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Sönmez HE, Batu ED, İşgüder R, Şahin N, Aliyev E, Aslan E, Çoban S, Güngörer V, Karadağ ŞG, Karaçayır N, Kısaoğlu H, Yekedüz Bülbül A, Garip S, Karalı Y, Ayduran S, Demir S, Kaya Akça Ü, Başaran Ö, Şahin S, Kasap B, Kilic SS, Kışla Ekinci RM, Kısaarslan AP, Kalyoncu M, Bakkaloğlu S, Yüksel S, Aktay Ayaz N, Çelikel Acar B, Sözeri B, Kasapçopur Ö, Ünsal E, Özen S. Exploring gastrointestinal manifestations in childhood onset systemic lupus erythematosus - Insights from a multicenter study. Lupus 2024:9612033241279071. [PMID: 39186467 DOI: 10.1177/09612033241279071] [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: 08/28/2024]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) constitutes an autoimmune disorder with potential involvement of the gastrointestinal system (GIS). Our objective was to assess the gastrointestinal (GI) manifestations in patients diagnosed with childhood onset SLE. METHODS The study cohort consisted of 123 patients with childhood onset-SLE and GIS involvement from 16 referral departments of pediatric rheumatology. All participants met the Systemic Lupus International Collaborating Clinics criteria. RESULTS Out of 123 patients, 78 (63.4%) exhibited GIS involvement at the initial SLE diagnosis, whereas the remaining 45 (36.6%) developed GI symptoms after a median duration of 12 (3-140) months. Eighty-two (66.7%) individuals experienced symptoms related to the GI tract, whereas the remaining patients received a diagnosis of GI involvement through laboratory assessments. The predominant initial GIS involvement symptom was abdominal pain, observed in 77 (62.6%) patients, followed by elevated hepatic transaminases in 70 (56.9%), hepatomegaly in 40 (32.5%), diarrhea in 26 (21.1%), and jaundice in 11 (8.9%) patients. The GIS involvement was associated with SLE in 82 (78.6%), while it resulted from drug-related adverse events in 35 (28.5%) patients or comorbidities in 6 (0.5%) patients. CONCLUSION GIS involvement should be considered in all childhood onset-SLE patients, especially in the presence of suggestive symptoms or elevated hepatic transaminases. It is also crucial to consider SLE in the differential diagnosis of GIS manifestations in children. Apart from GIS involvement directly associated with SLE, adverse events of drugs should be kept in mind.
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Affiliation(s)
- Hafize Emine Sönmez
- Faculty of Medicine, Department of Pediatric Rheumatology, Kocaeli University, Kocaeli, Turkey
| | - Ezgi Deniz Batu
- Faculty of Medicine, Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Rana İşgüder
- Faculty of Medicine, Department of Pediatric Rheumatology, Dokuz Eylül University, Izmir, Turkey
| | - Nihal Şahin
- Faculty of Medicine, Department of Pediatric Rheumatology, Kocaeli University, Kocaeli, Turkey
| | - Emil Aliyev
- Faculty of Medicine, Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Esma Aslan
- Cerrahpaşa Medical Faculty, Department of Pediatric Rheumatology, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Sümeyra Çoban
- Department of Pediatric Rheumatology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Vildan Güngörer
- Department of Pediatric Rheumatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Şerife Gül Karadağ
- Faculty of Medicine, Department of Pediatric Rheumatology, Istanbul University, Istanbul, Turkey
| | - Nihal Karaçayır
- Department of Pediatric Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Hakan Kısaoğlu
- Department of Pediatric Rheumatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | | | - Sevinç Garip
- Department of Pediatric Gastroenterology, Adana City Training and Research Hospital, Adana, Turkey
| | - Yasin Karalı
- Department of Pediatric Rheumatology, Uludağ University, Bursa, Turkey
| | - Semra Ayduran
- Department of Pediatric Rheumatology, Pamukkale University, Denizli, Turkey
| | - Selcan Demir
- Department of Pediatric Rheumatology, Osmangazi University, Eskişehir, Turkey
| | - Ümmüşen Kaya Akça
- Department of Pediatric Rheumatology, Aydın State Hospital, Aydın, Turkey
| | - Özge Başaran
- Faculty of Medicine, Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Sezgin Şahin
- Cerrahpaşa Medical Faculty, Department of Pediatric Rheumatology, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Belde Kasap
- Department of Pediatric Rheumatology, Izmir Katip Celebi University, Izmir, Turkey
| | - Sara Sebnem Kilic
- Department of Pediatric Rheumatology, Uludağ University, Bursa, Turkey
| | - Rabia Miray Kışla Ekinci
- Department of Pediatric Gastroenterology, Adana City Training and Research Hospital, Adana, Turkey
| | | | - Mukaddes Kalyoncu
- Department of Pediatric Rheumatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Sevcan Bakkaloğlu
- Department of Pediatric Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Selçuk Yüksel
- Department of Pediatric Rheumatology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Nuray Aktay Ayaz
- Faculty of Medicine, Department of Pediatric Rheumatology, Istanbul University, Istanbul, Turkey
| | - Banu Çelikel Acar
- Department of Pediatric Rheumatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Betül Sözeri
- Department of Pediatric Rheumatology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Özgür Kasapçopur
- Cerrahpaşa Medical Faculty, Department of Pediatric Rheumatology, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Erbil Ünsal
- Faculty of Medicine, Department of Pediatric Rheumatology, Dokuz Eylül University, Izmir, Turkey
| | - Seza Özen
- Faculty of Medicine, Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
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Peyronel F, Rossi GM, Palazzini G, Odone L, Errichiello C, Emmi G, Vaglio A. Early-onset lupus nephritis. Clin Kidney J 2024; 17:sfae212. [PMID: 39135943 PMCID: PMC11318049 DOI: 10.1093/ckj/sfae212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Indexed: 08/15/2024] Open
Abstract
Early-onset systemic lupus erythematous (SLE) is a distinct clinical entity characterized by the onset of disease manifestations during childhood. Despite some similarities to patients who are diagnosed during adulthood, early-onset SLE typically displays a greater disease severity, with aggressive multiorgan involvement, lower responsiveness to classical therapies, and more frequent flares. Lupus nephritis is one of the most severe complications of SLE and represents a major risk factor for long-term morbidity and mortality, especially in children. This review focuses on the clinical and histological aspects of early-onset lupus nephritis, aiming at highlighting relevant differences with adult patients, emphasizing long-term outcomes and discussing the management of long-term complications. We also discuss monogenic lupus, a spectrum of conditions caused by single gene variants affecting the complement cascade, extracellular and intracellular nucleic acid sensing and processing, and occasionally other metabolic pathways. These monogenic forms typically develop early in life and often have clinical manifestations that resemble sporadic SLE, whereas their response to standard treatments is poor.
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Affiliation(s)
- Francesco Peyronel
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giovanni M Rossi
- Nephrology Unit, Parma University Hospital, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Laboratorio di Immunopatologia Renale “Luigi Migone”, University of Parma, Parma, Italy
| | - Giulia Palazzini
- Department of Biomedical Experimental and Clinical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Ludovica Odone
- Nephrology and Dialysis Unit, Azienda Socio-Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Carmela Errichiello
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Giacomo Emmi
- Department of Medical, Surgery and Health Sciences, University of Trieste, Italy
- Clinical Medicine and Rheumatology Unit, Cattinara University Hospital, Trieste, Italy
- Centre for Inflammatory Diseases, Monash University Department of Medicine, Monash Medical Centre, Melbourne, Australia
| | - Augusto Vaglio
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Biomedical Experimental and Clinical Sciences “Mario Serio”, University of Florence, Florence, Italy
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Patel A, Krishnapura Lakshminarayana S, Kumble D, Kariyappa M, Ramkumar G, Anilkumar H, Bhattad S. Enteritis: a window to the diagnosis of systemic lupus erythematosus in an adolescent girl: case report. Paediatr Int Child Health 2024; 44:42-47. [PMID: 38184810 DOI: 10.1080/20469047.2023.2299581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 12/20/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Enteritis is one of the rare systemic manifestations in childhood-onset systemic lupus erythematosus and its diagnosis is very challenging. This is a rare case of an adolescent girl with recurrent non-specific gastro-intestinal symptoms which were later diagnosed to be owing to lupus enteritis, the only presenting manifestation of an active flare. CASE REPORT A 15-year-old girl was admitted with recurrent episodes of abdominal pain, vomiting and loose stools. She had diffuse abdominal tenderness. Abdominal ultrasonography demonstrated moderate ascites. A contrast-enhanced abdominal computerised tomography scan revealed thickening of the small bowel wall. On colonoscopy, there were rectal erosions, and microscopic examination of the biopsy specimens demonstrated mild inflammation. Non-specific enteritis was diagnosed and she was given antibiotics and supportive care. She was re-admitted 6months later with abdominal pain. An abdominal contrast-enhanced computerised tomography scan revealed thickening of the bowel wall and the target sign and comb sign in the small intestine. The anti-nuclear antibody was positive. Renal biopsy demonstrated grade 2 lupus nephritis. Lupus enteritis was diagnosed and the case satisfied the 2019 EULAR-ACR criteria and SLICC criteria. She was treated with methylprednisolone, cyclophosphamide and hydroxychloroquine. She improved with treatment and has remained asymptomatic during follow-up. CONCLUSION This case emphasises the need for healthcare providers to be alert to the possibility of lupus enteritis. It also highlights the importance of close follow-up of cases who have non-specific gastro-intestinal symptoms. Lupus enteritis should be considered in the differential diagnosis of recurrent non-specific gastro-intestinal symptoms in children, especially adolescents, to ensure timely diagnosis and treatment.Abbreviations: ACR American College of Rheumatology; ANA anti-nuclear antibody; CRP: C-reactive protein; CT: computerised tomography; CECT: contrast-enhanced computerised tomography; EULAR: European League Against Rheumatism; GI: gastro-intestinal; LE: lupus enteritis; SLE systemic lupus erythematosis; SLICC: Systemic Lupus International Collaborating Clinics; SLEDAI: SLE disease activity index.
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Affiliation(s)
- Ashray Patel
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, India
| | | | - Dhanalakshmi Kumble
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, India
| | - Mallesh Kariyappa
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, India
| | - Gautham Ramkumar
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, India
| | - H Anilkumar
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, India
| | - Sagar Bhattad
- Division of Paediatric Immunology and Rheumatology, Department of Paediatrics, Aster CMI Hospital, Bengaluru, India
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Granel J, Fernandes H, Bader-Meunier B, Guth A, Richer O, Pillet P, Leverger G, Ducassou S, Fahd M, Pasquet M, Garnier N, Barlogis V, Guitton C, Jeziorski E, Thomas C, Bayart S, Cheikh N, Paillard C, Abou Chahla W, Chastagner P, Neven B, Millot F, Lejeune J, Li-Thiao Te V, Armari-Alla C, Briandet C, Carausu L, Deparis M, Piguet C, Benadiba J, Marie-Cardine A, Stephan JL, Pellier I, Pluchart C, Doré E, Michaux K, Héritier S, Leblanc T, Aladjidi N. Antinuclear antibody-associated autoimmune cytopenia in childhood is a risk factor for systemic lupus erythematosus. Blood 2024; 143:1576-1585. [PMID: 38227934 DOI: 10.1182/blood.2023021884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 01/18/2024] Open
Abstract
ABSTRACT Autoimmune cytopenia (AIC) in children may be associated with positive antinuclear antibodies (ANA) and may progress to systemic lupus erythematosus (SLE). We evaluated the risk of progression to SLE of childhood-onset ANA-associated AIC. In the French national prospective OBS'CEREVANCE cohort, the long-term outcome of children with ANA-associated AIC (ANA titer ≥1/160) and a subgroup of children who developed SLE were described. ANA were positive in 355 of 1803 (20%) children with AIC. With a median follow-up of 5.8 (range, 0.1-29.6) years, 79 of 355 (22%) patients developed SLE at a median age of 14.5 (1.1-21.4) years; 20% of chronic immune thrombocytopenic purpura, 19% of autoimmune hemolytic anemia, and 45% of Evans syndrome. None of the patients with ANA-negative test developed SLE. Severe manifestations of SLE were observed in 21 patients, and 2 patients died. In multivariate analysis including patients with positive ANA within the first 3 months after AIC diagnosis, age >10 years at AIC diagnosis (relative risk [RR], 3.67; 95% confidence interval [CI], 1.18-11.4; P = .024) and ANA titer >1/160 (RR, 5.28; 95% CI, 1.20-23.17; P = .027) were associated with the occurrence of SLE after AIC diagnosis. ANA-associated AIC is a risk factor for progression to SLE, especially in children with an initial ANA titer >1/160 and an age >10 years at AIC diagnosis. ANA screening should be recommended in children with AIC, and patients with ANA should be monitored long-term for SLE, with special attention to the transition period. This trial was registered at www.ClinicalTrials.gov as #NCT05937828.
