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Barrios-Menéndez JC, Carías-Alvarado CC, Cayax LI, López-Hun F, Santizo A, Herrera MA, Hernández-Zaragoza DI, Escobar-Castro K. HLA-DRB1 and HLA-DQB1 genes in patients diagnosed with systemic lupus erythematosus in Guatemala. Hum Immunol 2024; 85:110803. [PMID: 38653667 DOI: 10.1016/j.humimm.2024.110803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disorder that impacts connective tissue and can affect various organs and systems within the body. One important aspect of this disease is the role of the human leukocyte antigen (HLA) system, a protein complex that plays a role in the immune response. Specifically, the HLA-DRB1 and HLA-DQB1 genes have been implicated in the development of SLE. In order to better understand this relationship in the Guatemalan population, a study was conducted with the objective of characterizing the allelic and haplotype profiles of the HLA-DQB1 and HLA-DRB1 loci in 50 patients diagnosed with SLE who were receiving treatment at a hospital in Guatemala. Allele and haplotype frequencies were determined and compared to 127 healthy Guatemalan subjects as a control group. The results of the analysis showed a reduction in the frequencies of HLA-DQB1*03 and HLA-DRB1*14 in SLE patients, which could suggest a protective effect on the development of the disease. In contrast, a risk association was found between HLA-DRB1*07, HLA-DRB1*08, HLA-DQB1*02 and HLA-DQB1*06 in SLE patients. Finally, we observed an additional protective associated of haplotype HLA-DRB1*04∼DQB1*03 with SLE patients, while haplotypes HLA-DRB1*07∼DQB1*02 and DRB1*08-DQB1*06 showed a risk association.
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Affiliation(s)
- Juan C Barrios-Menéndez
- General Directorate of Research, University of San Carlos de Guatemala, Guatemala City, Guatemala
| | | | - Lilian Isabel Cayax
- Medical Sciences Faculty, University of San Carlos de Guatemala, Guatemala City, Guatemala
| | - Francisco López-Hun
- General Directorate of Research, University of San Carlos de Guatemala, Guatemala City, Guatemala
| | - Adolfo Santizo
- Histocompatibility Laboratory, Nephrology and Transplant Department, General San Juan de Dios Hospital, Guatemala City, Guatemala
| | - Maynor A Herrera
- Rheumatology Unit, Roosevelt Hospital, Guatemala City, Guatemala
| | - Diana Iraíz Hernández-Zaragoza
- Molecular Genetics Laboratory, Escuela Nacional de Antropología e Historia (ENAH), Mexico City, Mexico; Department of Archaeogenetics, Max-Planck Institute for Evolutionary Anthropology (MPI-EVA), Leipzig, Germany.
| | - Karla Escobar-Castro
- Histocompatibility Laboratory, Nephrology and Transplant Department, General San Juan de Dios Hospital, Guatemala City, Guatemala
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Hassan MR, Hossain A, Mahata J, Srivastava V, Sarkar S. Hematological manifestation of Pediatric Systemic Lupus Erythematosus (SLE) - A single centered cross-sectional study. J Family Med Prim Care 2024; 13:1787-1792. [PMID: 38948621 PMCID: PMC11213417 DOI: 10.4103/jfmpc.jfmpc_1583_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/15/2023] [Accepted: 12/23/2023] [Indexed: 07/02/2024] Open
Abstract
Introduction Systemic lupus erythematosus (SLE), the commonest type of lupus, is an autoimmune multisystemic disorder that can affect any organ system of the body, especially blood vessels and connective tissues, causing widespread inflammation. Pediatric onset of SLE is a rare condition with more hematological involvement. Aim This study was undertaken to observe various hematological abnormalities and their association with various autoantibodies present in pediatric SLE in Eastern India. Methodology It was a single-centered, cross-sectional, observational, hospital-based study conducted in the Department of Pediatric Medicine in collaboration with the Department of Rheumatology in IPGME and R and SSKM Hospital, Kolkata. The duration of the study was 1.5 years, and a total of 30 children up to 12 years of age of either gender were enrolled. Study participants were evaluated for various parameters like demographic, hematological (anemia, neutropenia, leucopenia, lymphopenia, and thrombocytopenia), biochemical (CRP, Lactate dehydrogenase (LDH), and bilirubin), autoantibodies (anti-dsDNA, anti-Ro 52, and anti-Ribonucleoprotein [RNP]), and SLE related pathologies (Cutaneous, nephritis, serositis). Results In the present study, most of the participants had arthritis, muscle pain (86.66%), and hematological involvement (80%). Among cytopenias, anemia was the commonest. dsDNA autoantibody was positive in most of the patients (83%), and about one-third suffered from autoimmune hemolytic anemia (AIHA). No association was observed between autoantibodies and various hematological manifestations. Conclusion It can be concluded from the present study that anemia is the most common cytopenia in pediatric SLE, but there is no association between autoantibodies and these cytopenias. However, study on larger population may give better results.
