in the MCTD group; juvenile idiopathic arthritis and dermatomyositis/polymyositis, respectively, in the overlap group. At the last visit, systemic sclerosis (SSc) phenotype was more frequent among MCTD than overlap patients (60% vs. 33.3%; p = 0.038). The frequency of the predominant SLE phenotype had decreased (60% to 36.7%), while predominant SSc phenotype had increased (13.3% to 33.3%) during follow-up in MCTD patients. Weight loss (36.7% vs. 13.3%), digital ulcers (20% vs. 0), swollen hands (60% vs. 20%), Raynaud phenomenon (86.7% vs. 46.7%), hematologic involvement (70% vs. 26.7%), and anti-Sm positivity (29% vs. 3.3%) were more common, while Gottron papules (16.7% vs. 40%) were less frequent among MCTD than overlap patients (p < 0.05). A higher percentage of overlap patients achieved complete remission than MCTD patients (51.7% vs. 24.1%; p = 0.047). The disease phenotype and outcome differ between pediatric MCTD and other overlap syndromes where MCTD may be regarded as a more severe disease. Analyzing these patients could pave the way for early and effective treatment.
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Affiliation(s)
- Ezgi Deniz Batu
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
- Çocuk Romatoloji Bölümü, Hacettepe Üniversitesi İhsan Doğramacı Çocuk Hastanesi, Kat: 3 Sıhhiye, 06100, Ankara, Turkey.
| | - Aybüke Günalp
- Cerrahpasa Medical School, Department of Pediatrics, Division of Rheumatology, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Sezgin Şahin
- Cerrahpasa Medical School, Department of Pediatrics, Division of Rheumatology, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Semanur Özdel
- Dr. Sami Ulus Maternity and Child Health and Diseases Research and Training Hospital, Department of Pediatrics, Division of Rheumatology, University of Health Sciences, Ankara, Turkey
| | - Zehra Kızıldağ
- Department of Pediatrics, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | - Aysenur Pac Kısaarslan
- Faculty of Medicine, Department of Pediatrics, Division of Rheumatology, Erciyes University, Kayseri, Turkey
| | - İlknur Bağrul
- Dr. Sami Ulus Maternity and Child Health and Diseases Research and Training Hospital, Department of Pediatrics, Division of Rheumatology, University of Health Sciences, Ankara, Turkey
| | - Muserref Kasap Cuceoglu
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ayşe Tanatar
- Faculty of Medicine, Department of Pediatrics, Division of Rheumatology, Istanbul University, Istanbul, Turkey
| | - Hafize Emine Sonmez
- Faculty of Medicine, Department of Pediatrics, Division of Rheumatology, Kocaeli University, Kocaeli, Turkey
| | - Erdal Sag
- Ankara Research and Training Hospital, Department of Pediatrics, Division of Rheumatology, University of Health Sciences, Ankara, Turkey
| | - Selcan Demir
- Department of Pediatrics, Division of Rheumatology, Erzurum Regional Research and Training Hospital, Erzurum, Turkey
| | - Elif Çelikel
- Ankara City Hospital, Department of Pediatrics, Division of Rheumatology, University of Health Sciences, Ankara, Turkey
| | - Sengul Cağlayan
- Umraniye Research and Training Hospital, Department of Pediatrics, Division of Rheumatology, University of Health Sciences, Istanbul, Turkey
| | - Banu Çelikel Acar
- Ankara City Hospital, Department of Pediatrics, Division of Rheumatology, University of Health Sciences, Ankara, Turkey
| | - Betül Sözeri
- Umraniye Research and Training Hospital, Department of Pediatrics, Division of Rheumatology, University of Health Sciences, Istanbul, Turkey
| | - Nuray Aktay Ayaz
- Faculty of Medicine, Department of Pediatrics, Division of Rheumatology, Istanbul University, Istanbul, Turkey
| | - Yelda Bilginer
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - M Hakan Poyrazoğlu
- Faculty of Medicine, Department of Pediatrics, Division of Rheumatology, Erciyes University, Kayseri, Turkey
| | - Erbil Ünsal
- Department of Pediatrics, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | - Özgür Kasapçopur
- Cerrahpasa Medical School, Department of Pediatrics, Division of Rheumatology, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Seza Özen
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Consider the wrist: a retrospective study on pediatric connective tissue disease with MRI. Rheumatol Int 2019; 39:2095-2101. [PMID: 31222439 DOI: 10.1007/s00296-019-04353-1] [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: 04/26/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Abstract
The aim of this study is to describe the clinical characteristics and MRI findings of the wrist in a cohort of children suffering from connective tissue disease with musculoskeletal involvement. Ten patients with pediatric connective tissue disease [median age 14.7 years (IQR 12.7-16.6 years), 70% female] were identified from a large MRI database. Clinical findings during the disease course were retrospectively obtained from patient charts and findings at the time of MRI were prospectively registered in the MRI database. MRI wrist datasets were evaluated by three readers in consensus for synovitis, tenosynovitis, bone marrow changes, bone erosions and myositis. Patients suffered from connective tissue disease with clinical overlap of subtypes systemic lupus erythematosus, Sjögren syndrome and dermatomyositis. Median onset of disease was at 12.3 years (IQR 7.8-14.8 years). Clinical arthritis activity was scored low (median visual analogue scale physician 19, IQR 7-31). Notwithstanding, extensive inflammatory abnormalities such as synovitis and tenosynovitis were found in the wrist of 7/10 patients. Osteochondral involvement was detected in 3/10 patients. In a small cohort of children with connective tissue disease and musculoskeletal symptoms, severe inflammatory abnormalities of the involved wrist were present in the MRI, while clinical disease scores suggested mild disease activity. Therefore, clinicians should consider the wrist as vulnerable for joint damage and can add MRI as a helpful tool in the management of patients with pediatric connective tissue disease and musculoskeletal involvement.
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