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Affiliation(s)
- Jérôme Granel
- Paediatric Clinical Immunology, Pellegrin Hospital, CIC1401, INSERM CICP, Bordeaux University Hospital, Bordeaux, France
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant, Bordeaux, France
| | - Helder Fernandes
- Paediatric Clinical Immunology, Pellegrin Hospital, CIC1401, INSERM CICP, Bordeaux University Hospital, Bordeaux, France
| | - Brigitte Bader-Meunier
- Paediatric Haematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Amandine Guth
- Paediatric Department, Pontarlier Hospital, Pontarlier, France
| | - Olivier Richer
- Paediatric Clinical Immunology, Pellegrin Hospital, CIC1401, INSERM CICP, Bordeaux University Hospital, Bordeaux, France
| | - Pascal Pillet
- Paediatric Clinical Immunology, Pellegrin Hospital, CIC1401, INSERM CICP, Bordeaux University Hospital, Bordeaux, France
| | - Guy Leverger
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant, Bordeaux, France
- Paediatric Oncology Immunology Haematology Unit, Armand-Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stéphane Ducassou
- Paediatric Clinical Immunology, Pellegrin Hospital, CIC1401, INSERM CICP, Bordeaux University Hospital, Bordeaux, France
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant, Bordeaux, France
| | - Mony Fahd
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant, Bordeaux, France
- Paediatric Haematology and Immunology Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marlène Pasquet
- Paediatric Oncology Immunology Haematology Unit, Children's University Hospital, Toulouse, France
| | - Nathalie Garnier
- Institute of Paediatric Haematology and Oncology, Hospices Civils de Lyon, Lyon, France
| | - Vincent Barlogis
- Department of Paediatric Haematology, La Timone Hospital, Marseille University Hospital, Marseille, France
| | - Corinne Guitton
- Department of Paediatrics, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Eric Jeziorski
- Paediatric Oncology Haematology Unit, Arnaud de Villeneuve University Hospital, Montpellier, France
| | - Caroline Thomas
- Paediatric Haematology Unit, Nantes University Hospital, Nantes, France
| | - Sophie Bayart
- Paediatric Haematology Unit, Rennes University Hospital, Rennes, France
| | - Nathalie Cheikh
- Department of Paediatric Haematology-Oncology, Besançon University Hospital, Besançon, France
| | - Catherine Paillard
- Department of Paediatric Haematology and Oncology, Hautepierre University Hospital, Strasbourg, France
| | - Wadih Abou Chahla
- Department of Paediatric Haematology, Jeanne de Flandre Hospital, Lille University Hospital, Lille, France
| | - Pascal Chastagner
- Department of Paediatric Haematology and Oncology, Children's University Hospital, Nancy, France
| | - Bénédicte Neven
- Paediatric Haematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Frédéric Millot
- Department of Paediatric Haematology, Poitiers University Hospital, Poitiers, France
| | - Julien Lejeune
- Department of Paediatric Haematology-Oncology, Clocheville Hospital, Tours University Hospital, Tours, France
| | - Valérie Li-Thiao Te
- Department of Paediatric Haematology/Oncology, Amiens University Hospital, Amiens, France
| | - Corinne Armari-Alla
- Paediatric Haematology-Oncology Department, Grenoble University Hospital, Grenoble, France
| | - Claire Briandet
- Department of Paediatrics, Dijon University Hospital, Dijon, France
| | - Liana Carausu
- Department of Paediatric Hematology, CHU de Brest, Brest, France
| | - Marianna Deparis
- Paediatric Oncology- Haematology Unit Department, Caen University Hospital, Caen, France
| | - Christophe Piguet
- Paediatric Oncology Hematology Unit, Limoges University Hospital, Limoges, France
| | - Joy Benadiba
- Department of Haematology-Oncology Paediatrics, Nice University Hospital, Nice, France
| | - Aude Marie-Cardine
- Department of Paediatric Haematology and Oncology, Rouen University Hospital, Rouen, France
| | - Jean-Louis Stephan
- University Hospital of Saint Etienne, North Hospital, Department of Paediatric Oncology, Saint Etienne, France
| | | | - Claire Pluchart
- Paediatric Haematology-Oncology Unit, Institut Jean Godinot, Reims University Hospital, Reims, France
| | - Eric Doré
- Paediatric Unit, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Katell Michaux
- Paediatric Unit, Martinique University Hospital, Fort-de-France, France
| | - Sébastien Héritier
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant, Bordeaux, France
- Paediatric Oncology Immunology Haematology Unit, Armand-Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Thierry Leblanc
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant, Bordeaux, France
- Paediatric Haematology and Immunology Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nathalie Aladjidi
- Paediatric Clinical Immunology, Pellegrin Hospital, CIC1401, INSERM CICP, Bordeaux University Hospital, Bordeaux, France
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant, Bordeaux, France
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Tusseau M, Khaldi-Plassart S, Cognard J, Viel S, Khoryati L, Benezech S, Mathieu AL, Rieux-Laucat F, Bader-Meunier B, Belot A. Mendelian Causes of Autoimmunity: the Lupus Phenotype. J Clin Immunol 2024; 44:99. [PMID: 38619739 DOI: 10.1007/s10875-024-01696-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/25/2024] [Indexed: 04/16/2024]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that is characterized by its large heterogeneity in terms of clinical presentation and severity. The pathophysiology of SLE involves an aberrant autoimmune response against various tissues, an excess of apoptotic bodies, and an overproduction of type-I interferon. The genetic contribution to the disease is supported by studies of monozygotic twins, familial clustering, and genome-wide association studies (GWAS) that have identified numerous risk loci. In the early 70s, complement deficiencies led to the description of familial forms of SLE caused by a single gene defect. High-throughput sequencing has recently identified an increasing number of monogenic defects associated with lupus, shaping the concept of monogenic lupus and enhancing our insights into immune tolerance mechanisms. Monogenic lupus (moSLE) should be suspected in patients with either early-onset lupus or syndromic lupus, in male, or in familial cases of lupus. This review discusses the genetic basis of monogenic SLE and proposes its classification based on disrupted pathways. These pathways include defects in the clearance of apoptotic cells or immune complexes, interferonopathies, JAK-STATopathies, TLRopathies, and T and B cell dysregulations.
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Affiliation(s)
- Maud Tusseau
- Centre International de Recherche en Infectiologie, Inserm, U1111, University Claude Bernard, Lyon 1, Centre National de La Recherche Scientifique, UMR5308, ENS de Lyon, Lyon, France
| | - Samira Khaldi-Plassart
- National Referee Centre for Rheumatic and AutoImmune and Systemic Diseases in Children, European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center, Hospices Civils de Lyon, Lyon, France
- Pediatric Nephrology, Rheumatology, Dermatology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Jade Cognard
- Centre International de Recherche en Infectiologie, Inserm, U1111, University Claude Bernard, Lyon 1, Centre National de La Recherche Scientifique, UMR5308, ENS de Lyon, Lyon, France
- Pediatric Nephrology, Rheumatology, Dermatology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Sebastien Viel
- Centre International de Recherche en Infectiologie, Inserm, U1111, University Claude Bernard, Lyon 1, Centre National de La Recherche Scientifique, UMR5308, ENS de Lyon, Lyon, France
| | - Liliane Khoryati
- Centre International de Recherche en Infectiologie, Inserm, U1111, University Claude Bernard, Lyon 1, Centre National de La Recherche Scientifique, UMR5308, ENS de Lyon, Lyon, France
| | - Sarah Benezech
- Centre International de Recherche en Infectiologie, Inserm, U1111, University Claude Bernard, Lyon 1, Centre National de La Recherche Scientifique, UMR5308, ENS de Lyon, Lyon, France
| | - Anne-Laure Mathieu
- Centre International de Recherche en Infectiologie, Inserm, U1111, University Claude Bernard, Lyon 1, Centre National de La Recherche Scientifique, UMR5308, ENS de Lyon, Lyon, France
| | - Fréderic Rieux-Laucat
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Imagine Institute, INSERM UMR 1163, Université Paris Cité, Paris, France
| | - Brigitte Bader-Meunier
- National Referee Centre for Rheumatic and AutoImmune and Systemic Diseases in Children, European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center, Hospices Civils de Lyon, Lyon, France
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Imagine Institute, INSERM UMR 1163, Université Paris Cité, Paris, France
- Department for Immunology, Hematology and Pediatric Rheumatology, Necker Hospital, APHP, Institut IMAGINE, Paris, France
| | - Alexandre Belot
- Centre International de Recherche en Infectiologie, Inserm, U1111, University Claude Bernard, Lyon 1, Centre National de La Recherche Scientifique, UMR5308, ENS de Lyon, Lyon, France.
- National Referee Centre for Rheumatic and AutoImmune and Systemic Diseases in Children, European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center, Hospices Civils de Lyon, Lyon, France.
- Pediatric Nephrology, Rheumatology, Dermatology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France.
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6
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Fu C, Sun W, Peng H, Zhu X. Neonatal lupus erythematosus as a rare trigger of gastrointestinal involvement in neonates. Sci Rep 2024; 14:3791. [PMID: 38360914 PMCID: PMC10869832 DOI: 10.1038/s41598-024-54091-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/08/2024] [Indexed: 02/17/2024] Open
Abstract
Cutaneous and cardiac involvement in neonatal lupus erythematosus (NLE) has been extensively studied; however, gastrointestinal system involvement (GSI) remains unexplored. This study aimed to investigate the clinical features of GSI in patients with NLE with a particular focus on feeding intolerance (FI) and diarrhea. We conducted a retrospective analysis of the clinical data of patients diagnosed with NLE at the Children's Hospital of Soochow University between 2011 and 2022. In this study, of 39 patients diagnosed with NLE, 27 presented with GSI. 9 patients who presented with FI or diarrhea as the primary manifestation were positive for anti-SSA antibody, and 5 were dual positive for anti-SSA and anti-SSB antibodies. Among the mothers of the NLE patients with GSI, 18 had systemic lupus erythematosus, 3 had Sjogren's syndrome, 2 had mixed connective tissue disease, and one each had autoantibody abnormalities and photosensitivity symptoms; 4 mothers denied having any autoimmune disease. In this study, 69.23% of patients with NLE exhibited GSI, which was linked to hypocomplementemia and anti-SSA antibodies. Thus, clinicians should remain vigilant for NLE in neonates, particularly when accompanied with rash and other organ dysfunction and when the high-risk factors of FI and diarrhea have been excluded.
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Affiliation(s)
- Changchang Fu
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, 215000, China
| | - Wenqiang Sun
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, 215000, China
| | - Hanghang Peng
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, 215000, China
| | - Xueping Zhu
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, 215000, China.
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7
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Tkak H, Sara A, Hamami A, Elouali A, Babakhouya A, Rkain M. Lupus Hepatitis: A Rare Manifestation Revealing Systemic Lupus Erythematosus. Cureus 2024; 16:e54003. [PMID: 38476795 PMCID: PMC10928964 DOI: 10.7759/cureus.54003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 03/14/2024] Open
Abstract
Systemic lupus erythematosus (SLE) is a rare disease in children but is more severe than in adults. SLE may be associated with various non-specific hepatic manifestations, but subacute lupus hepatitis remains unusual and is rarely a mode of revelation. Diagnosis is based on a combination of clinical, laboratory, and histological findings after ruling out other causes of hepatitis, notably autoimmune hepatitis (AIH). We report the case of a young girl with undiagnosed SLE, which first revealed itself as liver involvement and progressed well on corticosteroid therapy. During the course of her illness, she presented with other manifestations that led us to think of SLE with lupus hepatitis.
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Affiliation(s)
- Hassnae Tkak
- Department of Pediatrics, University Hospital Mohamed VI, Faculty of Medicine and Pharmacy, University Mohamed First, Oujda, MAR
| | - Anane Sara
- Department of Pediatrics, University Hospital Mohamed VI, Faculty of Medicine and Pharmacy, University Mohamed First, Oujda, MAR
| | - Amal Hamami
- Department of Pediatrics, University Hospital Mohamed VI, Faculty of Medicine and Pharmacy, University Mohamed First, Oujda, MAR
| | - Aziza Elouali
- Department of Pediatrics, University Hospital Mohamed VI, Faculty of Medicine and Pharmacy, University Mohamed First,, Oujda, MAR
| | - Abdeladim Babakhouya
- Department of Pediatrics, University Hospital Mohamed VI, Faculty of Medicine and Pharmacy, University Mohamed First, Oujda, MAR
| | - Maria Rkain
- Department of Pediatrics, University Hospital Mohamed VI, Faculty of Medicine and Pharmacy, University Mohamed First, Oujda, MAR
- Department of Pediatric Gastroenterology, University Hospital Mohamed VI, Faculty of Medicine and Pharmacy, University Mohamed First, Oujda, MAR
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8
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Lou L, Guo H, Shao M. Systemic lupus erythematosus complicated with Fanconi syndrome: a case report and literature review. Front Pediatr 2024; 11:1230366. [PMID: 38250590 PMCID: PMC10796690 DOI: 10.3389/fped.2023.1230366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024] Open
Abstract
Background Systemic lupus erythematosus is an autoimmune disease with diverse clinical manifestations. The symptoms of SLE in children are more atypical than adults. Childhood SLE complicated with Fanconi syndrome is extremely rare and even more difficult to diagnose. Case presentation This article reports a preschool boy with SLE who presented with renal tubular acidosis, accompanied by weakness in both lower limbs, delayed growth, and malnutrition. It was later found that the patient had the complication of Fanconi syndrome with renal tubular acidosis. Ultimately, renal biopsy confirmed lupus nephritis. The patient was treated with corticosteroid combined with mycophenolate mofetil, hydroxychloroquine, and belimumab. The symptoms of the child were relieved. Conclusion Here we report an extremely rare case of childhood SLE complicated with Fanconi syndrome. There has been no similar clinical report. It is necessary to be alert to the possibility of atypical SLE in children to avoid missed diagnosis and misdiagnosis.
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Affiliation(s)
- Lili Lou
- Department of Pediatric Pulmonology and Immunology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Hui Guo
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Meiying Shao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
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Palafox-Flores JG, Valencia-Ledezma OE, Vargas-López G, Jamaica-Balderas L, Acevedo-Silva N, Castro-Fuentes CA. Systemic lupus erythematosus in pediatric patients: Pulmonary manifestations. Respir Med 2023; 220:107456. [PMID: 37926179 DOI: 10.1016/j.rmed.2023.107456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023]
Abstract
The pulmonary manifestations of Systemic Lupus Erythematosus (SLE) in pediatric patients are poorly understood and the pulmonary manifestations reported from the adult population are generally extrapolated to the pediatric population. In the present work, the review of 228 files was carried out, in which the pulmonary manifestations, symptoms and antibody levels of the patients treated at the Hospital Regional de Alta Especialidad de Ixtapaluca (HRAEI), State of Mexico, Mexico, were identified. Statistical significance between groups was estimated using the Chi-square and Mann-Whitney U test. The main pulmonary manifestations identified were pleurisy (14 %), pulmonary hemorrhage (3.9 %), pulmonary thromboembolism (0.9 %), acute lupus pneumonitis (0.4 %), pulmonary arterial hypertension (0.4 %), and small lung syndrome (0.4 %). While the initial symptomatology was dyspnea with an incidence of 9.6 %, the mean oxygen saturation in the population was 96.87 %. Pleural effusion was identified as the most frequent pulmonary manifestation in radiographic changes. No statistically significant difference was found in antibody levels when comparing the groups. The most common pulmonary manifestation associated with SLE is pleurisy, however, the range of pulmonary manifestations in this type of patient can be very varied, as well as the presentation of each of them.
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Affiliation(s)
| | | | | | | | - Nydia Acevedo-Silva
- Pediatric Rheumatology Unit, Hospital Regional de Alta Especialidad de Ixtapaluca, Mexico
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10
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Mohd Shukri ND, Wan Mohamad WM, Wan Ab Rahman WS. Childhood-Onset Systemic Lupus Erythematosus Presenting With Concomitant Gastrointestinal Manifestation and Antiphospholipid Syndrome. Cureus 2023; 15:e49205. [PMID: 38024034 PMCID: PMC10663094 DOI: 10.7759/cureus.49205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 12/01/2023] Open
Abstract
Childhood-onset systemic lupus erythematosus is a rare disease that is more prevalent in Southeast Asian children than in Western children. It is characterised by a peripubertal onset and a female predominance that rises with age. Haematological, renal, and mucocutaneous are among the frequently involved organs upon diagnosis. Some of the typical symptoms include cutaneous vasculitis, malar rash, and fever. Patients frequently had proliferative class IV lupus nephritis, which increases disease activity and kidney damage. We reported a child presented with fever associated with multiple joint pain, skin rashes over the fingers of the right hand, and generalised abdominal pain.
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Chen YC, Huang YC, Chen JP, Tsai Mc MC, Fu LS. The correlation between trajectories of serum C3 variability and clinical course in Pediatric-onset systemic lupus erythematosus. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:1098-1104. [PMID: 37574434 DOI: 10.1016/j.jmii.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 07/05/2023] [Accepted: 07/26/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE The aim of this study is to investigate the usefulness which 2-year trajectories of C3 variability have in predicting clinical remission and systemic corticosteroids (SCS) use in pediatric patients with systemic lupus erythematosus (pSLE). METHODS We recruited 189 confirmed pSLE patients from the electronic database of our hospital, all had undergone SCS treatment. The follow up period was 4.17-14.83 years. We used Group-Based Trajectory modeling to divide the patients into four different trajectory groups by their initial 2-year C3 variability. We divided the patients into groups A, B or C by their clinical course and SCS use. Statistical methods included Kruskal-Wallis and Chi-square tests and logic regression test. RESULTS There were 4 separate trajectories. The distribution of groups A, B and C in these 4 trajectories showed a significant difference (p = 0.005). Initial C3 and C4 levels in these 4 revealed significant differences (p ≦ 0.001, p ≦ 0.016). When compared to other trajectories, trajectory1 showed a higher risk for persistent SCS use (p < 0.05). The distributions of severe clinical manifestations, including proteinuria, hematuria, CNS involvement and thrombocytopenia were different in these 4 trajectories (p = 0.003). Nevertheless, none of the above manifestations contributed to the risk of persistent SCS use. CONCLUSIONS We have found 4 distinct C3 trajectories in pSLE patients. Distributions of clinical outcome groups were different in these 4 trajectories. Patients with trajectory1 displayed a higher risk for persistent SCS use, thus an earlier institution of immunosuppressant(s) and biological agents can be considered for these children.