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Affiliation(s)
- Md Rakibul Hassan
- Department of Pediatrics, IPGME&R and SSKM Hospital, Kolkata, West Bengal, India
| | - Ashik Hossain
- Department of Pediatrics, IPGME&R and SSKM Hospital, Kolkata, West Bengal, India
| | - Joyanti Mahata
- Department of Biochemistry, Burdwan Medical College, Burdwan, West Bengal, India
| | - Vartika Srivastava
- Department of Pharmacology, Kalinga Institute of Medical Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - Sougata Sarkar
- Department of Clinical and Experimental Pharmacology, School of Tropical Medicine, Kolkata, West Bengal, India
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Grk M, Miskovic R, Jeremic I, Basaric M, Dusanovic Pjevic M, Jekic B, Miljanovic D, Lazarevic I, Despotovic A, Cirkovic A, Banko A. Association of IL10RA, IL10RB, and IL22RA Polymorphisms/Haplotypes with Susceptibility to and Clinical Manifestations of SLE. Int J Mol Sci 2023; 24:11292. [PMID: 37511050 PMCID: PMC10379357 DOI: 10.3390/ijms241411292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is characterized by an imbalance between proinflammatory and anti-inflammatory mediators. Single-nucleotide polymorphisms (SNPs) in genes coding IL10RA, IL10RB, and IL22RA could affect their expression or function and disrupt immune homeostasis. We aimed to analyze the associations of IL10RA, IL10RB, and IL22RA polymorphisms/haplotypes with patients' susceptibility to and clinical manifestations of SLE. Our study included 103 SLE patients and 99 healthy controls. The genotypes of the selected polymorphisms within IL10RA (rs10892202, rs4252270, rs3135932, rs2228055, rs2229113, and rs9610), IL10RB (rs999788, rs2834167, and rs1058867), and IL22RA (rs3795299 and rs16829204) genes were determined by TaqMan® Assays. IL10RB rs1058867 G allele carriers were significantly more frequent among the controls than among the SLE patients (76.8% vs. 61.2%; p = 0.017, OR = 0.477, 95% CI: 0.258-0.879). The IL10RB CAA haplotype was more frequent among the SLE patients than in the control group (42.7% vs. 30.7%; p = 0.027). The IL22RA rs3795299 C allele and rs16829204 CC genotype were associated with Hashimoto thyroiditis in the SLE patients (n = 103; p = 0.002 and p = 0.026, respectively), and in all the included participants (n = 202, p < 0.000 and p = 0.007, respectively), and the IL22RA CC haplotype was more frequent in the SLE patients with Hashimoto thyroiditis (p = 0.047) and in the overall participants with Hashimoto thyroiditis (n = 32, p = 0.004). The IL10RA, IL10RB, and IL22RA polymorphisms/haplotypes could be associated with SLE susceptibility and various clinical manifestations, and the IL22RA CC haplotype could be associated with Hashimoto thyroiditis.
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Affiliation(s)
- Milka Grk
- Institute of Human Genetics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Rada Miskovic
- Clinic of Allergy and Immunology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Internal Medicine Department, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Ivica Jeremic
- Internal Medicine Department, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute of Rheumatology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milica Basaric
- Institute of Rheumatology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Marija Dusanovic Pjevic
- Institute of Human Genetics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Biljana Jekic
- Institute of Human Genetics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Danijela Miljanovic
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Ivana Lazarevic
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Aleksa Despotovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Andja Cirkovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Ana Banko
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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Hamijoyo L, Sapartini G, Rahmadi AR, Wachjudi RG, Dewi S, Ghrahani R, Praptama S, Rainy NR, Usman SY, Suryajaya BS, Candrianita S, Sutedja E, Setiabudiawan B. Comparison of clinical presentation and outcome of childhood-onset and adulthood-onset of systemic lupus erythematosus among Indonesian patients. Lupus 2022; 31:759-764. [PMID: 35379039 DOI: 10.1177/09612033221093482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The clinical presentation of childhood-onset systemic lupus erythematosus (SLE) is generally perceived to differ from that of adult-onset SLE. OBJECTIVE We aimed to compare the demographic and clinical manifestation between childhood-onset vs. adult-onset SLE in a cohort of Indonesian patients at tertiary care centers. METHODS This retrospective study included patients in the Hasan Sadikin Lupus Registry from 2008 until December 2017. The demographics, clinical presentations, and outcomes were compared between childhood-onset SLE (<18 years old) (Group 1) and adult-onset SLE (≥18 years old) (Group 2). RESULTS Eight hundred seventy patients were involved into this study. The proportion of childhood-onset SLE was 20% (174 patients). The mean age of group 1 versus group 2 was 13.56 ± 3.04 vs 30.41 ± 8.54 years. The following clinical manifestations at SLE diagnosis were significantly more common in childhood-onset than in adult-onset SLE patients: hematological disorder (p = 0.033) and arthritis (p = 0.006). While discoid rash (p = 0.036) and photosensitivity (p < 0.001) were significantly found higher in adult-onset SLE. Cyclophosphamide therapy was significantly more common to be used in childhood-onset (38.5% vs 21.0%, p = <0.001). However, frequency of mortality on follow-up tended to be higher in childhood-onset group (11.5% vs 7.0%, p = 0.208). CONCLUSION Arthritis and hematologic involvements at SLE diagnosis were more prominent in childhood-onset compared to adult-onset patients, and mortality in childhood-onset SLE during follow-up relatively higher. This data may suggest the need for more aggressive management approach to childhood-onset patients with SLE.
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Affiliation(s)
- Laniyati Hamijoyo
- Rheumatology Division, Faculty of Medicine, Department of Internal Medicine, 61809Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia.,Lupus Study Group, Immunology Study Center, Faculty of Medicine, 4321Universitas Padjadjaran, Bandung, Indonesia
| | - Gartika Sapartini
- Allergy and Immunology Division, Faculty of Medicine, Department of Child Health, 61809Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Andri R Rahmadi
- Rheumatology Division, Faculty of Medicine, Department of Internal Medicine, 61809Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Rachmat G Wachjudi
- Rheumatology Division, Faculty of Medicine, Department of Internal Medicine, 61809Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Sumartini Dewi
- Rheumatology Division, Faculty of Medicine, Department of Internal Medicine, 61809Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Reni Ghrahani
- Allergy and Immunology Division, Faculty of Medicine, Department of Child Health, 61809Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Suhendra Praptama
- Lupus Study Group, Immunology Study Center, Faculty of Medicine, 4321Universitas Padjadjaran, Bandung, Indonesia
| | - Nisa R Rainy
- Lupus Study Group, Immunology Study Center, Faculty of Medicine, 4321Universitas Padjadjaran, Bandung, Indonesia
| | - Stefanie Y Usman
- Lupus Study Group, Immunology Study Center, Faculty of Medicine, 4321Universitas Padjadjaran, Bandung, Indonesia
| | - Bernard S Suryajaya
- Lupus Study Group, Immunology Study Center, Faculty of Medicine, 4321Universitas Padjadjaran, Bandung, Indonesia
| | - Sasfia Candrianita
- Lupus Study Group, Immunology Study Center, Faculty of Medicine, 4321Universitas Padjadjaran, Bandung, Indonesia
| | - Endang Sutedja
- Immunodermatology Division, Faculty of Medicine, Department of Dermato Venereology, 61809Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Budi Setiabudiawan
- Allergy and Immunology Division, Faculty of Medicine, Department of Child Health, 61809Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
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Figueiredo-Braga M, Silva B, Ganhão S, Aguiar F, Cornaby C, Brito I, Poole BD. Kidney Function, Age, and Education as Contributors to Depression and Anxiety in Juvenile Systemic Lupus Erythematosus. Eur J Investig Health Psychol Educ 2021; 11:1503-1515. [PMID: 34940385 PMCID: PMC8700036 DOI: 10.3390/ejihpe11040107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
Juvenile systemic lupus erythematosus (JSLE) is diagnosed in children younger than 18 years of age. Depression and anxiety are common, but not well understood in JSLE. We investigated the clinical and psychological factors associated with the psychological manifestations of JSLE. Twenty-nine JSLE patients were recruited for the study. Patients completed surveys evaluating their psychological status and perceptions about their health. Medical records were used to obtain laboratory results. The JSLE patient population was compared with adult-onset SLE (ASLE) patients and unaffected controls. Kidney involvement was associated with depression in the JSLE patients. The BUN levels, BUN/creatinine ratio, and leukocyturia were all significantly associated with depressive symptoms. Multivariate analysis found that the BUN/creatinine ratio was the most predictive value for both depression and anxiety. Depressive symptoms in JSLE were less pronounced than in ASLE, although anxiety was not different. Age and education are likely to be protective against depression in the JSLE patients. These findings may indicate that symptomatology is an important indicator of whether the patient needs psychiatric care.
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Affiliation(s)
- Margarida Figueiredo-Braga
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- i3S.Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-319 Porto, Portugal
- Correspondence: ; Tel.: +351-225513672
| | - Beatriz Silva
- Young Adult and Pediatric Rheumatology Unit, Centro Hospitalar e Universitário do Hospital de São João, 4200-319 Porto, Portugal; (B.S.); (S.G.); (F.A.)
| | - Sara Ganhão
- Young Adult and Pediatric Rheumatology Unit, Centro Hospitalar e Universitário do Hospital de São João, 4200-319 Porto, Portugal; (B.S.); (S.G.); (F.A.)
| | - Francisca Aguiar
- Young Adult and Pediatric Rheumatology Unit, Centro Hospitalar e Universitário do Hospital de São João, 4200-319 Porto, Portugal; (B.S.); (S.G.); (F.A.)
| | - Caleb Cornaby
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Iva Brito
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- Young Adult and Pediatric Rheumatology Unit, Centro Hospitalar e Universitário do Hospital de São João, 4200-319 Porto, Portugal; (B.S.); (S.G.); (F.A.)
| | - Brian D. Poole
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo, UT 84602, USA;
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Edward S, Obiajunwa P, Ayeleke O. Systemic lupus erythematosus masquerading as disseminated tuberculosis: Case report in a Nigerian adolescent. NIGERIAN JOURNAL OF MEDICINE 2020. [DOI: 10.4103/njm.njm_2_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Vasculite digital inicial em uma grande coorte multicêntrica de pacientes com lúpus eritematoso sistêmico de início na infância. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Sakamoto AP, Silva CA, Silva MFCD, Lopes AS, Russo GCS, Sallum AME, Kozu K, Bonfá E, Saad-Magalhães C, Pereira RMR, Len CA, Terreri MT. Initial digital vasculitis in a large multicenter cohort of childhood-onset systemic lupus erythematosus. REVISTA BRASILEIRA DE REUMATOLOGIA 2017; 57:583-589. [PMID: 29050884 DOI: 10.1016/j.rbre.2017.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 05/10/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES To assess clinical digital vasculitis (DV) as an initial manifestation of childhood-onset systemic lupus erythematosus (cSLE) within a large population. METHODS Multicenter cross-sectional study including 852 cSLE patients (ACR criteria) followed in ten Pediatric Rheumatology centers in São Paulo State, Brazil. RESULTS DV was observed in 25/852 (3%) cSLE patients. Periungual hemorrhage was diagnosed in 12 (48%), periungual infarction in 7 (28%), tip finger ulceration in 4 (16%), painful nodules in 1 (4%) and gangrene in 1 (4%). A poor outcome, with digital resorption, occurred in 5 (20%). Comparison of patients with and without DV revealed higher frequency of malar rash (80% vs. 53%, p=0.008), discoid rash (16% vs. 4%, p=0.017), photosensitivity (76% vs. 45%, p=0.002) and other cutaneous vasculitides (80% vs. 19%, p<0.0001), whereas the frequency of overall constitutional features (32% vs. 61%, p=0.003), fever (32% vs. 56%, p=0.020) and hepatomegaly (4% vs. 23%, p=0.026) were lower in these patients. Frequency of female gender, severe multi-organ involvement, autoantibodies profile and low complement were alike in both groups (p>0.05). SLEDAI-2K median, DV descriptor excluded, was significantly lower in patients with DV compared to those without this manifestation [10 (0-28) vs. 14 (0-58), p=0.004]. Visceral vasculitis or death were not observed in this cSLE cohort. The frequency of cyclophosphamide use (0% vs. 18%, p=0.014) was significantly lower in the DV group. CONCLUSION Our large multicenter study identified clinical DV as one of the rare initial manifestation of active cSLE associated with a mild multisystemic disease, in spite of digital resorption in some of these patients.