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Affiliation(s)
| | - Yung-Chieh Huang
- Department of Pediatrics, Taiwan, ROC; National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Jun-Peng Chen
- Department of Research, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | | | - Lin-Shien Fu
- Department of Pediatrics, Taiwan, ROC; National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC.
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12
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Martín-Marín L, Fernández-Ávila DG, Espitia-Caro GP. Prevalence of juvenile systemic lupus erythematosus in Colombia: An approach from the national health registry data. Lupus 2023:9612033231184315. [PMID: 37328161 DOI: 10.1177/09612033231184315] [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: 06/18/2023]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a chronic, systemic, autoimmune disease of multifactorial origin. There are no previous studies in Colombia describing juvenile SLE (jSLE) prevalence, prompting this demographic description. OBJECTIVE This study aimed for prevalence calculation and epidemiologic analysis of jSLE) in Colombian patients, ages 0-19, from 2015 to 2019. METHODS This descriptive, cross-sectional study searched the Colombian Ministry of Health database for codes of the International Classification of Diseases, 10th revision (ICD-10) associated with jSLE to estimate the disease prevalence for the total population and for specific age groups at national and regional levels. Calculations used intercensal estimates of population based on the projections of the national statistics administrative department (DANE) from the most recent census. This paper presents a sociodemographic analysis of patients with jSLE. RESULTS The study identified in Colombia, from 2015 to 2019, 3680 cases with jSLE as the principal diagnosis. Calculated prevalence of jSLE was 25 cases per 100,000 population, with highest frequency in ages 15-19 and females (84%), with a female:male ratio of 5.1:1. CONCLUSION Estimated prevalence of jSLE in Colombia is at the highest limit of worldwide findings. Consistent with reports in the literature, the disease involves females more frequently than males.
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Affiliation(s)
- Lorena Martín-Marín
- Faculty of Medicine, Department of Pediatrics, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá D.C., Colombia
- Department of Infantile Rheumatology, Hospital Universitario San Ignacio, Bogotá D.C., Colombia
| | - Daniel G Fernández-Ávila
- Faculty of Medicine, Rheumatology Unit, Department of Internal Medicine, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá D.C., Colombia
| | - Greis P Espitia-Caro
- Faculty of Medicine, Department of Pediatrics, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá D.C., Colombia
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Yost C, Vercillo D, Abuqare A, Yost MB, Love AN. Pleural and Pericardial Effusion With COVID-19 and Systemic Lupus Erythematosus and Its Recurrence: A Case Study. Cureus 2023; 15:e37988. [PMID: 37223159 PMCID: PMC10202560 DOI: 10.7759/cureus.37988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
As a chronic autoimmune disease, systemic lupus erythematosus (SLE) primarily affects young women and does not discriminate against any particular organs. In December 2019, coronavirus disease 2019 (COVID-19) spread worldwide, with many speculations of cardiac involvement in the pathogenesis of infection. Moreover, in cases where cardiac symptoms were described, they consisted solely of chest pain or a general deterioration in health if the patient presented with pleural effusion or pericardial effusion. Our patient, a 25-year-old Hispanic woman, initially complained of chest pain, cough, and shortness of breath. After being admitted, she noticed growing dyspnea and mild discomfort on the right side of her chest. The patient had both SLE and COVID-19 and had developed pleural and pericardial effusions. After two days in culture, nothing had grown from the fluid samples. In addition, measures of brain natriuretic peptide and total creatine kinase fell within the normal range. Considering the investigational findings, pericardiocentesis was performed. After the procedure, the patient's condition improved, and she was discharged. The patient continued taking CellCept® 1,500 mg and Plaquenil 200 mg and started taking colchicine. Her daily prednisone dose was increased to 40 milligrams. She felt well initially; however, after two weeks of follow-up, the pericardial effusion recurred, and pericardiocentesis was performed again. The patient was discharged in stable condition after a two-day hospital stay. After treatment of both initial and recurrent effusions, the patient's cardiac symptoms were resolved, and blood pressure became stable. We hypothesize that there may be other unreported cases of COVID-19-related viral pericarditis, pericardial effusion, and pericardial tamponade that could be caused by a combination of COVID-19 and a pre-existing condition, mainly autoimmune disorders. Due to the lack of clarity surrounding typical COVID-19 manifestations, it is crucial to record all cases of this unique illness and analyze any increased incidence of pericarditis, pericardial effusion, and pericardial tamponade in the public.
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Affiliation(s)
- Connor Yost
- Internal Medicine, A.T. Still University-School of Osteopathic Medicine in Arizona (ATSU-SOMA), Mesa, USA
| | - Darin Vercillo
- Internal Medicine, Davis Hospital and Medical Center, Layton, USA
| | | | - Mckenna B Yost
- Internal Medicine, A.T. Still University-School of Osteopathic Medicine in Arizona (ATSU-SOMA), Mesa, USA
| | - Avery N Love
- Internal Medicine, A.T. Still University-School of Osteopathic Medicine in Arizona (ATSU-SOMA), Mesa, USA
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14
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Hsu TC, Yang YH, Wang LC, Lee JH, Yu HH, Lin YT, Hu YC, Chiang BL. Risk factors for subsequent lupus nephritis in patients with juvenile-onset systemic lupus erythematosus: a retrospective cohort study. Pediatr Rheumatol Online J 2023; 21:28. [PMID: 36964531 PMCID: PMC10039593 DOI: 10.1186/s12969-023-00806-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/08/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Lupus nephritis (LN) is a crucial organ involvement in systemic lupus erythematosus (SLE). Patients with LN have higher morbidity and mortality rates than those without. Among all patients with LN, 20-40% had delayed onset, but the data for patients with juvenile-onset SLE (jSLE), who have a higher percentage of LN than patients with adult-onset SLE (aSLE), were limited. This study aimed to determine the risk factors for subsequent LN in patients with jSLE. METHODS A retrospective cohort study was conducted between 2008 and 2018 in a single tertiary medical centre. Patients with diagnosed jSLE were reviewed. We investigated those without LN at diagnosis and whether they developed LN afterward. The primary outcome was the development of subsequent LN. Clinical manifestations at diagnosis, serial laboratory data, and treatments were reviewed during follow-up periods. RESULTS Among the 48 patients with jSLE without initial LN, 20 developed subsequent LN later (Group 1), whereas 28 remained free of LN (Group 2). There was no difference in the percentage of initial manifestations except for more discoid rashes in Group 2 patients. In the Cox regression model, elevated average anti-double-stranded DNA (dsDNA) antibody, low average serum complements, and high average erythrocyte sedimentation rate (ESR) levels during follow-up were predictors of subsequent LN. After adjusting for these factors in multivariable analyses, only high average anti-dsDNA antibody and high average ESR levels remained predictive of subsequent LN. For every 100 IU/ml increase in anti-dsDNA antibody, the risk for subsequent LN in jSLE increases by 1.29 times (hazard ratio = 1.29, 95% confidence interval 1.055-1.573). CONCLUSION Persistently high anti-dsDNA antibody and ESR levels during the follow-up period were risk factors for subsequent LN in patients with jSLE.
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Affiliation(s)
- Tzu-Chuan Hsu
- Department of Paediatrics, National Taiwan University Hospital, No. 8 Chung-Shan South Road, Taipei, 100, Taipei, Taiwan
- Department of Paediatrics, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yao-Hsu Yang
- Department of Paediatrics, National Taiwan University Hospital, No. 8 Chung-Shan South Road, Taipei, 100, Taipei, Taiwan
- Department of Paediatrics, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Li-Chieh Wang
- Department of Paediatrics, National Taiwan University Hospital, No. 8 Chung-Shan South Road, Taipei, 100, Taipei, Taiwan
| | - Jyh-Hong Lee
- Department of Paediatrics, National Taiwan University Hospital, No. 8 Chung-Shan South Road, Taipei, 100, Taipei, Taiwan
| | - Hsin-Hui Yu
- Department of Paediatrics, National Taiwan University Hospital, No. 8 Chung-Shan South Road, Taipei, 100, Taipei, Taiwan
| | - Yu-Tsan Lin
- Department of Paediatrics, National Taiwan University Hospital, No. 8 Chung-Shan South Road, Taipei, 100, Taipei, Taiwan
| | - Ya-Chiao Hu
- Department of Paediatrics, National Taiwan University Hospital, No. 8 Chung-Shan South Road, Taipei, 100, Taipei, Taiwan.
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Bor-Luen Chiang
- Department of Paediatrics, National Taiwan University Hospital, No. 8 Chung-Shan South Road, Taipei, 100, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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15
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Mauro A, Giani T, Di Mari C, Sandini M, Talenti A, Ansuini V, Biondi L, Di Nardo G, Bernardo L. Gastrointestinal Involvement in Children with Systemic Lupus Erythematosus. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020309. [PMID: 36832440 PMCID: PMC9955206 DOI: 10.3390/children10020309] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/05/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023]
Abstract
Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder. When it presents before the age of 18 years (childhood-onset systemic lupus erythematosus, cSLE), the disease course tends to be more severe with a higher rate of organ involvement and requires an early diagnosis. Gastrointestinal involvement in cSLE is rare and scarcely reported in the literature. Any organ of the gastrointestinal system may be affected, either as a direct consequence of the disease, as a subsequent complication, or as an adverse drug event. Abdominal pain is the most common GI symptom, it can be diffuse or well localized, and can underline different conditions such as hepatitis, pancreatitis, appendicitis, peritonitis, or enteritis. cSLE may have an alteration of the intestinal barrier with features of protein-losing enteropathy or, in genetically predisposed patients, may develop associated autoimmune disorders such as Coeliac Disease or Autoimmune Hepatitis. The aim of this manuscript is to provide a narrative review of gastrointestinal manifestations in cSLE focused on hepatic, pancreatic, and intestinal involvement. A comprehensive literature search based on the PubMed database was performed.
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Affiliation(s)
- Angela Mauro
- Pediatric Rheumatology Unit, Department of Childhood and Developmental Medicine, Fatebenefratelli-Sacco Hospital, Piazzale Principessa Clotilde, 20121 Milano, Italy
| | - Teresa Giani
- Department of Pediatrics, Meyer Children's Hospital, 50139 Firenze, Italy
| | - Clelia Di Mari
- Pediatric Rheumatology Unit, Department of Childhood and Developmental Medicine, Fatebenefratelli-Sacco Hospital, Piazzale Principessa Clotilde, 20121 Milano, Italy
| | - Martina Sandini
- Pediatric Rheumatology Unit, Department of Childhood and Developmental Medicine, Fatebenefratelli-Sacco Hospital, Piazzale Principessa Clotilde, 20121 Milano, Italy
| | - Antonella Talenti
- Pediatric Rheumatology Unit, Department of Childhood and Developmental Medicine, Fatebenefratelli-Sacco Hospital, Piazzale Principessa Clotilde, 20121 Milano, Italy
| | - Valentina Ansuini
- Pediatric Rheumatology Unit, Department of Childhood and Developmental Medicine, Fatebenefratelli-Sacco Hospital, Piazzale Principessa Clotilde, 20121 Milano, Italy
| | - Luigi Biondi
- Pediatric Rheumatology Unit, Department of Childhood and Developmental Medicine, Fatebenefratelli-Sacco Hospital, Piazzale Principessa Clotilde, 20121 Milano, Italy
| | - Giovanni Di Nardo
- Faculty of Medicine and Psycology, Sapienza University of Rome-NESMOS Department, Sant'Andrea University Hospital, Via Grottarossa 1035-1039, 00189 Roma, Italy
| | - Luca Bernardo
- Pediatric Rheumatology Unit, Department of Childhood and Developmental Medicine, Fatebenefratelli-Sacco Hospital, Piazzale Principessa Clotilde, 20121 Milano, Italy
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16
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Shin JI, Lee KH, Park S, Yang JW, Kim HJ, Song K, Lee S, Na H, Jang YJ, Nam JY, Kim S, Lee C, Hong C, Kim C, Kim M, Choi U, Seo J, Jin H, Yi B, Jeong SJ, Sheok YO, Kim H, Lee S, Lee S, Jeong YS, Park SJ, Kim JH, Kronbichler A. Systemic Lupus Erythematosus and Lung Involvement: A Comprehensive Review. J Clin Med 2022; 11:jcm11226714. [PMID: 36431192 PMCID: PMC9698564 DOI: 10.3390/jcm11226714] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/27/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a complex autoimmune disease with multiorgan manifestations, including pleuropulmonary involvement (20-90%). The precise mechanism of pleuropulmonary involvement in SLE is not well-understood; however, systemic type 1 interferons, circulating immune complexes, and neutrophils seem to play essential roles. There are eight types of pleuropulmonary involvement: lupus pleuritis, pleural effusion, acute lupus pneumonitis, shrinking lung syndrome, interstitial lung disease, diffuse alveolar hemorrhage (DAH), pulmonary arterial hypertension, and pulmonary embolism. DAH has a high mortality rate (68-75%). The diagnostic tools for pleuropulmonary involvement in SLE include chest X-ray (CXR), computed tomography (CT), pulmonary function tests (PFT), bronchoalveolar lavage, biopsy, technetium-99m hexamethylprophylene amine oxime perfusion scan, and (18)F-fluorodeoxyglucose positron emission tomography. An approach for detecting pleuropulmonary involvement in SLE includes high-resolution CT, CXR, and PFT. Little is known about specific therapies for pleuropulmonary involvement in SLE. However, immunosuppressive therapies such as corticosteroids and cyclophosphamide are generally used. Rituximab has also been successfully used in three of the eight pleuropulmonary involvement forms: lupus pleuritis, acute lupus pneumonitis, and shrinking lung syndrome. Pleuropulmonary manifestations are part of the clinical criteria for SLE diagnosis. However, no review article has focused on the involvement of pleuropulmonary disease in SLE. Therefore, this article summarizes the literature on the epidemiology, pathogenesis, diagnosis, and management of pleuropulmonary involvement in SLE.
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Affiliation(s)
- Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Keum Hwa Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Seoyeon Park
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Jae Won Yang
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Hyung Ju Kim
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Kwanhyuk Song
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Seungyeon Lee
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Hyeyoung Na
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Yong Jun Jang
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Ju Yun Nam
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Soojin Kim
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Chaehyun Lee
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Chanhee Hong
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Chohwan Kim
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Minhyuk Kim
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Uichang Choi
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Jaeho Seo
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Hyunsoo Jin
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - BoMi Yi
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Se Jin Jeong
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Yeon Ook Sheok
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Haedong Kim
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Sangmin Lee
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Sangwon Lee
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Young Soo Jeong
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Se Jin Park
- Department of Pediatrics, Eulji University School of Medicine, Daejeon 34824, Republic of Korea
| | - Ji Hong Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 26426, Republic of Korea
- Correspondence:
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17
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Felix A, Delion F, Suzon B, Martin E, Ogrizek A, Mohamed Sahnoun M, Hospice C, Armougon A, Cuadro E, Elenga N, Dramé M, Bader-Meunier B, Deligny C, Hatchuel Y. Systemic lupus of pediatric onset in Afro-Caribbean children: a cohort study in the French West Indies and French Guiana. Pediatr Rheumatol Online J 2022; 20:95. [PMID: 36371201 PMCID: PMC9652926 DOI: 10.1186/s12969-022-00759-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/29/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Systemic diseases of pediatric onset are more frequent in the Afro-Caribbean population. We performed a study of patients followed in the French overseas departments of America (FOAD) for pediatric systemic lupus erythematosus (pSLE). The aims were to describe the clinical and biological specificities during childhood in this population. METHODS A retrospective study was conducted between January 2000 and September 2021. Patients with pSLE were identified from multiple sources: computerized hospital archives, registry of referring pediatricians, adult specialists in internal medicine and the French National Registry for rare diseases. We studied SLE with pediatric onset defined by international criteria. RESULTS Overall, 2148 patients were identified, of whom 54 were included. The average follow-up was 8.3 years (range: 0.3-25 years). We observed an increase in new diagnoses over time. At onset, pSLE patients had a median of 10 SLICC criteria (range: 4-12), and the median EULAR/ACR 2019 score was 38 (12-54). At onset, one third of patients had renal involvement, 15% had neurolupus and 41% cardiac involvement. During childhood, 54% had renal involvement, and 26% suffered from neurolupus. Patients suffered a median of 3 flares during childhood, and 26% had more than 5 flares. Patients with younger age at onset had worse outcomes than those who were older at diagnosis, i.e., more flares (median 5, p = 0.02) and requiring an average of 4 background therapies (p = 0.04). CONCLUSION The outcomes of Afro-Caribbean patients were similar to those in Western population, but with worse disease activity at onset. Further studies should be performed to identify the genetic and environmental factors in this population.