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Affiliation(s)
- Ana Paula Sakamoto
- Universidade Federal de São Paulo (UNIFESP), Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil
| | - Clovis Artur Silva
- Universidade de São Paulo (USP), Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Divisão de Reumatologia, São Paulo, SP, Brazil
| | - Marco Felipe Castro da Silva
- Universidade de São Paulo (USP), Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil
| | - Anandreia Simões Lopes
- Universidade Federal de São Paulo (UNIFESP), Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil
| | | | - Adriana Maluf Elias Sallum
- Universidade de São Paulo (USP), Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil
| | - Katia Kozu
- Universidade de São Paulo (USP), Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil
| | - Eloisa Bonfá
- Universidade de São Paulo (USP), Faculdade de Medicina, Divisão de Reumatologia, São Paulo, SP, Brazil
| | - Claudia Saad-Magalhães
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Hospital das Clínicas de Botucatu, Botucatu, SP, Brazil
| | | | - Claudio Arnaldo Len
- Universidade Federal de São Paulo (UNIFESP), Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil
| | - Maria Teresa Terreri
- Universidade Federal de São Paulo (UNIFESP), Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil.
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Gutiérrez Nava ZJ, Jiménez-Aparicio AR, Herrera-Ruiz ML, Jiménez-Ferrer E. Immunomodulatory Effect of Agave tequilana Evaluated on an Autoimmunity Like-SLE Model Induced in Balb/c Mice with Pristane. Molecules 2017; 22:molecules22060848. [PMID: 28587079 PMCID: PMC6152617 DOI: 10.3390/molecules22060848] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/05/2017] [Accepted: 05/07/2017] [Indexed: 01/20/2023] Open
Abstract
In this work, the immunomodulatory activity of the acetone extract and the fructans obtained from Agave tequilana were evaluated, on the systemic autoimmunity type-SLE model generated by the administration of 2,6,10,14-tetramethylpentadecane (TMPD, also known as pristane) on Balb/c female mice. The systemic autoimmunity type-SLE was observed seven months after the application of TMPD, in which the animals from the negative control group (animals with damage and without any other treatment) developed articular inflammation, proteinuria, an increment of the antinuclear antibody titters and tissue pro-inflammatory cytokines levels (IL-1β, IL-6, TNF-α e IFN-γ) as well as the anti-inflammatory cytokine IL-10. The administration of the different treatments and the extracts of A. tequilana, provoked the decrease of: articular inflammation, the development of proteinuria, ssDNA/dsDNA antinuclear antibody titters and cytokines IL-1β, IL-6, TNF-α, IFN-γ and IL-10. The phytochemical analysis of the acetone extract identified the presence of the following compounds: β-sitosterol glycoside; 3,7,11,15-tetramethyl-2-hexadecen-1-ol (phytol); octadecadienoic acid-2,3-dihydroxypropyl ester; stigmasta-3,5-dien-7-one; cycloartenone and cycloartenol. Therefore, A. tequilana contains active compounds with the capacity to modify the evolution of the systemic autoimmunity type-SLE on a murine model.
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Affiliation(s)
- Zúlima Jannette Gutiérrez Nava
- Centro de Desarrollo de Productos Bióticos (CEPROBI), Instituto Politécnico Nacional (IPN), Yautepec, Morelos C.P. 62731, Mexico.
- Centro de Investigación Biomédica del Sur (CIBIS), Instituto Mexicano del Seguro Social (IMSS), Xochitepec, Morelos C.P. 62790, Mexico.
| | - Antonio Ruperto Jiménez-Aparicio
- Centro de Investigación Biomédica del Sur (CIBIS), Instituto Mexicano del Seguro Social (IMSS), Xochitepec, Morelos C.P. 62790, Mexico.
| | - Maribel Lucila Herrera-Ruiz
- Centro de Investigación Biomédica del Sur (CIBIS), Instituto Mexicano del Seguro Social (IMSS), Xochitepec, Morelos C.P. 62790, Mexico.
| | - Enrique Jiménez-Ferrer
- Centro de Investigación Biomédica del Sur (CIBIS), Instituto Mexicano del Seguro Social (IMSS), Xochitepec, Morelos C.P. 62790, Mexico.
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Gomes RC, Silva MF, Kozu K, Bonfá E, Pereira RM, Terreri MT, Magalhães CS, Sacchetti SB, Marini R, Fraga M, Carvalho LM, Barbosa CM, Carneiro-Sampaio M, Silva CA. Features of 847 Childhood-Onset Systemic Lupus Erythematosus Patients in Three Age Groups at Diagnosis: A Brazilian Multicenter Study. Arthritis Care Res (Hoboken) 2016; 68:1736-1741. [PMID: 27014968 DOI: 10.1002/acr.22881] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 01/14/2016] [Accepted: 03/01/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate demographic data and clinical and laboratory features at disease diagnosis in 3 different age groups of childhood-onset systemic lupus erythematosus (SLE): group A, early-onset (<6 years); group B, school age (≥6 to <12 years); and group C, adolescent (≥12 to <18 years). METHODS This was a Brazilian multicenter cohort retrospective study in 10 pediatric rheumatology centers, including 847 childhood-onset SLE patients. RESULTS Patients were divided into 3 groups: group A with 39 patients (4%), group B with 395 patients (47%), and group C with 413 patients (49%). Of 39 childhood-onset SLE patients in group A, 3 (8%) were ages <2 years, 4 (10%) were ≥2 to <3 years, and 32 (82%) were ≥3 and <6 years. A total of 74 childhood-onset SLE patients were analyzed for C1q levels, and complete C1q deficiency was observed in 3 of 74 patients (4%), all in group A. Groups were similar regarding high frequencies of female sex, nephritis, neuropsychiatric involvement, Systemic Lupus Erythematosus Disease Activity Index 2000 score ≥8, autoantibody profile, elevated acute phase proteins, and low complement levels (P > 0.05). However, the frequency of fever (78% versus 61% versus 47%; P < 0.0001), hepatomegaly (42% versus 29% versus 14%; P < 0.0001), splenomegaly (28% versus 12% versus 4%; P < 0.0001), and discoid lupus (13% versus 4% versus 4%; P = 0.020) was significantly higher in group A compared to groups B and C. The frequency of weight loss >2 kg (19% versus 28% versus 36%; P = 0.017), photosensitivity (34% versus 41% versus 51%; P = 0.006), leukopenia <4,000/mm3 (14% versus 25% versus 30%; P = 0.048), and lymphopenia <1,500/mm3 (22% versus 41% versus 47%; P = 0.011) was significantly lower in group A. CONCLUSION Our large multicenter study identified the finding that the initial appearance of childhood-onset SLE is characterized by comparable high frequency of internal organ involvement and some distinct clinical and laboratory features in early-onset and adolescent groups.
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Affiliation(s)
- Roberta C Gomes
- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marco F Silva
- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Katia Kozu
- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Eloisa Bonfá
- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rosa M Pereira
- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | | | - Roberto Marini
- State University of Campinas (UNICAMP), Sao Paulo, Brazil
| | - Melissa Fraga
- Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | | | | | - Clovis A Silva
- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
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Characterization of chronic arthritis in a multicenter study of 852 childhood-onset systemic lupus erythematosus patients. Rheumatol Int 2016; 36:1641-1648. [PMID: 27629113 DOI: 10.1007/s00296-016-3564-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 09/01/2016] [Indexed: 10/21/2022]
Abstract
Chronic arthritis (CA) is an unusual condition in childhood-onset systemic lupus erythematosus (cSLE) and data in children is very limited. The aim of the study is to assess CA in a large population of cSLE patients, in a multicenter cross-sectional study including 852 cSLE patients followed in ten Pediatric Rheumatology referral services in state of São Paulo, Brazil. CA was observed in 32/852 (3.7 %) cSLE patients mostly in hands and ankles. Chronic monoarthritis was diagnosed in four cSLE patients, oligoarthritis in nine and polyarthritis in 19. In the latter group, six had rhupus syndrome. Two oligoarticular patients had Jaccoud's arthropathy. CA was an isolated manifestation observed at disease onset in 13/32 (41 %) cSLE patients, and juvenile idiopathic arthritis (JIA) was the first diagnosis in 18/32 (56 %). The comparison of last visit of patients with CA and without this manifestation revealed higher frequency of splenomegaly (28 vs. 11 %, p = 0.002). The median of SLICC/ACR-DI score [1(0-9) vs. 0(0-7), p = 0.003] was significantly higher in CA patients compared to patients without this manifestation, likewise the frequency of musculoskeletal damage (31 vs. 9 % p = 0.001). Frequencies of treatment with nonsteroidal anti-inflammatory drugs (75 vs. 26 %, p < 0.0001), hydroxychloroquine sulfate (87 vs. 59 %, p = 0.001) and methotrexate (47 vs. 22 %, p = 0.001) were significantly higher in CA patients. This large multicenter study allowed us to characterize CA as a rare and early manifestation of cSLE, frequently mimicking JIA at disease onset. It is predominantly polyarticular, involving more often hands and ankles and it is associated with significant musculoskeletal accrual damage.
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13
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Febronio MV, Pereira RMR, Bonfa E, Takiuti AD, Pereyra EAG, Silva CAA. Inflammatory cervicovaginal cytology is associated with disease activity in juvenile systemic lupus erythematosus. Lupus 2016; 16:430-5. [PMID: 17664234 DOI: 10.1177/0961203307079298] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
To evaluate cervicovaginal cytology in adolescents with juvenile systemic lupus erythematosus (JSLE) and to compare them to controls. Fifty-two female adolescents with JSLE (ACR criteria) were compared to 52 age-matched healthy controls. All Pap smears were evaluated by the same cytopathologist blinded to gynecology examination (Bethesda 2001). The mean age of JSLE patients and controls were similar (16.17 ± 1.94 versus 16.13 ± 2.16 years, P = 0.92). The cervicovaginal cytology was found to be similar in both groups, although sexual intercourses in the last month were less frequent in JSLE than controls (23% versus 59.6%, P = 0.0003). Only one patient (2%) with JSLE versus two controls (4%) had cervical dysplasia (LGSIL) and human papilomavirus ( P = 1.0). Candida spp vaginitis was observed in seven JSLE (14%) versus none in controls ( P = 0.012) and was associated with immunosuppressive drugs ( P = 0.01) and high dose of prednisone ( P = 0.002). Of interest, inflammatory cervicovaginal cytology was observed in 21 (60%) of patients with SLEDAI ≥ 4 and only four (23%) of those with SLEDAI < 4 ( P = 0.001). Likewise, a higher frequency of inflammatory changes was also observed in virgin JSLE (57% versus 8%, P = 0.005). Our findings supports the notion that female genital tract may be a potential target organ in SLE since cervical inflammation is associated to disease activity independently of sexual activity. Lupus (2007) 16, 430—435.