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Affiliation(s)
- Arthur Felix
- Department of Pediatrics, Martinique University Hospital, MFME. CHU de La Martinique, La Meynard 97261, Fort-de France, France.
| | - Frederique Delion
- Department of Pediatrics, Guadeloupe University Hospital, Pointe-À-Pitre, France
| | - Benoit Suzon
- grid.412874.c0000 0004 0641 4482Department of Internal Medicine, Martinique University Hospital, Fort-de France, France
| | - Elise Martin
- Department of Pediatrics, Andrée Rosemon Hospital, Cayenne, France
| | - Anais Ogrizek
- grid.412874.c0000 0004 0641 4482Department of Pediatrics, Martinique University Hospital, MFME. CHU de La Martinique, La Meynard 97261, Fort-de France, France
| | - M’hamed Mohamed Sahnoun
- Department of Pediatrics, Centre Hospitalier de L’ouest Guyanais, St-Laurent-du-Maroni, France
| | - Claudia Hospice
- grid.412874.c0000 0004 0641 4482Department of Pediatrics, Martinique University Hospital, MFME. CHU de La Martinique, La Meynard 97261, Fort-de France, France
| | - Aurelie Armougon
- grid.412874.c0000 0004 0641 4482Department of Pediatrics, Martinique University Hospital, MFME. CHU de La Martinique, La Meynard 97261, Fort-de France, France
| | - Emma Cuadro
- Department of Pediatrics, Andrée Rosemon Hospital, Cayenne, France
| | - Narcisse Elenga
- Department of Pediatrics, Andrée Rosemon Hospital, Cayenne, France
| | - Moustapha Dramé
- grid.412874.c0000 0004 0641 4482Department of Clinical Research and Innovation, Martinique University Hospital, Fort-de-France, France
| | - Brigitte Bader-Meunier
- grid.412134.10000 0004 0593 9113Department of Pediatric Rheumatology, Necker Hospital, Paris, France
| | - Christophe Deligny
- grid.412874.c0000 0004 0641 4482Department of Internal Medicine, Martinique University Hospital, Fort-de France, France
| | - Yves Hatchuel
- grid.412874.c0000 0004 0641 4482Department of Pediatrics, Martinique University Hospital, MFME. CHU de La Martinique, La Meynard 97261, Fort-de France, France
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18
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Elgormus Y. Biomarkers and their Clinical Applications in Pediatrics. Biomark Med 2022. [DOI: 10.2174/9789815040463122010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Biomarker studies are becoming increasingly interesting for many fields of
medicine. The use of biomarkers in medicine is involved in detecting diseases and
supporting diagnosis and treatment decisions. New research and new discoveries on the
molecular basis of the disease show that there may be a number of promising new
biomarkers for use in daily clinical practice. Clinical trials in children lag behind adult
research both in quality and quantity. The number of biomarkers validated to optimize
pediatric patient management is limited. In the pathogenesis of many diseases, it should
not be extrapolated to the pediatric clinical setting, taking into account that biomarkers
that are effective in adults are clearly different in children and that ontogeny directly
affects disease development and therapeutic response in children. The search for ideal
biomarkers or markers that can make an early and definitive diagnosis in neonatal
sepsis is still ongoing. The ideal biomarker for pediatric diseases should be costeffective,
noninvasive, applicable to pediatric specific diseases, and its results should
correspond to age-related physiological changes. Lactate, troponin and B-type
natriuretic peptide are valuable biomarkers in the evaluation and management of
critically ill children with cardiac disease. Tumor markers in children are biochemical
substances used in the clinical treatment of pediatric tumors and to detect the presence
of cancer (regression or progression). In this chapter, current and brief information
about biomarkers and their clinical applications used in the diagnosis and monitoring of
pediatric diseases is presented.;
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Affiliation(s)
- Yusuf Elgormus
- Medicine Hospital,Department of Pediatric Health and Diseases,Department of Pediatric Health and Diseases, Medicine Hospital, Istanbul, Turkey,Istanbul,Turkey
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19
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Koker O, Aktay Ayaz N. Autoimmune and autoinflammatory diseases with mucocutaneous manifestations: A pediatric rheumatology perspective. Int J Dermatol 2022; 62:723-736. [PMID: 35843911 DOI: 10.1111/ijd.16352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/25/2022] [Accepted: 06/24/2022] [Indexed: 12/01/2022]
Abstract
The presence of mucocutaneous manifestations has clinical significance, as it may be a part of the initial presentation or activation stage of both autoimmune and autoinflammatory rheumatic diseases. The cutaneous signs may display a particular morphological and topographic distribution according to taxonomy, whereas heterogeneity is likely observed among the individuals. The review aims to cluster and systematically approach the mucocutaneous manifestations met in autoimmune and autoinflammatory rheumatic diseases of childhood. The search strategy involved a comprehensive inquiry on Web of Science, PubMed, MEDLINE, and Embase databases using relevant search terms such as "dermatologic, cutaneous, mucocutaneous, skin, rash" for each disease and category. The awareness of the distinctive mucocutaneous manifestations and their correlation with rheumatic diseases provides a convenient definition, well-timed control of the underlying condition, and prevention of cosmetic issues. In the management of rheumatic diseases, planning the pertinent differential diagnosis and determining the requirement of histopathological assessment are essential with a multidisciplinary approach to rheumatology, dermatology, and allergy-immunology specialties.
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Affiliation(s)
- Oya Koker
- Istanbul Faculty of Medicine, Department of Pediatric Rheumatology, Istanbul University, Istanbul, Turkey
| | - Nuray Aktay Ayaz
- Istanbul Faculty of Medicine, Department of Pediatric Rheumatology, Istanbul University, Istanbul, Turkey
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20
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Hussain A, Maheshwari MV, Khalid N, Patel PD, Alghareeb R. Diagnostic Delays and Psychosocial Outcomes of Childhood-Onset Systemic Lupus Erythematosus. Cureus 2022; 14:e26244. [PMID: 35911281 PMCID: PMC9313193 DOI: 10.7759/cureus.26244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 11/15/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that manifests in affected individuals with a variety of clinical features and involves multiple organs. Despite recent advances over the past decades, higher morbidity and mortality have been reported by studies in patients with childhood-onset systemic lupus erythematosus (cSLE) compared to patients with adult-onset. The interplay of several factors can cause diagnostic delays resulting in worse disease activity, multiple organ damage, increased risk of hospitalization, and management with aggressive treatment. Significant factors include demographic, clinical, and socioeconomic characteristics of patients with cSLE. Moreover, despite recent advances in lupus treatment, prolonged disease duration in these young patients can result in debilitating psychosocial outcomes and can significantly impact their health-related and general quality of life (QOL). Important domains affected include patient self-esteem, education, employment, healthcare utilization, and mental health. In this review, we examined the barriers that lead to a delay in diagnosing lupus in the pediatric population and addressed cSLE morbimortality and its long-term impact on patient health-related and general QOL.
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21
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Vollbach K, Schuetz C, Hedrich CM, Speth F, Mönkemöller K, Brunner J, Neudorf U, Rietschel C, Hospach A, Kallinich T, Hinze C, Wagner N, Tönshoff B, Weber LT, Latta K, Thumfart J, Bald M, Wiemann D, Zappel H, Tenbrock K, Haffner D. Working Towards a Treat-to-Target Protocol in Juvenile Proliferative Lupus Nephritis - A Survey of Pediatric Rheumatologists and Nephrologists in Germany and Austria. Front Pediatr 2022; 10:851998. [PMID: 35529329 PMCID: PMC9072733 DOI: 10.3389/fped.2022.851998] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/07/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND To describe treatment practices for juvenile proliferative lupus nephritis (LN) class III and IV of pediatric rheumatologists and nephrologists in Germany and Austria in preparation for a treat-to-target treatment protocol in LN. METHODS Survey study by members of the Society for Pediatric and Adolescent Rheumatology (GKJR) and the German Society for Pediatric Nephrology (GPN) on diagnostics and (concomitant) therapy of LN. RESULTS Fifty-eight physicians completed the survey. Overall, there was a considerable heterogeneity regarding the suggested diagnostics and management of juvenile proliferative LN. Increased urinary protein excretion, either assessed by 24 h urine collection or spot urine (protein-creatinine ratio), and reduced estimated glomerular filtration rate were specified as important parameters for indication of kidney biopsy to diagnose proliferative LN and monitoring of therapy. Corticosteroids were generally proposed for induction and maintenance therapy, most often in conjunction with either mycophenolate mofetil (MMF) or cyclophosphamide (CP) as steroid-sparing immunosuppressants. MMF was clearly preferred over CP for induction therapy of LN class III, whereas CP and MMF were equally proposed for LN class IV. MMF was most often recommended for maintenance therapy in conjunction with oral corticosteroids and continued for at least 3 years and 1 year, respectively, after remission. Hydroxychloroquine was widely accepted as a concomitant measure followed by renin-angiotensin system inhibitors in cases of arterial hypertension and/or proteinuria. CONCLUSION The majority of pediatric rheumatologists and nephrologists in Germany and Austria propose the use of corticosteroids, most often in combination with either MMF or CP, for treatment of proliferative LN in children. The considerable heterogeneity of responses supports the need for a treat-to-target protocol for juvenile proliferative LN between pediatric rheumatologists and nephrologists.
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Affiliation(s)
- Kristina Vollbach
- Department of Pediatrics, RWTH Aachen University Hospital, Aachen, Germany
| | - Catharina Schuetz
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christian M Hedrich
- Department of Pediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, United Kingdom.,Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Fabian Speth
- Universitätsmedizin Hamburg, Kinder- und Jugendklinik, Hamburg, Germany
| | - Kirsten Mönkemöller
- Department of Pediatrics, Kinderkrankenhaus Amsterdamer Strasse, Cologne, Germany
| | - Jürgen Brunner
- Department of Pediatrics, Pediatric Rheumatology, Medizinische Universität Innsbruck, Innsbruck, and Danube Private University, Krems an der Donau, Austria
| | - Ulrich Neudorf
- Clinic for Pediatrics III, University Hospital Essen, Essen, Germany
| | - Christoph Rietschel
- Department of Pediatric Rheumatology, Clementine Kinderhospital, Frankfurt, Germany
| | - Anton Hospach
- Center for Pediatric Rheumatology, Olgahospital, Stuttgart, Germany
| | - Tilmann Kallinich
- German Rheumatism Research Center, Leibniz Institute, Berlin, and Charité Universitätsmedizin Berlin, Pediatric Pneumology, Immunology and Critical Care Medicine and SPZ (Center for Chronically Sick Children), Berlin, Germany
| | - Claas Hinze
- Department of Pediatric Rheumatology and Immunology, University Hospital, Münster, Germany
| | - Norbert Wagner
- Department of Pediatrics, RWTH Aachen University Hospital, Aachen, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | - Lutz T Weber
- Division of Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Kay Latta
- Clementine Kinderhospital Frankfurt, Frankfurt, Germany
| | - Julia Thumfart
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Bald
- Division of Pediatric Nephrology, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Dagobert Wiemann
- Division of Pediatric Diabetology/Endocrinology, University Hospital Magdeburg, Magdeburg, Germany
| | - Hildegard Zappel
- Clinic of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Klaus Tenbrock
- Department of Pediatrics, RWTH Aachen University Hospital, Aachen, Germany
| | - Dieter Haffner
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hanover, Germany
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22
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Alexander T, Hedrich CM. Systemic lupus erythematosus - Are children miniature adults? Clin Immunol 2021; 234:108907. [PMID: 34890808 DOI: 10.1016/j.clim.2021.108907] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/02/2021] [Accepted: 12/02/2021] [Indexed: 12/13/2022]
Abstract
Systemic lupus erythematosus (SLE) is a systemic autoimmune/inflammatory disease that can affect any organ system and cause significant damage and organ failure. Disease-onset during childhood (juvenile-onset SLE) is associated with less typical autoantibody patterns, diffuse organ involvement, more damage already at diagnoses, and a higher need of immunomodulating treatment, including corticosteroids, when compared to adult-onset SLE. Differences in the molecular pathophysiology within SLE, and over-representation of patients with "genetic SLE" contribute to differences in clinical presentation and treatment responses between children and adults. This manuscript summarizes currently available literature focusing on parallels and differences between clinical pictures, known pathomechanisms, and available treatment options in juvenile- versus adult-onset SLE.
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Affiliation(s)
- Tobias Alexander
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, 10117 Berlin, Germany; Deutsches Rheuma-Forschungszentrum (DRFZ Berlin), ein Leibniz Institute, 10117 Berlin, Germany
| | - Christian M Hedrich
- Department of Women's and Children's Health, Institute of Live Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
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23
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Smitherman EA, Goh I, Pooni R, Vora SS, Yildirim-Toruner C, von Scheven E. Implementation Science in Pediatric Rheumatology: A Path to Health Equity. Rheum Dis Clin North Am 2021; 48:331-342. [PMID: 34798956 DOI: 10.1016/j.rdc.2021.08.006] [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: 11/27/2022]
Abstract
Implementation science is the study of processes that promote reliable uptake of evidence-based practices into clinical care. The integration of implementation science and health disparities research approaches has been proposed as a method to reduce health inequity through detection, understanding, and implementation of health equity-focused interventions. In this review, we provide an argument for the study of implementation science in pediatric rheumatology in light of previously observed health disparities, present a framework for the study of health equity and implementation science in pediatric rheumatology, and propose next steps to accelerate action.
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Affiliation(s)
- Emily A Smitherman
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Alabama at Birmingham, 1601 4th Avenue South, Park Place North Suite G10, Birmingham, AL 35233, USA.
| | - Ingrid Goh
- Division of Rheumatology, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M5G 0A4, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Rajdeep Pooni
- Division of Allergy, Immunology, and Rheumatology, Stanford University School of Medicine, Stanford Children's Health, 700 Welch Road, Suite 301, Palo Alto, CA 94304, USA
| | - Sheetal S Vora
- Department of Pediatrics, Atrium Health Levine Children's Hospital, 1000 Blythe Boulevard, 4th Floor, Charlotte, NC 28203, USA
| | - Cagri Yildirim-Toruner
- Department of Pediatrics, Baylor College of Medicine, 6701 Fannin Street, 11th Floor, Houston, TX 77030, USA
| | - Emily von Scheven
- Division of Pediatric Rheumatology, University of California San Francisco, 550 16th Street, 5th Floor, #5453, San Francisco, CA, USA
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24
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[Systemic lupus erythematosus-are children small adults?]. Z Rheumatol 2021; 81:28-35. [PMID: 34748078 DOI: 10.1007/s00393-021-01116-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 10/19/2022]
Abstract
Systemic lupus erythematosus (SLE) is a systemic inflammatory disease that can affect any organ of the human body and cause significant damage. As compared to patients with adult-onset SLE, children and young people (juvenile SLE) more frequently experience extensive diffuse organ involvement, more organ damage at diagnoses, and resistance to immunomodulatory treatment. This manuscript emphasizes parallels and differences between the clinical pictures, known pathomechanisms, and available treatment options of juvenile and adult-onset SLE.
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25
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Plott C, Gracie T, Alvis C, Schlefman A, Dudas R. A 4-year old presenting with fever and achiness. SAGE Open Med Case Rep 2021; 9:2050313X211056416. [PMID: 34733521 PMCID: PMC8558788 DOI: 10.1177/2050313x211056416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/12/2021] [Indexed: 11/15/2022] Open
Abstract
In children under the age of 5 who have abnormalities in history, physical examination, and laboratory studies indicating multi-system disease, uncovering the correct diagnosis is challenging. Here, we report the course of a 4-year-old girl who presented with a change in behavior, fever, arthralgia, arthritis, and hematuria following three recent hospitalizations for pneumonia and impetigo. Serologic findings were suggestive of a rheumatologic etiology and a renal biopsy was consistent with Membranous Lupus Nephritis Class V which helped secure the diagnosis of pediatric systemic lupus erythematosus. We review the clinical features and diagnostic criteria of early-onset systemic lupus erythematosus and discuss diagnostic considerations and prognosis.
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Affiliation(s)
| | - Thomas Gracie
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Courtney Alvis
- Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Amanda Schlefman
- Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Robert Dudas
- Johns Hopkins School of Medicine, Baltimore, MD, USA.,Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
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26
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Chiang YJ, Hu YC, Chiang BL. A significant improvement of thromboses treated by a new oral anticoagulant in an 11-year-old girl with systemic lupus erythematosus associated antiphospholipid syndrome: A case report. Lupus 2021; 30:1338-1341. [PMID: 34000880 DOI: 10.1177/09612033211016096] [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: 11/15/2022]
Abstract
Pediatric venous thrombosis is associated with a variety of chronic diseases. Antiphospholipid syndrome (APS) is one of them and is commonly related to systemic lupus erythematosus (SLE). Warfarin is the mainstream of anticoagulation treatment in pediatric APS currently but it needs close monitoring and frequent dose adjustment. New oral anticoagulants (NOAC) is one of the innovative options in recent years but there is a lack of report in secondary prevention of deep vein thrombosis (DVT), especially pediatric APS. Herein we reported the significant therapeutic effect of edoxaban in a 11-year-old girl of newly diagnosed SLE and APS, who had deep vein thrombosis as the initial presentation.
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Affiliation(s)
- Yen-Jung Chiang
- Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Ya-Chiao Hu
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Bor-Luen Chiang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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27
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Abdelnabi HH. Is podocytopathy another image of renal affection in p-SLE? Pediatr Rheumatol Online J 2021; 19:57. [PMID: 33902643 PMCID: PMC8077747 DOI: 10.1186/s12969-021-00547-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 04/14/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Lupus podocytopathy (LP) is a renal affection described in systemic lupus erythematosus (SLE) patients with nephrotic range proteinuria, characterized by diffuse foot process effacement without immune deposits and glomerular proliferation. This study describes LP, its pathological features and outcomes of pediatric (p-SLE) patients in comparison to the usual lupus nephritis (LN) cases. METHODOLOGY A retrospective cohort study conducted on a 10-year registration (2010-2019) of 140 p-SLE patients at the Pediatric Department, Tanta University. Histopathological analysis with light microscopy (LM) and immunofluorescence (IF) of all renal biopsies were evaluated according to the International Society of Nephrology Renal Pathology Society (ISN/RPS) grading system. In addition, some biopsies were examined with electron microscopy (EM). RESULTS Eighty-six p-SLE cases (61.4%) had renal involvement; seventy-nine biopsies (91.86%) of them met the classification criteria of LN as defined by ISN/RPS system. Five biopsies were normal (MCD) and two showed focal segmental sclerosis (FSGN) that did not meet any known classification of LN. Hence, they were reevaluated using EM that revealed diffuse effaced podocytes without glomerular sub-epithelial, endocapillary or basement membrane immune deposits, and were classified as having lupus podocytopathy, representing (8.14%) of all LN biopsies. Those seven cases showed good response to steroids with a complete remission duration of 3.40 ± 1.95 weeks. However, some case had 1-3 relapses during the duration of follow up. CONCLUSIONS LP is a spectrum of p-SLE, not an association as it is related to disease activity and its initial presentation.
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Affiliation(s)
- Hend H. Abdelnabi
- grid.412258.80000 0000 9477 7793Nephrology Unit, Pediatric Department, Tanta University, El-Geesh Street, Tanta, Egypt
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28
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Szymanik-Grzelak H, Barabasz M, Wikiera-Magott I, Banaszak B, Wieczorkiewicz-Płaza A, Bieniaś B, Drożynska-Duklas M, Tkaczyk M, Pańczyk-Tomaszewska M. Retrospective analysis of clinical and pathomorphological features of lupus nephritis in children. Adv Med Sci 2021; 66:128-137. [PMID: 33545446 DOI: 10.1016/j.advms.2021.01.004] [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: 07/21/2020] [Revised: 12/08/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of the study was to evaluate the clinical course and pathomorphological correlations in Polish children with the diagnosis of lupus nephritis (LN). METHODS We retrospectively analyzed the medical records of 39 children hospitalized due to LN in 7 pediatric nephrology units in Poland between 2010 and 2019. Demographic data, clinical symptoms at the onset of LN and laboratory parameters were reviewed. We analyzed Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), histological LN findings with the activity (IA) and chronicity index (IC). RESULTS We examined 32 girls and 7 boys, median age at LN onset was 14.75 (IQR 13.0-16.0) years, SLEDAI of 22.0 (IQR 18.0-27.0) points; LN histological class: IV (59.4%), III (18.9%), III/V (10.8%), IV/V (8.1%), VI (2.7%); IA 8.0 (IQR 6.0-11.0) points, IC 1.05 (IQR 0-2.0) points. Children with nephrotic (n = 22) and non-nephrotic (n = 17) proteinuria differed in median Hb level (9.55, IQR 8.3-11.2 vs 10.9, IQR 10.1-11.6 g/L; P < 0.05), albumin level (2.5, IQR 2.1-3.19 vs 3.6, IQR 3.4-4.1 g/dL; P < 0.001), proteinuria (5.76, IQR 3.0-7.5 vs 1.08, IQR 0.53-1.50 g/day; P < 0.0001), eGFR (53.9, IQR 27.0-68.8 vs 96.7, IQR 73.8-106.2 mL/min/1.73 m2; P < 0.01) and occurrence of hypertension (77% vs 23%; P < 0.01). In multivariate analysis Hb level (β = 8.0; 95%CI, 1.90-14.11) was the significant predictor of eGFR<90 mL/min/1.73 m2. CONCLUSIONS Proliferative forms of LN in children may have a varying clinical presentation. Children with LN with nephrotic range proteinuria have lower Hb level, lower eGFR and higher occurrence of hypertension. Hb level is the significant predictor of eGFR<90 mL/min/1.73 m2 in children with LN.
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29
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Hsu D, Khalsa UK, Hassan M, Sandborg CI, Namjoshi SS. Early Intervention and Resolution of Pediatric Intestinal Pseudo-Obstruction in Systemic Lupus Erythematosus: A Pediatric Case Report. JPGN REPORTS 2021; 2:e041. [PMID: 37206925 PMCID: PMC10191485 DOI: 10.1097/pg9.0000000000000041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/04/2020] [Indexed: 05/21/2023]
Affiliation(s)
- Diane Hsu
- From The Division of Gastroenterology, Hepatology and Nutrition, Stanford University, Palo Alto, CA
| | - Uptej K. Khalsa
- The Division of Allergy, Immunology and Rheumatology, Stanford University, Palo Alto, CA
| | - Maheen Hassan
- From The Division of Gastroenterology, Hepatology and Nutrition, Stanford University, Palo Alto, CA
| | - Christy I. Sandborg
- The Division of Allergy, Immunology and Rheumatology, Stanford University, Palo Alto, CA
| | - Shweta S. Namjoshi
- From The Division of Gastroenterology, Hepatology and Nutrition, Stanford University, Palo Alto, CA
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30
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Mycophenolic acid area under the concentration-time curve is associated with therapeutic response in childhood-onset lupus nephritis. Pediatr Nephrol 2021; 36:341-347. [PMID: 32856157 DOI: 10.1007/s00467-020-04733-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 07/15/2020] [Accepted: 07/28/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Mycophenolic acid (MPA), the active compound of mycophenolate mofetil (MMF), is widely used in lupus nephritis treatment. Therapeutic drug monitoring of adults suggests that area under the concentration-time curve (AUC) of MPA (MPA-AUC) is associated with clinical outcomes, but childhood data are scarce. METHODS Retrospective study of 27 children with biopsy-proven lupus nephritis treated with MMF between 2008 and 2016. In 25 children, MPA-AUC was performed within 6 months after kidney biopsy and MMF initiation. Treatment response at 6 months was defined as normal or improved GFR by 25% compared with baseline, 50% reduction of proteinuria to < 0.5 g/day or 50 mg/mmol, and no hematuria. RESULTS A total of 62 MPA-AUC were analyzed in 27 patients. Overall median was 44 mg h/L (interquartile range [IQR] 33-54). Individual dose adaptation was required in 32 cases (52%) to achieve target AUC of 30-60 mg h/L. At 6 months, 14/25 patients were defined as responders (56%, median MPA-AUC 49 mg h/L (40-59)) and 11/25 as non-responders (44%, 29 mg h/L (24-38)). Patients with MPA-AUC levels > 45, 30-45, and < 30 mg h/L had 6-month response rates of 89% (8/9), 60% (6/10), and 0% (0/6), respectively. In a logistic regression model adjusted for age, sex, lupus nephritis classification, and time since MMF initiation, an MPA-AUC > 45 mg h/L was significantly associated with therapeutic response (OR 3.6, 95% CI 2.4-9.5, p = 0.03). CONCLUSIONS Therapeutic drug monitoring leading to individualized dosing may improve efficacy of MMF. MPA-AUC > 45 mg h/L is associated with better response rate and may be considered as a target value in pediatric lupus nephritis.
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El-Garf K, El-Garf A, Gheith R, Badran S, Salah S, Marzouk H, Farag Y, Khalifa I, Mostafa N. A comparative study between the disease characteristics in adult-onset and childhood-onset systemic lupus erythematosus in Egyptian patients attending a large university hospital. Lupus 2020; 30:211-218. [PMID: 33175664 DOI: 10.1177/0961203320972778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Disease features and laboratory abnormalities differ among adult-onset and childhood-onset systemic lupus erythematosus (aSLE and cSLE). Socioeconomic status both independent of, and in combination with, ethnicity influences the disease phenotype and outcome. OBJECTIVE To compare the various disease features among patients with cSLE and aSLE in a limited monetary income Egyptian cohort attending a large free-of-charge university hospital. Patients and methods: Retrospective analysis of the medical records of 714 SLE patients attending Cairo University Hospitals from January 2000 to December 2019. Of them 602 (400 with aSLE and 202 with cSLE) were enrolled in the study. RESULTS The mean age of disease onset was 28.27 ± 10.55 among aSLE patients compared to 12.88 ± 4.26 years among cSLE patients. Disease duration was 12.03 ± 5.05 and 4.14 ± 3.18 years in aSLE and cSLE, respectively. Female to male ratio was 15:1 among patients with aSLE, as compared to 2.67:1 among cSLE (<0.001). Arthritis (69%), oral ulcers (48.5%), neuropsychiatric (18.3%) and thrombotic manifestations of antiphospholipid syndrome (12%) were significantly more frequent in aSLE. On the other hand, renal (67.8%), serositis (49.6%), fever (49%), lymphopenia (40.6%), hemolytic anemia (38.6%), and discoid lupus (13.4%) were significantly more frequent in cSLE. Weight loss, malar rash, photosensitivity, thrombocytopenia, leucopenia and lymphadenopathy were not significantly different between the two groups. Hypocomplementemia, proteinuria, urinary sediments, hematuria were significantly more frequent in cSLE. For those patients with renal involvement, who underwent renal biopsy (58.3% in aSLE and 63.5% in cSLE), there was no significant difference with regard to the different histopathological classes. Anti-Smith, anti-cardiolipin antibodies and rheumatoid factor were significantly more frequent among aSLE patients, while anti-La antibodies were more frequent among cSLE patients. CONCLUSION Arthritis was the most common clinical manifestation over time in aSLE compared to renal involvement in cSLE. Renal disease tends to be more active in cSLE. The differences in disease manifestations between this cohort and other studies can be attributed to the ethnic and socioeconomic disparities.
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Affiliation(s)
- Kamal El-Garf
- Department of Rheumatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman El-Garf
- Department of Rheumatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rasha Gheith
- Department of Rheumatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Shaimaa Badran
- Department of Rheumatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Samia Salah
- Department of Pediatrics, Rheumatology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Huda Marzouk
- Department of Pediatrics, Rheumatology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yomna Farag
- Department of Pediatrics, Rheumatology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Iman Khalifa
- Department Pediatric, Helwan University, Cairo, Egypt
| | - Noha Mostafa
- Department of Pediatrics, Rheumatology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
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Ogbu EA, Chandrakasan S, Rouster-Stevens K, Greenbaum LA, Sanz I, Gillespie SE, Marion C, Okeson K, Prahalad S. Impact of autoimmune cytopenias on severity of childhood-onset systemic lupus erythematosus: A single-center retrospective cohort study. Lupus 2020; 30:109-117. [PMID: 33108953 DOI: 10.1177/0961203320969806] [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: 12/15/2022]
Abstract
OBJECTIVE To assess whether children with autoimmune cytopenias prior to or at diagnosis of systemic lupus erythematosus (cSLE), differ phenotypically from other cSLE patients; and have a lower risk and severity of lupus nephritis (LN) as observed in prior adult studies. To assess the effect of prior immune therapy for autoimmune cytopenias on 2-year risk of LN. METHODS This was a retrospective cohort study of incident cSLE cases. We included patients aged less than 17 years at diagnosis. We excluded patients with LN at cSLE diagnosis. Our follow-up period was 2 years. We defined autoimmune cytopenias as either autoimmune hemolytic anemia, immune thrombocytopenia or Evan's syndrome. RESULTS Forty-three (33%) of the 130 patients had autoimmune cytopenias before or at cSLE diagnosis. Those with autoimmune cytopenias had significantly more neuropsychiatric symptoms and higher mean ESR but less arthritis, malar rash and myositis versus those without autoimmune cytopenias. They had lower 2-year incidence proportion of LN compared to other cSLE patients (7% vs 15%). Of the 16 patients who developed LN, those with autoimmune cytopenias had mostly class V (2 of 3 patients) versus mostly class III and IV in those without autoimmune cytopenias (6 of 12 patients). None of the 13 patients pre-treated for autoimmune cytopenias developed LN. CONCLUSION Patients with autoimmune cytopenias before or at cSLE diagnosis have intriguing differences from other cSLE patients. They may represent a unique sub-type of cSLE patients and should be further explored.