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Affiliation(s)
- M V Febronio
- Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Mak A, Mok CC, Chu WP, To CH, Wong SN, Au TC. Renal damage in systemic lupus erythematosus: a comparative analysis of different age groups. Lupus 2016; 16:28-34. [PMID: 17283582 DOI: 10.1177/0961203306074469] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Renal damage in systemic lupus erythematosus: a comparative analysis of different age groups A Mak, CC Mok, WP Chu, CH To, SN Wong and TC Au Please note that the following pdf is a corrected version of the article which appears in the printed version of Lupus 16/1. An Erratum will also appear in print in Lupus; 16(2). The corrected line can be found in the abstract. It was changed from: Patients were categorized into childhood (age ≥6 years), adult (between 16 and 50 years) or late onset (≥50 years) SLE. To: Patients were categorized into childhood (age 16 years), adult (between 16 and 50 years) or late onset (50 years) SLE.The objective of this study was to compare the frequency and severity of renal damage in systemic lupus erythematosus (SLE) with regard to the age of disease onset. Among 287 patients with new onset SLE diagnosed between 1991 and 2003 in our hospital, we identified those who fulfilled the American College of Rheumatology (ACR) criteria for renal involvement. Patients were categorized into childhood (age <6 years), adult (between 16 and 50 years) or late onset (≥50 years) SLE. Clinical presentation of renal disease and cumulative renal damage as assessed by the renal domain of the Systemic Lupus International Collaborating Clinics/ACR damage index (SDI) were compared. A linear regression model was constructed to study the effect of age on renal damage. One-hundred and forty-nine patients were studied (134 women and 15 men), including 28 childhood, 107 adult and 14 late onset SLE patients. The mean age of SLE onset was 29.7 ± 14 years. The prevalence of renal disease was 53% in childhood onset, 50% in adult onset and 58% in late onset SLE patients (P = 0.66). At renal disease presentation, late onset SLE patients had significantly lower creatinine clearance and were more likely to be hypertensive. Histological classes of nephritis and initial treatment response, however, did not differ significantly among the patients. After a mean observation of 80.3 months, 32 (21%) patients developed renal damage (renal SDI ≥ 1). Late onset SLE patients had accrued more renal damage than the others. In a multiple regression model, age was not a significant determinant of renal damage after adjustment for baseline renal parameters, duration of renal disease, use of cyclophosphamide and initial treatment response. We concluded that the prevalence of renal disease was similar among SLE patients of different ages of onset. Late onset SLE patients had accrued more renal damage but age did not correlate with renal damage after adjustment for various clinical parameters.
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Affiliation(s)
- A Mak
- Department of Medicine and Geriatrics, Tuen Mun Hospital, Tsing Chung Koon Road, Hong Kong SAR
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15
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Lube GE, Ferriani MPL, Campos LMA, Terreri MT, Bonfá E, Magalhães CS, Aikawa NE, Piotto DP, Peracchi OAB, Dos Santos MC, Appenzeller S, Ferriani VPL, Pereira RMR, Silva CA. Evans Syndrome at Childhood-Onset Systemic Lupus Erythematosus Diagnosis: A Large Multicenter Study. Pediatr Blood Cancer 2016; 63:1238-43. [PMID: 27018636 DOI: 10.1002/pbc.25976] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 02/04/2016] [Accepted: 02/23/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND Evans syndrome (ES) in childhood-onset systemic lupus erythematosus (cSLE) patients has been rarely reported and limited to small populations. PROCEDURES A retrospective multicenter cohort study (Brazilian cSLE group) was performed in 10 Pediatric Rheumatology services including 850 patients with cSLE. ES was assessed at disease diagnosis and defined by the combination of immune thrombocytopenia and autoimmune hemolytic anemia. RESULTS ES was observed in 11 of 850 (1.3%) cSLE patients. The majority of them had hemorrhagic manifestations (91%) and active disease (82%). All patients with ES were hospitalized and none died. Comparisons of cSLE patients with and without ES at diagnosis revealed similar frequencies of female gender, multiorgan involvement, autoantibodies profile, and low complement (P > 0.05). Patients with ES had a lower frequency of malar rash (9% vs. 53%, P = 0.003) and musculoskeletal involvement (18% vs. 69%, P = 0.001) than those without this complication. The frequencies of intravenous methylprednisolone (82% vs. 43%, P = 0.013) and intravenous immunoglobulin use (64% vs. 3%, P < 0.0001) were significantly higher in the ES group, with similar current prednisone dose between groups (1.1 [0.76-1.5] vs. 1.0 mg/kg/day [0-30], P = 0.195). CONCLUSIONS Our large multicenter study identified ES as a rare and severe initial manifestation of active cSLE with good outcome. Diagnosis is challenging due to the lack of typical signs and symptoms of lupus and the requirement to exclude infection and primary immunodeficiency.
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Affiliation(s)
- Gabriella E Lube
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo city, São Paulo - Brazil
| | - Mariana Paes Leme Ferriani
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo city, São Paulo - Brazil
| | - Lucia Maria Arruda Campos
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo city, São Paulo - Brazil
| | - Maria Teresa Terreri
- Pediatric Rheumatology Unit, Universidade Federal de São Paulo (UNIFESP), São Paulo city, São Paulo - Brazil
| | - Eloisa Bonfá
- Division of Rheumatology, FMUSP, São Paulo city, São Paulo - Brazil
| | - Claudia Saad Magalhães
- São Paulo State University (UNESP), Faculdade de Medicina de Botucatu, Botucatu, São Paulo - Brazil
| | - Nadia Emi Aikawa
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo city, São Paulo - Brazil.,Division of Rheumatology, FMUSP, São Paulo city, São Paulo - Brazil
| | - Daniela Petry Piotto
- Pediatric Rheumatology Unit, Universidade Federal de São Paulo (UNIFESP), São Paulo city, São Paulo - Brazil
| | | | | | - Simone Appenzeller
- Rheumatology Unit, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo - Brazil
| | | | | | - Clovis Artur Silva
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo city, São Paulo - Brazil.,Division of Rheumatology, FMUSP, São Paulo city, São Paulo - Brazil
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Nabavizadeh SH, Farahbakhsh N, Fazel A, Houshmand H, Anushiravani A. Pulmonary embolism in an adolescent girl with negative ACLA systemic lupus erythematosus (SLE): a case report. Electron Physician 2016; 8:1874-9. [PMID: 27053993 PMCID: PMC4821299 DOI: 10.19082/1874] [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] [Received: 08/16/2015] [Accepted: 12/21/2015] [Indexed: 11/20/2022] Open
Abstract
Pulmonary involvement is a common manifestation in systemic lupus erythematosus (SLE), whereas pulmonary thromboembolism (PTE) is rarely seen in SLE. PTE related to anti-phospholipid antibody syndrome (APS) is also a rare disease. We have reported a 13-year-old female diagnosed with SLE Two years ago, who is being treated with hydroxychloroquine and prednisolone. She presented with shortness of breath, dry cough, and fever about two weeks prior to admission. She was initially admitted with the diagnosis of pneumonia, but no clinical improvement was seen she was given antibiotics. Hemoptysis was added to her symptoms, so spiral high resolution computed tomography (HRCT) of the lungs was requested, and it indicated patchy consolidations bilaterally. With suspicion of pulmonary thromboembolism (PTE), spiral computed tomography angiography of pulmonary vessels was done, revealing PTE. After initiation of anti-coagulants, her clinical condition and respiratory status improved significantly. We present a rare case of SLE where only lupus anti-coagulant test was abnormal while other tests, such as anti-cardiolipin antibody and anti-phospholipid antibody were normal. Therefore, we can conclude that clinical suspicion had the main role in diagnosis in our case, as it has in medicine.