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Affiliation(s)
- Ekemini A Ogbu
- Department of Pediatrics, Division of Pediatric Allergy, Immunology and Rheumatology, Johns Hopkins University, Baltimore, USA
| | - Shanmuganathan Chandrakasan
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Emory University School of Medicine and Children's Healthcare of Atlanta, Georgia, USA
| | - Kelly Rouster-Stevens
- Department of Pediatrics, Division of Pediatric Rheumatology, Emory University School of Medicine and Children's Healthcare of Atlanta, Georgia, USA
| | - Larry A Greenbaum
- Department of Pediatrics, Division of Pediatric Nephrology, Emory University School of Medicine and Children's Healthcare of Atlanta, Georgia, USA
| | - Ignacio Sanz
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Georgia, USA
| | - Scott E Gillespie
- Department of Pediatrics, Emory University School of Medicine, Georgia, USA
| | | | - Karli Okeson
- Department of Pediatrics, Emory University School of Medicine, Georgia, USA
| | - Sampath Prahalad
- Department of Pediatrics, Division of Pediatric Rheumatology, Emory University School of Medicine and Children's Healthcare of Atlanta, Georgia, USA
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Elkoumi MA, Allah MA, Mohamed FY, Boraey NF, Abdellatif SH, Shehab MM, Sherif AH, Akeel NE, Saleh RM, Elshreif AM, Abdelrahman HM, Soliman AA, Emam AA, Youssef MA, Fahmy DS, Sallam MM, Nawara AM, Elgohary EA, Ismael A, El-Kaffas SM, Sobeih AA, Ibrahim LM, Ibrahim MA, Abdou AM, Yousry SM, Osman SF, El-Deeb FM, Elhewala AA, Hafez SF, Waked NM, Elbasyouni HA, Fouad RA, Zeidan NM, Nashat M, Farghaly MA. Association of interleukin-17A gene polymorphisms and susceptibility to systemic lupus erythematosus in Egyptian children and adolescents: a multi-centre study. Lupus 2020; 29:767-775. [PMID: 32380889 DOI: 10.1177/0961203320922305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Recently, the interleukin-17A (IL-17A) gene has emerged as a potential candidate gene for autoimmune disorders, including systemic lupus erythematosus (SLE). OBJECTIVES This study aimed to investigate whether IL-17A polymorphisms at rs2275913 G/A, rs8193036 C/T and rs3748067 C/T could be susceptibility markers for juvenile-onset SLE (JSLE) and lupus nephritis (LN) in Egyptian children and adolescents. METHODS In this multi-centre study, we genotyped 320 patients diagnosed with JSLE and 320 matched control children for three IL-17A polymorphisms at rs2275913 G/A, rs8193036 C/T and rs3748067 C/T using TaqMan probe-based real-time polymerase chain reaction. Meanwhile, IL-17A serum levels were assessed using ELISA. RESULTS The IL-17 rs2275913 A/A genotype and A allele were more represented in JSLE patients compared to the control group (21% vs. 7%, odds ratio (OR) = 3.8, 95% confidence interval (CI) 1.78-5.5, p = 0.001, pBonf = 0.003 for the A/A genotype; 37% vs. 29%, OR = 1.4, 95% CI 1.11-1.8, p = 0.003, pBonf = 0.009 for the A allele. No significant difference was found for IL-17 rs8193036 and rs3748067 single nucleotide polymorphisms (SNPs) in genotype distribution or allele frequencies (p>0.05). Patients carrying the IL-17 rs2275913 A/A genotype and A allele were more likely to develop LN (OR = 5.64, 95% CI 2.39-13.77, pBonf = 0.001 for the A/A genotype; OR = 2.73, 95% CI 1.84-4.07, pBonf = 0.02 for the A allele). CONCLUSION The IL-17 rs2275913 A allele and A/A genotype were associated with high IL-17 serum levels and may contribute to susceptibility to JSLE and the development of LN in Egyptian children and adolescents. However, no significant association was evident between the studied IL-17A SNPs and other clinical phenotypes, disease activity scores or laboratory profile of JSLE.
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Affiliation(s)
- Mohamed A Elkoumi
- Department of Paediatrics, Faculty of Medicine, Zagazig University, Egypt
| | - Mayy An Allah
- Department of Paediatrics, Faculty of Medicine, Zagazig University, Egypt
| | - Faisal Y Mohamed
- Department of Paediatrics, Faculty of Medicine, Ain-Shams University, Egypt
| | - Naglaa F Boraey
- Department of Paediatrics, Faculty of Medicine, Sohag University, Egypt
| | | | - Mohamed Mm Shehab
- Department of Paediatrics, Faculty of Medicine, Zagazig University, Egypt
| | - Ahmed H Sherif
- Department of Paediatrics, Faculty of Medicine, Zagazig University, Egypt
| | - Nagwa E Akeel
- Department of Paediatrics, Faculty of Medicine, Zagazig University, Egypt
| | - Rabab M Saleh
- Department of Paediatrics, Faculty of Medicine, Zagazig University, Egypt
| | - Anas M Elshreif
- Department of Paediatrics, Faculty of Medicine, Al Azhar University, Egypt
| | - Hind M Abdelrahman
- Department of Paediatrics, Faculty of Medicine, Zagazig University, Egypt
| | - Attia A Soliman
- Department of Paediatrics, Faculty of Medicine, Zagazig University, Egypt
| | - Ahmed A Emam
- Department of Paediatrics, Faculty of Medicine, Zagazig University, Egypt
| | - Manal Aa Youssef
- Department of Rheumatology, Faculty of Medicine, Zagazig University, Egypt
| | - Dalia S Fahmy
- Department of Rheumatology, Faculty of Medicine, Zagazig University, Egypt
| | - Mohammad M Sallam
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Egypt
| | - Abdalla M Nawara
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Egypt
| | - Elsayed A Elgohary
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Egypt
| | - Ali Ismael
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Egypt
| | | | - Alaa A Sobeih
- Department of Paediatrics, Faculty of Medicine, Cairo University, Egypt
| | - Lamya M Ibrahim
- Department of Clinical Pathology, Faculty of Medicine, Mansoura University, Egypt
| | - Mohamed Am Ibrahim
- Department of Clinical Pathology, Faculty of Medicine, Sohag University, Egypt
| | - Adel M Abdou
- Department of Clinical Pathology, Faculty of Medicine, Al Azhar University, Egypt
| | - Sherif M Yousry
- Department of Clinical pathology, Faculty of Medicine, Cairo University, Egypt
| | - Sherif F Osman
- Department of Radiology, Texas Tech University Health Sciences Center El Paso, USA
| | - Fatma M El-Deeb
- Department of Dermatology, Faculty of Medicine, Zagazig University, Egypt
| | - Ahmed A Elhewala
- Department of Paediatrics, Faculty of Medicine, Zagazig University, Egypt
| | - Sahbaa Fm Hafez
- Department of Paediatrics, Faculty of Medicine, Zagazig University, Egypt
| | - Nevin M Waked
- Department of Paediatrics, Faculty of Medicine, October 6 University, Egypt
| | - Hany Aa Elbasyouni
- Department of Internal Medicine, Faculty of Medicine, Menoufia University, Egypt
| | - Rania A Fouad
- Department of Medical Biochemistry, Faculty of Medicine, Zagazig University, Egypt
| | - Nancy Ms Zeidan
- Department of Paediatrics, Faculty of Medicine, Cairo University, Egypt
| | - Mohamed Nashat
- Department of Paediatrics, Faculty of Medicine, Aswan University, Egypt
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Agarwal M, Freychet C, Jain S, Shivpuri A, Singh A, Dinand V, Sawhney S. Factors impacting referral of JIA patients to a tertiary level pediatric rheumatology center in North India: a retrospective cohort study. Pediatr Rheumatol Online J 2020; 18:21. [PMID: 32131855 PMCID: PMC7057446 DOI: 10.1186/s12969-020-0408-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/03/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND JIA studies demonstrate that there is a "window of opportunity" early in the disease course during which appropriate management improves outcomes. No data is available regarding patients' pathway, before first pediatric rheumatology (PR) evaluation in India, a country where health-care costs are self- paid by patients and where a significant shortage of pediatric rheumatologists (PRsts) is known. This study aimed to describe time from onset of symptoms to first PR visit of JIA patients to a tertiary center in India and factors that impact this. METHODS This retrospective study is from data collected at the PR center, Sir Ganga Ram Hospital (SGRH) in New Delhi. JIA patients fulfilling ILAR 2004 criteria and seen at least twice from 1st October 2013 to 30th September 2018 were included. Data collected were: demographic details, history of disease, referral practitioner, clinical and laboratory features, treatments. Mann-Whitney U-test, Chi square and logistic regression were used as appropriate to study factors that determined time to first PR visit. RESULTS Five hundred and twenty patients were included: 396 were diagnosed at this PR center (group A), 124 were previously diagnosed as JIA and managed by non PRsts before first PR visit (group B). Median time from symptom onset to first PR visit was 4.1 months and median distance travelled 119.5 km. Despite ongoing treatment, group B patients had more aggressive disease and resided further away as compared to Group A patients. On univariate analysis, factors that predicted PR visit within 3 months were private patients, short distance to travel, family history of inflammatory disease, history of fever, history of acute uveitis or high ESR. On multivariate analysis all these factors were significant except high ESR and acute uveitis. CONCLUSION Time to first PR assessment at this center was comparable to that seen in western countries. Cost of care and long distance to the center delayed consultation; acuity of complaints and family history of rheumatologic condition hastened referral. Possible solutions to improve referral to PR centers would be to increase the number of PRsts and to improve medical insurance coverage.
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Affiliation(s)
- Manjari Agarwal
- 0000 0004 1767 8547grid.415985.4Division of Pediatric Rheumatology, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
| | - Caroline Freychet
- Division of Pediatric Rheumatology, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India. .,HESPER Laboratory, Claude-Bernard University, Lyon, France.
| | - Sumidha Jain
- 0000 0004 1767 8547grid.415985.4Division of Pediatric Rheumatology, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
| | - Abhay Shivpuri
- 0000 0004 1767 8547grid.415985.4Division of Pediatric Rheumatology, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
| | - Anju Singh
- 0000 0004 1767 8547grid.415985.4Division of Pediatric Rheumatology, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
| | - Veronique Dinand
- 0000 0004 1767 8547grid.415985.4Department of Research, Sir Ganga Ram Hospital, New Delhi, India
| | - Sujata Sawhney
- 0000 0004 1767 8547grid.415985.4Division of Pediatric Rheumatology, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
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Jeamsripong S, Charuvanij S. Features distinguishing juvenile idiopathic arthritis among children with musculoskeletal complaints. World J Pediatr 2020; 16:74-81. [PMID: 30498888 DOI: 10.1007/s12519-018-0212-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 11/13/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Musculoskeletal (MSK) complaints in children vary, ranging from benign, self-limited conditions to serious disorders. Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease, initially presenting with MSK complaints. Delayed diagnosis and appropriate treatment have an enormous impact on the long-term outcomes and the level of disability. This study aimed to identify the features distinguishing JIA among children presenting with MSK complaints and to describe the spectrum of diseases at a large, single, tertiary center. METHODS A retrospective chart review was performed of patients evaluated by pediatric rheumatology consultation at the Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand, from July 2011 to June 2015. RESULTS Of 531 patients, 285 (53.6%) had at least one MSK complaint. The mean age of the patients was 9.1 ± 4.1 years. Joint pain was the most common MSK complaint (86.3%), followed by limping (33%) and refusal to walk (19.6%). Joint swelling and limited range of motion were found in 146 (51.2%) and 115 (40.4%) patients, respectively. Seventy-three (25.6%) patients were diagnosed as JIA. The other common diagnoses included Henoch-Schönlein purpura (16.1%), reactive arthritis (14.2%), and systemic lupus erythematosus (13.7%). Morning stiffness ≥ 15 minutes [odds ratio (OR) 8.217 (3.404-19.833)]; joint swelling on MSK examination [OR 3.505 (1.754-7.004)]; a duration of MSK complaints of more than 6 weeks [OR 2.071 (1.120-3.829)]; and limping [OR 1.973 (1.048-3.712)] were significantly associated with the ultimate diagnosis of JIA. CONCLUSIONS Morning stiffness ≥ 15 minutes is a strong predictor of JIA. Comprehensive history taking and an MSK examination will provide clues for making the ultimate diagnosis for children with MSK complaints.
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Affiliation(s)
- Satita Jeamsripong
- 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, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
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Abstract
Lupus nephritis (LN) is a form of glomerulonephritis that constitutes one of the most severe organ manifestations of the autoimmune disease systemic lupus erythematosus (SLE). Most patients with SLE who develop LN do so within 5 years of an SLE diagnosis and, in many cases, LN is the presenting manifestation resulting in the diagnosis of SLE. Understanding of the genetic and pathogenetic basis of LN has improved substantially over the past few decades. Treatment of LN usually involves immunosuppressive therapy, typically with mycophenolate mofetil or cyclophosphamide and with glucocorticoids, although these treatments are not uniformly effective. Despite increased knowledge of disease pathogenesis and improved treatment options, LN remains a substantial cause of morbidity and death among patients with SLE. Within 10 years of an initial SLE diagnosis, 5-20% of patients with LN develop end-stage kidney disease, and the multiple comorbidities associated with immunosuppressive treatment, including infections, osteoporosis and cardiovascular and reproductive effects, remain a concern. Clearly, early and accurate diagnosis of LN and prompt initiation of therapy are of vital importance to improve outcomes in patients with SLE.
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Chowichian M, Aanpreung P, Pongpaibul A, Charuvanij S. Lupus enteritis as the sole presenting feature of systemic lupus erythematosus: case report and review of the literature. Paediatr Int Child Health 2019; 39:294-298. [PMID: 30191770 DOI: 10.1080/20469047.2018.1504430] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Systemic lupus erythematosus (SLE) is a multisystem, autoimmune inflammatory disease which can affect any organ, including the gastrointestinal tract. Lupus enteritis is one of the manifestations of gastrointestinal involvement in SLE patients. However, it is exceedingly rare that lupus enteritis is the sole initial presentation of SLE. A 12-year-old Thai girl who had had recurrent abdominal pain for 2 months with no other signs of SLE on initial presentation is described. A single-balloon enteroscopy demonstrated segmental erythema of the proximal and mid-jejunum. Histopathology demonstrated active enteritis and submucosal vasculitis. On the basis of evidence of intestinal vasculitis, autoimmune profiles were performed; the results supported the possibility of SLE. She subsequently developed leucopenia, lymphopenia and an oral ulcer, leading to a robust diagnosis of SLE. Her clinical condition improved dramatically with prednisolone. Even though lupus enteritis is rare, it can be the initial presentation of SLE. In young adolescent girls with recurrent abdominal pain, the possibility of lupus enteritis should be borne in mind.
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Affiliation(s)
- Monthira Chowichian
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand
| | - Prapun Aanpreung
- Division of Gastroenterology, Department of Pediatrics, Mahidol University , Bangkok , Thailand
| | - Ananya Pongpaibul
- Department of Pathology, 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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Wang W, Zhou Y, Zhong L, Wang L, Tang X, Ma M, Li J, Song H. RAS-associated Autoimmune Leukoproliferative disease (RALD) manifested with early-onset SLE-like syndrome: a case series of RALD in Chinese children. Pediatr Rheumatol Online J 2019; 17:55. [PMID: 31412876 PMCID: PMC6694547 DOI: 10.1186/s12969-019-0346-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/03/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Primary immunodeficiency diseases (PIDs) patients may show systemic lupus erythematosus (SLE)-like autoimmunity disorders, such as cytopenias, as well as polyarthritis, which leads to concerns of misdiagnosis. We diagnosed three RALD cases between 2015 and 2018, who were suspected as SLE and summarized clinical characteristics. METHODS We collected and analyzed the clinical data of the 3 cases. DNA was extracted from the patients' and their parents' peripheral blood as well as oral mucosa cells, hair follicles, and nails. Genes were detected with the application of gene trapping high-throughput sequencing using PIDs panel and suspicious gene or mutation was further verified by Sanger sequencing. RESULTS 1. CLINICAL FEATURES On the one hand, the patients presented with severe thrombocytopenia, facial erythema, arthritis, positive autoantibodies and other manifestations, supporting the diagnosis of SLE. On the other hand, symptoms including early onset ages, recurrent infections, lymphadenopathy, hepatosplenomegaly, monocytosis and hypergammaglobulinemia, were common observed in PIDs. 2. Gene analysis: NRAS mutations (c.38G > A, p.G13D or c.37G > T, p.G13C) were found in the blood of the patients. Besides, the same set of mutations was detected in buccal mucosa of patient 1 and nails of patient 3 while the frequency was much lower. However, no mutation was found in other tissues or in their parents' blood. Consequently, they were NRAS somatic mutated RALD. CONCLUSIONS For those early-onset SLE-like patients with predominant hematologic disorders, monocytosis, recurrent infectious history, accompanied with hepatosplenomegaly and lymphadenopathy, a genetic screening of PIDs might be required.
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Affiliation(s)
- Wei Wang
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yu Zhou
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China ,0000 0001 0662 3178grid.12527.33School of Medicine, Tsinghua University, Beijing, China
| | - Linqing Zhong
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lin Wang
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoyan Tang
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingsheng Ma
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ji Li
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongmei Song
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
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Lin Q, Zhang M, Tang H, Shen Y, Zhu Y, Xu Q, Li X. Acute pancreatitis and macrophage activation syndrome in pediatric systemic lupus erythematosus: case-based review. Rheumatol Int 2019; 40:811-819. [PMID: 31377830 DOI: 10.1007/s00296-019-04388-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 07/17/2019] [Indexed: 12/14/2022]
Abstract
Pancreatitis is uncommon in systemic lupus erythematosus (SLE) and is rarely reported in children, possibly being related to macrophage activation syndrome (MAS). The incidence of MAS in children with lupus pancreatitis is unknown, as is their prognosis. In this case-based review, we report a pediatric patient with SLE complicated with pancreatitis and MAS, and performed a literature review. We report an 11-year-old girl with SLE and MAS who developed pancreatitis on the second day of methylprednisolone pulse therapy (500 mg/day). We continued methylprednisolone pulse therapy, and performed three rounds of DNA-immunoadsorption and three rounds of hemoperfusion. A second course of methylprednisolone pulse therapy was initiated 9 days later. The patient received a monthly cyclophosphamide pulse therapy (10 mg/kg/day, 2 consecutive days every month) for 6 months, after which she was treated with mycophenolate mofetil 20 mg/kg/day. The condition of the patient gradually improved, her blood amylase and lipase decreased. She was in a stable condition during 13-month follow-up period. Review of the literature of pediatric patients with SLE and pancreatitis showed that there are 127 cases that have been reported in the past 30 years, 40 cases were excluded in our study because of inadequate information. Of the 87 patients included in our literature review, the mortality rate was 33.33%, and 52.86% of the patients with pancreatitis had MAS at the same time. Pancreatitis is uncommon in SLE, but must be suspected if a patient with SLE develops digestive symptoms. Patients with SLE with pancreatitis have a high incidence of MAS and high mortality rate; however, early recognition and effective treatment can relieve the disease symptoms.
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Affiliation(s)
- Qiang Lin
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, 303, Jingde Road, Suzhou, Jiangsu, The People's Republic of China
| | - Man Zhang
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, 303, Jingde Road, Suzhou, Jiangsu, The People's Republic of China
| | - Hanyun Tang
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, 303, Jingde Road, Suzhou, Jiangsu, The People's Republic of China
| | - Yunyan Shen
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, 303, Jingde Road, Suzhou, Jiangsu, The People's Republic of China
| | - Yun Zhu
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, 303, Jingde Road, Suzhou, Jiangsu, The People's Republic of China
| | - Qinying Xu
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, 303, Jingde Road, Suzhou, Jiangsu, The People's Republic of China
| | - Xiaozhong Li
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, 303, Jingde Road, Suzhou, Jiangsu, The People's Republic of China.
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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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Zhang CX, Cai L, Zhou ZY, Mao YY, Huang H, Yin L, Chen TX, Zhou W. Clinical manifestations, immunological features and prognosis of Chinese pediatric systemic lupus erythematosus: A single-center study. Int J Rheum Dis 2019; 22:1070-1076. [PMID: 30957986 DOI: 10.1111/1756-185x.13547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 02/15/2019] [Accepted: 02/17/2019] [Indexed: 11/30/2022]
Abstract
AIM Since there are only a few reports on pediatric systemic lupus erythematosus (pSLE) in Chinese populations, therefore we retrospectively report the clinical and immunological features as well as renal outcome in Chinese pSLE. METHODS Patients diagnosed with pSLE at Shanghai Children's Medical Center between 2001 and 2016 were evaluated and clinical data were retrospectively collected. RESULTS A total of 102 pSLE patients were analyzed. Renal disorder including proteinuria (81.37%) and hematuria (65.69%) were most commonly identified. Class IV was the most common finding on renal biopsy. In lupus nephritis (LN), 67.21%, 78.0%, 86.0% and 94.55% achieved complete remission within 6, 12, 18 and 24 months, respectively. Furthermore, 16.67% of LN patients suffered at least one renal flare. Antinuclear antibodies were detected in nearly all patients (97.62%), followed by anti-double-stranded DNA (anti-dsDNA) antibodies (70.0%) and anti-Sjögren's syndrome A (anti-SSA) antibodies (60.64%). Oral corticosteroid (93.14%) and mycophenolate mofetil (64.71%) was used in the majority of patients. Infection (32.35%) was the main side effect caused by the medications. CONCLUSIONS Our population-based pSLE cohort indicated that compared to other international cohorts, there was a higher prevalence of LN in Chinese pSLE. Proteinuria was the most frequent manifestation both at disease onset and during the entire clinical course. Class IV LN was the dominant renal pathological type. Nevertheless, there was a favorable renal remission rate and relatively low incidence of renal flare in our cohort. Apart from antinuclear antibodies and anti-dsDNA antibodies, anti-SSA antibodies were most frequently detected. Infection was the leading complication caused by the medications.
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Affiliation(s)
- Chen-Xing Zhang
- Department of Nephrology and Rheumatology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Division of Immunology, Institute of Pediatric Translational Medicine, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Li Cai
- Department of Nephrology and Rheumatology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Division of Immunology, Institute of Pediatric Translational Medicine, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zheng-Yu Zhou
- Department of Nephrology and Rheumatology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - You-Ying Mao
- Department of Nephrology and Rheumatology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hua Huang
- Department of Nephrology and Rheumatology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lei Yin
- Department of Nephrology and Rheumatology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tong-Xin Chen
- Department of Nephrology and Rheumatology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Division of Immunology, Institute of Pediatric Translational Medicine, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Department of Allergy and Immunology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wei Zhou
- Department of Nephrology and Rheumatology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Dalby ST, Tang X, Daily JA, Sukumaran S, Collins RT, Bolin EH. Effect of pericardial effusion on outcomes in children admitted with systemic lupus erythematosus: a multicenter retrospective cohort study from the United States. Lupus 2019; 28:389-395. [PMID: 30744520 DOI: 10.1177/0961203319828523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We sought to describe characteristics of children admitted with pericardial effusion (PCE) and systemic lupus erythematosus (SLE) and determine the association between PCE and outcomes of interest. METHODS We performed a retrospective cohort study of the Pediatric Health Information System (PHIS). Patients were included if they were admitted to a PHIS participating hospital from 2004 to 2015 with a diagnosis of SLE and age ≤18 years. Children with congenital heart disease or who had undergone heart surgery were excluded. PCE was the primary predictor variable; multivariable analysis was used to evaluate the effect of PCE on the following outcomes: mortality, length of stay (LOS), and readmission within 30 days. RESULTS There were 5679 admissions, of which 705 (12.4%) had PCE. Median age at admission was 15 years (interquartile range: 13-17). There were no significant differences for age or sex between patients admitted either with or without PCE. A significantly higher percentage of children in the PCE group were black compared with those without PCE (43% vs. 31%, p < 0.001). In multivariable analysis, the odds of a black patient having PCE were 1.7 higher than non-black patients ( p < 0.001). In-hospital mortality was 2.5 times higher in children with PCE compared with those without PCE ( p = 0.027). Those with PCE also had 1.5 greater odds of readmission within 30 days ( p < 0.001). PCE was not associated with increased LOS (0.99, p = 0.753). CONCLUSION PCE is common in admissions of children with SLE. There are disproportionately more black patients with SLE affected by PCE than non-black. PCE is associated with significantly higher mortality and rates of readmission.
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Affiliation(s)
- S T Dalby
- 1 University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock AR, USA
| | - X Tang
- 1 University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock AR, USA
| | - J A Daily
- 1 University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock AR, USA
| | - S Sukumaran
- 1 University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock AR, USA
| | - R T Collins
- 2 Stanford University and Lucille Packard Children's Hospital, Palo Alto, CA, USA
| | - E H Bolin
- 1 University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock AR, USA
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Balci S, Ekinci RMK, Bayazit AK, Melek E, Dogruel D, Altintas DU, Yilmaz M. Juvenile systemic lupus erythematosus: a single-center experience from southern Turkey. Clin Rheumatol 2019; 38:1459-1468. [PMID: 30648229 DOI: 10.1007/s10067-019-04433-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/10/2018] [Accepted: 01/03/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVES This study was conducted to analyze clinical characteristics, laboratory data, disease activity, and outcome of juvenile systemic lupus erythematosus (jSLE) patients from southern Turkey. METHODS Fifty-three patients with jSLE diagnosed according to the revised American College of Rheumatology 1997 criteria between January 2005 and June 2018 were included in the present study. RESULTS The median age at the diagnosis was 12.8 (range, 5.1-17.7) years. The female to male ratio was 9.6:1. The most prevalent clinical features were mucocutaneous involvement (96.2%) and constitutional manifestations (94.3%). Renal manifestations, hematological manifestations, and neuropsychiatric involvement were detected in 40 (75%), in 38 (71.7%), and in 13 (24.5%) patients, respectively. Renal biopsy was performed to 49 patients (92.5%). Class IV lupus nephritis (LN) (34%) and class II LN (20.4%) were the most common findings. Mycophenolate mofetil, cyclophosphamide with corticosteroid were the main treatment options. Eighteen patients received rituximab and one tocilizumab. The mean SLE Disease Activity Index (SLEDAI) score at the time of diagnosis was 22.47 ± 8.8 (range = 3-49), and 1.34 ± 1.85 (range = 0-7) at last visit. Twenty-one patients (39.6%) had damage in agreement with Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (PedSDI; mean = 0.60 ± 0.94; range = 0-5) criteria. Growth failure was the most prevalent cause of damage (n = 13, 26%). One patient deceased due to severe pulmonary hemorrhage and multiple cerebral thromboses. CONCLUSION jSLE patients in this cohort have severe disease in view of the higher frequency of renal and neurologic involvement. Nevertheless, multicenter studies are needed to make a conclusion for all Turkish children with jSLE.
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Affiliation(s)
- Sibel Balci
- Department of Pediatric Rheumatology, Faculty of Medicine, Cukurova University, Adana, Turkey.
| | | | - Aysun Karabay Bayazit
- Department of Pediatric Nephrology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Engin Melek
- Department of Pediatric Nephrology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Dilek Dogruel
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Derya Ufuk Altintas
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Mustafa Yilmaz
- Department of Pediatric Rheumatology, Faculty of Medicine, Cukurova University, Adana, Turkey
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Ishimori S, Kaito H, Shima Y, Kamioka I, Hamahira K, Nozu K, Nakanishi K, Tanaka R, Yoshikawa N, Iijima K. Clinicopathological characteristics and renal outcomes of childhood-onset lupus nephritis with acute kidney injury: A multicenter study. Mod Rheumatol 2018; 29:970-976. [DOI: 10.1080/14397595.2018.1532861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Shingo Ishimori
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
- Department of Pediatrics, Kakogawa Central City Hospital, Hyogo, Japan
| | - Hiroshi Kaito
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Yuko Shima
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Ichiro Kamioka
- Department of Pediatrics, Kakogawa Central City Hospital, Hyogo, Japan
| | - Kiyoshi Hamahira
- Department of Pediatrics, Himeji Red-Cross Hospital, Hyogo, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Koichi Nakanishi
- Department of Pediatrics, Ryukyu University Graduate School of Medicine, Okinawa, Japan
| | - Ryojiro Tanaka
- Department of Nephrology, Hyogo Prefectural Kobe Children’s Hospital, Hyogo, Japan
| | | | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
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Blay G, Rodrigues JC, Ferreira JCO, Leal GN, Gormezano NW, Novak GV, Pereira RMR, Terreri MT, Magalhães CS, Molinari BC, Sakamoto AP, Aikawa NE, Campos LMA, Fernandes TAP, Clemente G, Peracchi OAB, Bugni V, Marini R, Sacchetti SB, Carvalho LM, Fraga MM, Castro TCM, Ramos VC, Bonfá E, Silva CA. Diffuse alveolar hemorrhage in childhood-onset systemic lupus erythematosus: a severe disease flare with serious outcome. Adv Rheumatol 2018; 58:39. [PMID: 30657099 DOI: 10.1186/s42358-018-0038-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 10/16/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To evaluate prevalence, clinical manifestations, laboratory abnormalities and treatment in a multicenter cohort study including 847 childhood-onset systemic lupus erythematosus (cSLE) patients with and without diffuse alveolar hemorrhage (DAH), as well as concomitant parameters of severity. METHODS DAH was defined as the presence of at least three respiratory symptoms/signs associated with diffuse interstitial/alveolar infiltrates on chest x-ray or high-resolution computer tomography and sudden drop in hemoglobin levels. Statistical analysis was performed using Bonferroni correction (p < 0.0022). RESULTS DAH was observed in 19/847 (2.2%) cSLE patients. Cough/dyspnea/tachycardia/hypoxemia occurred in all cSLE patients with DAH. Concomitant parameters of severity observed were: mechanical ventilation in 14/19 (74%), hemoptysis 12/19 (63%), macrophage activation syndrome 2/19 (10%) and death 9/19 (47%). Further analysis of cSLE patients at DAH diagnosis compared to 76 cSLE control patients without DAH with same disease duration [3 (1-151) vs. 4 (1-151) months, p = 0.335], showed higher frequencies of constitutional involvement (74% vs. 10%, p < 0.0001), serositis (63% vs. 6%, p < 0.0001) and sepsis (53% vs. 9%, p < 0.0001) in the DAH group. The median of disease activity score(SLEDAI-2 K) was significantly higher in cSLE patients with DAH [18 (5-40) vs. 6 (0-44), p < 0.0001]. The frequencies of thrombocytopenia (53% vs. 12%, p < 0.0001), intravenous methylprednisolone (95% vs. 16%, p < 0.0001) and intravenous cyclophosphamide (47% vs. 8%, p < 0.0001) were also significantly higher in DAH patients. CONCLUSIONS This was the first study to demonstrate that DAH, although not a disease activity score descriptor, occurred in the context of significant moderate/severe cSLE flare. Importantly, we identified that this condition was associated with serious disease flare complicated by sepsis with high mortality rate.