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Affiliation(s)
- Seyed Hesamedin Nabavizadeh
- M.D., Professor, Department of Immunology and Allergy, Faculty of Medicine, Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nazanin Farahbakhsh
- M.D., Faculty Member, Department of Pediatrics, Faculty of Medicine, Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Fazel
- M.D., Faculty Member, Department of Immunology and Allergy, Faculty of Medicine, Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamidreza Houshmand
- M.D., Faculty Member, Department of Immunology and Allergy, Faculty of Medicine, Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Anushiravani
- M.D., Faculty Member, Department of Internal Medicine, Faculty of Medicine, Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Abstract
Though rare, childhood lupus is a disease with the potential to have serious short and long term effects in children. These effects are to do with the disease itself, organ damage consequent to ongoing inflammation and/or because of side effects of medications. As children have an early disease onset, accrual organ damage over the years and growth and puberty issues are important aspects of care. Thus it is essential to recognize the disease early, objectively assess the patient at regular intervals, treat to a target of remission and limit the use of steroids as far as possible. This review focuses on the elements that help identify these patients in the clinic, discusses the role of objective disease assessment and outlines management and co-morbidities in these patients.
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18
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Chiewchengchol D, Murphy R, Edwards SW, Beresford MW. Mucocutaneous manifestations in juvenile-onset systemic lupus erythematosus: a review of literature. Pediatr Rheumatol Online J 2015; 13:1. [PMID: 25587243 PMCID: PMC4292833 DOI: 10.1186/1546-0096-13-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 12/21/2014] [Indexed: 02/04/2023] Open
Abstract
Patients diagnosed with juvenile-onset systemic lupus erythematosus (JSLE) often have skin and oral lesions as part of their presentation. These mucocutaneous lesions, as defined by the American College of Rheumatology (ACR) in 1997, include malar rash, discoid rash, photosensitivity and oral ulcers. It is therefore essential to recognize mucocutaneous lesions to accurately diagnose JSLE. The mucocutaneous lesions can be divided into those with classical histological features (LE specific) and those strongly associated with and forming part of the diagnostic spectrum, but without the classical histological changes of lupus (LE nonspecific). A malar rash is the most commonly associated LE specific dermatological presentation. This skin manifestation is an acute form and also correlates with disease activity. Subacute (polycyclic or papulosquamous lesions) and chronic (discoid lesions) forms, whilst showing classical histological changes supportive of lupus, are less commonly associated with systemic lupus and do not correlate with disease activity. The most commonly associated skin lesions without classical lupus changes are cutaneous vasculitis, oral ulcers and diffuse non-scarring alopecia. These signs frequently relate to disease activity. An understanding of cutaneous signs and symptoms of lupus in children is important to avoid delay in diagnosis. They will often improve as lupus is adequately controlled and their reappearance is often the first indicator of a disease flare.