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Affiliation(s)
- Gabriela Blay
- Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, São Paulo, SP, 05403-000, Brazil.,Pediatric Pulmonology Unit, Children's Institute, FMUSP, Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Joaquim C Rodrigues
- Pediatric Pulmonology Unit, Children's Institute, FMUSP, Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Juliana C O Ferreira
- Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Gabriela N Leal
- Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | | | - Glaucia V Novak
- Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | | | - Maria T Terreri
- Pediatric Rheumatology Unit, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Claudia S Magalhães
- São Paulo State University (UNESP), Faculdade de Medicina de Botucatu, Sao Paulo, Brazil
| | - Beatriz C Molinari
- Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Ana P Sakamoto
- Pediatric Rheumatology Unit, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Nadia E Aikawa
- Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, São Paulo, SP, 05403-000, Brazil.,Division of Rheumatology, FMUSP, Sao Paulo, Brazil
| | - Lucia M A Campos
- Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Taciana A P Fernandes
- São Paulo State University (UNESP), Faculdade de Medicina de Botucatu, Sao Paulo, Brazil
| | - Gleice Clemente
- Pediatric Rheumatology Unit, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Octavio A B Peracchi
- Pediatric Rheumatology Unit, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Vanessa Bugni
- Pediatric Rheumatology Unit, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Roberto Marini
- São Paulo State University of Campinas (UNICAMP), Sao Paulo, Brazil
| | | | - Luciana M Carvalho
- Ribeirão Preto Medical School - University of São Paulo, Sao Paulo, Brazil
| | | | | | - Valéria C Ramos
- Pontifical Catholic University of Sorocaba, Sao Paulo, Brazil
| | - Eloisa Bonfá
- Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Clovis A Silva
- Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, São Paulo, SP, 05403-000, Brazil. .,Pediatric Pulmonology Unit, Children's Institute, FMUSP, Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, São Paulo, SP, 05403-000, Brazil.
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El-Gamasy MA, El-Naghy W. Urinary Neutrophil Gelatinase-Associated Lipocalin and Urinary Soluble CXCL16 as Biomarkers of Activity in Pediatric Lupus Nephritis. Indian J Nephrol 2018; 28:427-432. [PMID: 30647496 PMCID: PMC6309382 DOI: 10.4103/ijn.ijn_265_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
One of the challenges of treating patients with lupus nephritis (LN) is to assess disease activity. The aim of this study was to measure the urinary neutrophil gelatinase-associated lipocalin (uNGAL) and urinary soluble chemokine (C-X-C motif) ligand 16 (CXCL16) levels in children and adolescents with systemic lupus erythematosus (SLE) and investigate whether they are elevated in active LN. This study was conducted on 80 patients diagnosed as SLE by the Systemic Lupus International Collaborating Clinics criteria and 60 apparently healthy individuals as controls. Global and renal disease activities were evaluated by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and renal SLEDAI, respectively. uNGAL and urinary CXCL16 were measured for all participants by ELISA. Renal biopsy was done for all cases at initial diagnosis and was graded using ISN/RPS classification. uNGAL and CXCL16 were higher in patients than in the controls (8.9 ± 3.56 ng/dl and 1067 ± 367 ug/L vs. 2.26 ± 1.95 ng/dl and 471 ± 106 ug/L, respectively). uNGAL had higher sensitivity and specificity than urinary CXCL16 as predictor of LN (95% and 90% vs. 85% and 80%, respectively). There was significant positive correlations between uNGAL levels, 24-h urinary proteins (r = 0.732, P = 0.001), and SLEDAI (r = 0.359, P = 0.001). There was also significant positive correlations between urinary CXCL16 levels, 24-h urinary proteins (r = 0.47, P = 0.001), and SLEDAI (r = 0.17, P = 0.001). uNGAL and CXCL16 were reliable indicators of the activity of LN.
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Affiliation(s)
- M. A. El-Gamasy
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - W. El-Naghy
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Tanta University, Tanta, Egypt
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47
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Umer A, Bhatti S, Jawed S. Sub-acute Cardiac Tamponade as an Early Clinical Presentation of Childhood Systemic Lupus Erythematosus: A Case Report. Cureus 2018; 10:e3478. [PMID: 30648029 PMCID: PMC6318088 DOI: 10.7759/cureus.3478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease affecting multiple systems by the process of inflammation and formation of auto-antibodies. When it presents in childhood, it is referred to as childhood systemic lupus erythematosus (cSLE). Cardiac tamponade is a rare but potentially lethal complication of cSLE, even rarer as an initial presentation. Sub-acute cardiac tamponade (medical tamponade) is a non-emergent type of cardiac tamponade which develops slowly over time and does not necessarily present with acute distress. We present the case of an 11-year-old girl who presented to the emergency department with complaints of intermittent fever, periorbital puffiness, abdominal distension, and swelling on the hands and feet. She was not in any acute distress but was vitally unstable. Cardiovascular examination revealed muffled heart sounds. Chest examination further revealed decreased breathing sounds on the left side with dull notes on percussion. Abdominal examination revealed positive shifting dullness with a distended abdomen. Blood investigations were ordered which revealed anemia and thrombocytopenia. Chest X-ray showed an enlarged cardiac silhouette. Urine detailed report showed proteinuria and hematuria. Further investigations revealed the autoimmune root of the disease. Echocardiography was ordered which showed a large collection of fluid around the posterior aspect of heart with the concomitant collapse of atrial chambers suggestive of cardiac tamponade. A diagnosis of sub-acute cardiac tamponade secondary to childhood SLE was made. The patient was started on pulse therapy of methylprednisolone followed by a low-dose regime of mycophenolate mofetil. The patient was also provided with positive pressure ventilation, hemodialysis, and invasive cardiovascular monitoring along with the instillation of intravenous fluid supplements. To our knowledge, cases of sub-acute cardiac tamponade as the only and early clinical manifestation in childhood SLE are very rare.
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Affiliation(s)
- Anum Umer
- Internal Medicine, The Indus Hospital, Karachi, PAK
| | - Shoaib Bhatti
- Pediatrics, National Institute of Child Health, Karachi, PAK
| | - Shafaq Jawed
- Surgery, Jinnah Sindh Medical University, Karachi, PAK
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48
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Novak GV, Molinari BC, Ferreira JC, Sakamoto AP, Terreri MT, Pereira RMR, Saad-Magalhães C, Aikawa NE, Campos LM, Len CA, Appenzeller S, Ferriani VP, Silva MF, Oliveira SK, Islabão AG, Sztajnbok FR, Paim LB, Barbosa CM, Santos MC, Bica BE, Sena EG, Moraes AJ, Rolim AM, Spelling PF, Scheibel IM, Cavalcanti AS, Matos EN, Robazzi TC, Guimarães LJ, Santos FP, Silva CT, Bonfá E, Silva CA. Characteristics of 1555 childhood-onset lupus in three groups based on distinct time intervals to disease diagnosis: a Brazilian multicenter study. Lupus 2018; 27:1712-1717. [PMID: 30020023 DOI: 10.1177/0961203318787037] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective The objective of this study was to compare demographic data, clinical/laboratorial features and disease activity at diagnosis in three different groups with distinct time intervals between onset of signs/symptoms and disease diagnosis. Methods A multicenter study was performed in 1555 childhood-onset systemic lupus erythematosus (American College of Rheumatology criteria) patients from 27 pediatric rheumatology services. Patients were divided into three childhood-onset systemic lupus erythematosus groups: A: short time interval to diagnosis (<1 month); B: intermediate time interval (≥1 and <3 months); and C: long time interval (≥3 months). An investigator meeting was held to define the protocol. Demographic data, SLICC classification criteria and SLEDAI-2 K were evaluated. Results The number of patients in each group was: A = 60 (4%); B = 522 (33.5%); and C = 973 (62.5%). The median age at diagnosis (11.1 (4.2-17) vs. 12 (1.9-17.7) vs. 12.5 (3-18) years, P = 0.025) was significantly lower in group A compared with groups B and C. The median number of diagnostic criteria according to SLICC (7 (4-12) vs. 6 (4-13) vs. 6 (4-12), P < 0.0001) and SLEDAI-2 K (18 (6-57) vs. 16 (2-63) vs. 13 (1-49), P < 0.0001) were significantly higher in group A than the other two groups. The frequency of oral ulcers in the palate (25% vs. 15% vs. 11%, P = 0.003), pleuritis (25% vs. 24% vs. 14%, P < 0.0001), nephritis (52% vs. 47% vs. 40%, P = 0.009), neuropsychiatric manifestations (22% vs. 13% vs. 10%, P = 0.008), thrombocytopenia (32% vs. 18% vs. 19%, P = 0.037), leucopenia/lymphopenia (65% vs. 46% vs. 40%, P < 0.0001) and anti-dsDNA antibodies (79% vs. 66% vs. 61%, P = 0.01) were significantly higher in group A compared with the other groups. In contrast, group C had a less severe disease characterized by higher frequencies of synovitis (61% vs. 66% vs. 71%, P = 0.032) and lower frequencies of serositis (37% vs. 33% vs. 25%, P = 0.002), proteinuria >500 mg/day (48% vs. 45% vs. 36%, P = 0.002) and low complement levels (81% vs. 81% vs. 71%, P < 0.0001) compared with groups A or B. Conclusions Our large Brazilian multicenter study demonstrated that for most childhood-onset systemic lupus erythematosus patients, diagnosis is delayed probably due to mild disease onset. Conversely, the minority has a very short time interval to diagnosis and a presentation with a more severe and active multisystemic condition.
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Affiliation(s)
- G V Novak
- 1 Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - B C Molinari
- 1 Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - J C Ferreira
- 1 Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - A P Sakamoto
- 2 Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - M T Terreri
- 2 Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - R M R Pereira
- 3 Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - C Saad-Magalhães
- 4 Pediatric Rheumatology Division, Sao Paulo State University (UNESP), Botucatu, Brazil
| | - N E Aikawa
- 1 Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- 3 Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - L M Campos
- 1 Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - C A Len
- 2 Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - S Appenzeller
- 5 Pediatric Rheumatology Unit, University of Campinas (UNICAMP), Campinas, Brazil
| | - V P Ferriani
- 6 Pediatric Rheumatology Unit, University of Sao Paulo, Ribeirão Preto, Brazil
| | - M F Silva
- 7 Pediatric Rheumatology Unit, Hospital Geral de Fortaleza, Fortaleza, Brazil
| | - S K Oliveira
- 8 Pediatric Rheumatology Unit, Rio de Janeiro Federal University (IPPMG-UFRJ), Rio de Janeiro, Brazil
| | - A G Islabão
- 9 Pediatric Rheumatology Unit, Hospital Jose Alencar, Brasília, Brazil
| | - F R Sztajnbok
- 10 Pediatric Rheumatology Unit, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil
| | - L B Paim
- 11 Pediatric Rheumatology Unit, Albert Sabin Children's Hospital, Fortaleza, Brazil
| | - C M Barbosa
- 12 Pediatric Rheumatology Unit, Hospital Darcy Vargas, Sao Paulo, Brazil
| | - M C Santos
- 13 Pediatric Rheumatology Unit, Irmandade da Santa Casa de Misericórdia de Sao Paulo, Sao Paulo, Brazil
| | - B E Bica
- 14 Rheumatology Division, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - E G Sena
- 15 Pediatric Rheumatology Unit, Lauro Vanderley University Hospital, João Pessoa, Brazil
| | - A J Moraes
- 16 Pediatric Rheumatology Unit, Federal University of Pará, Belém, Brazil
| | - A M Rolim
- 17 Pediatric Rheumatology Unit, Obras Sociais Irmã Dulce, Salvador, Brazil
| | - P F Spelling
- 18 Pediatric Rheumatology Unit, Hospital Evangélico de Curitiba, Curitiba, Brazil
| | - I M Scheibel
- 19 Pediatric Rheumatology Unit, Hospital Criança Conceição, Porto Alegre, Brazil
| | - A S Cavalcanti
- 20 Pediatric Rheumatology Unit, Federal University of Pernambuco, Recife, Brazil
| | - E N Matos
- 21 Pediatric Rheumatology Unit, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - T C Robazzi
- 22 Pediatric Rheumatology Unit, Federal University of Bahia, Salvador, Brazil
| | - L J Guimarães
- 23 Pediatric Rheumatology Unit, University of Brasilia, Brasília, Brazil
| | - F P Santos
- 24 Pediatric Rheumatology Unit, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - C T Silva
- 25 Pediatric Rheumatology Unit, Hospital Municipal Piedade, Rio de Janeiro, Brazil
| | - E Bonfá
- 3 Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - C A Silva
- 1 Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- 3 Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Symptomatic polyautoimmunity at diagnosis of 1463 childhood-onset lupus: A Brazilian multicenter study. Autoimmun Rev 2018; 17:836-839. [PMID: 29885968 DOI: 10.1016/j.autrev.2018.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 03/01/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate symptomatic polyautoimmunity (PA) at childhood-onset systemic lupus erythematosus(cSLE) diagnosis, and its association with demographic data, disease activity, clinical manifestations and laboratorial abnormalities in a large Brazilian cSLE population. METHODS A multicenter retrospective study was performed in 1463 cSLE(ACR criteria) patients from 27 Pediatric Rheumatology services. Symptomatic PA was defined according to the presence of more than one concomitant autoimmune disease(AD) and symptomatic multiple autoimmune syndrome(MAS) was defined as three or more AD. An investigator meeting was held to define the protocol. Demographic data, SLICC classification criteria and SLEDAI-2K were evaluated. RESULTS At cSLE diagnosis symptomatic PA was observed in 144/1463(9.8%) and symptomatic MAS occurred in solely 10/1463(0.7%). In the former group the more frequently observed associated AD were Hashimoto thyroiditis n = 42/144(29%), antiphospholipid syndrome n = 42/144(29%), autoimmune hepatitis n = 26/144(18%) and type 1 diabetes mellitus n = 23/144(15.9%). Further comparisons between cSLE patients with and without PA showed a higher median age(p = 0.016) and lower mean SLICC criteria (p = 0.039) in those with PA. Additionally, these cSLE patients had less renal involvement(35% vs. 44%, p = 0.038) and red blood cell cast(6% vs. 12%, p = 0.042) and more antiphospholipid antibodies(29% vs. 15%, p < 0.0001). CONCLUSIONS Approximately 10% of cSLE had symptomatic PA at diagnosis, particularly endocrine autoimmune disorders and antiphospholipid syndrome. Lupus was characterized by a mild disease onset and MAS was infrequently evidenced. Further studies are necessary to determine if this subgroup of cSLE patients have a distinct genetic background with a less severe disease and a better long-term outcome.
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50
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Lo MS. Insights Gained From the Study of Pediatric Systemic Lupus Erythematosus. Front Immunol 2018; 9:1278. [PMID: 29922296 PMCID: PMC5996073 DOI: 10.3389/fimmu.2018.01278] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/22/2018] [Indexed: 12/21/2022] Open
Abstract
The pathophysiology of systemic lupus erythematosus (SLE) has been intensely studied but remains incompletely defined. Currently, multiple mechanisms are known to contribute to the development of SLE. These include inadequate clearance of apoptotic debris, aberrant presentation of self nucleic antigens, loss of tolerance, and inappropriate activation of T and B cells. Genetic, hormonal, and environmental influences are also known to play a role. The study of lupus in children, in whom there is presumed to be greater genetic influence, has led to new understandings that are applicable to SLE pathophysiology as a whole. In particular, characterization of inherited disorders associated with excessive type I interferon production has elucidated specific mechanisms by which interferon is induced in SLE. In this review, we discuss several monogenic forms of lupus presenting in childhood and also review recent insights gained from cytokine and autoantibody profiling of pediatric SLE.
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Affiliation(s)
- Mindy S Lo
- Division of Immunology, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
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