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Affiliation(s)
- Direkrit Chiewchengchol
- />Institute of Translational Medicine, Alder Hey Children’s NHS Foundation Trust, University of Liverpool, Liverpool, UK
- />Institute of Integrative Biology, University of Liverpool, Liverpool, UK
- />Immunology Unit & Center of Excellence in Immunology and Immune-mediated Disease, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ruth Murphy
- />Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, UK
| | - Steven W Edwards
- />Institute of Integrative Biology, University of Liverpool, Liverpool, UK
| | - Michael W Beresford
- />Institute of Translational Medicine, Alder Hey Children’s NHS Foundation Trust, University of Liverpool, Liverpool, UK
- />Department of Women’s and Children’s Health, Institute of Translational Medicine, Alder Hey Children’s NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP UK
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19
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Robazzi TCM, Alves C, Abreu L, Lemos G. Coexistência de lúpus eritematoso sistêmico e doença falciforme: relato de caso e revisão da literatura. REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 55:68-74. [DOI: 10.1016/j.rbr.2013.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 02/26/2013] [Accepted: 05/14/2013] [Indexed: 10/24/2022] Open
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20
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Lupus nephritis in Egyptian children: a 16-year experience. J Nephrol 2014; 28:557-62. [DOI: 10.1007/s40620-014-0157-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 11/05/2014] [Indexed: 11/25/2022]
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21
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Concannon A, Rudge S, Yan J, Reed P. The incidence, diagnostic clinical manifestations and severity of juvenile systemic lupus erythematosus in New Zealand Maori and Pacific Island children: The Starship experience (2000−2010). Lupus 2013; 22:1156-61. [DOI: 10.1177/0961203313503051] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives To describe the incidence, diagnostic clinical manifestations and severity of juvenile systemic lupus erythematosus (jSLE) in a cohort of New Zealand Maori and Pacific Island children compared to European children. Methods A chart review was conducted of children with jSLE seen by the Starship paediatric rheumatology and/or renal services between January 2000 and November 2010. Diagnostic clinical data and lupus nephritis data at anytime were collated while classic British Isles Lupus Assessment Group (BILAG) and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores were derived retrospectively. Results Thirty-two children were diagnosed with jSLE with an annual incidence of 0.52 per 100,000 per year. Compared with European children (0.31 per 100,000 per year) the incidence of jSLE was higher among Maori and Pacific (0.67 per 100,000 per year, p = 0.06) and significantly higher among Asian children (1.17 per 100,000 per year, p = 0.01). Compared with European children, Maori and Pacific children were more frequently diagnosed with lupus nephritis (80% vs 40%, p = 0.09) and severe (WHO class 4 or 5) renal lesions (60% vs 40%, p = 0.43) at presentation. Similarly, at any time during the study, lupus nephritis (100% vs 40%, p = 0.001) and severe (WHO class 4 or 5) renal lesions (73.3% vs 40%, p = 0.12) were more frequent among Maori and Pacific compared with European children. Furthermore, retrospective BILAG assessment of diagnostic disease severity demonstrated that Maori and Pacific children experienced the majority of severe “Category A” disease (56.8% vs 22.7%, p = 0.17) which was predominantly renal (73.3% vs 40%, p = 0.12) in nature. Conclusions This is the first description of the incidence and clinical manifestations of jSLE in a cohort of New Zealand children. Although limited by the small numbers involved it confirmed anecdotal suspicions that the incidence of jSLE among Maori, Pacific and Asian children is higher than European children. Lupus nephritis is also more frequent and severe in Maori and Pacific children.
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Affiliation(s)
- A Concannon
- Department of Paediatric Rheumatology, Starship children’s Hospital, Auckland, New Zealand
| | - S Rudge
- Department of Paediatric Rheumatology, Starship children’s Hospital, Auckland, New Zealand
| | - J Yan
- Department of Paediatric Rheumatology, Starship children’s Hospital, Auckland, New Zealand
| | - P Reed
- Department of Paediatric Rheumatology, Starship children’s Hospital, Auckland, New Zealand
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22
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Patel A, Rangaraj S, Wright B, Murphy R. An unusual presentation of juvenile systemic lupus erythematosus. Clin Exp Dermatol 2012; 37:249-51. [DOI: 10.1111/j.1365-2230.2011.04206.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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23
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Quezada A, Ramos S, Garcia M, Norambuena X, Pavon D. Lung involvement in rheumatologic diseases in children. Allergol Immunopathol (Madr) 2012; 40:88-91. [PMID: 21684670 DOI: 10.1016/j.aller.2011.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 01/31/2011] [Accepted: 02/14/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lung involvement in rheumatologic disease in children has been described with low frequency. OBJECTIVE To describe the lung function test and the radiological findings in a group of paediatric patients with rheumatologic diseases. METHODS Descriptive study. Pulmonary function was evaluated with spirometry, carbon monoxide diffusing capacity, blood arterial gas at rest and post exercise in addition to chest radiography and high resolution computed tomography were performed in children with rheumatologic disease. RESULTS Of the fourteen patients studied: 11 were diagnosed with juvenile idiopathic arthritis (JIA), two with systemic lupus erythematosus (SLE), and one with juvenile dermatomyositis (JDM). Mean age: 13 years (range 7-18 years). Nine females, duration of disease 4 ± 2.8 years (range 1-11 years). Four patients had any grade of abnormalities in one or more lung function tests and/or radiological test. CONCLUSION We recommend routine checks of pulmonary function in all patients with rheumatologic diseases even in the absence of respiratory symptoms.
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Affiliation(s)
- A Quezada
- University of Chile, Santiago de Chile, Chile.
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24
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Weiss JE. Pediatric systemic lupus erythematosus: more than a positive antinuclear antibody. Pediatr Rev 2012; 33:62-73; quiz 74. [PMID: 22301032 DOI: 10.1542/pir.33-2-62] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Based on strong research evidence and consensus, the most common disease manifestations at diagnosis of pSLE are constitutional symptoms, arthritis, and malar rash. Based on some research evidence and consensus, patients with pSLE tend to have major organ system involvement (renal/central nervous system) and a greater disease burden compared with adults. Despite these findings, mortality is low. Based on some research evidence and consensus, the diagnosis of pSLE is unlikely if the ANA is negative, and most patients with SLE have a positive ANA at a titer ≥1:160. Based on strong research evidence, both MMF and cyclophosphamide can be used for induction therapy in class III and IV lupus nephritis. Based on strong research evidence, patients with SLE and anticardiolipin antibodies or LA have a two and six times greater risk of venous thrombosis, respectively, compared with patients with SLE without antiphospholipid antibodies. Based on strong research evidence, patients with pSLE have a higher risk for subclinical atherosclerosis when there is weight-adjusted prednisone use, azathioprine use, increasing age, male gender, high BMI, abnormal creatinine clearance, and elevated lipoprotein(a) levels.
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Affiliation(s)
- Jennifer E Weiss
- University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ, USA
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25
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Otten MH, Cransberg K, van Rossum MAJ, Groothoff JW, Kist-van Holthe JE, Ten Cate R, Van Suijlekom-Smit LWA. Disease activity patterns in juvenile systemic lupus erythematosus and its relation to early aggressive treatment. Lupus 2010; 19:1550-6. [PMID: 20659970 DOI: 10.1177/0961203310374485] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to determine disease activity patterns in juvenile systemic lupus erythematosus (jSLE) and its relation to early treatment. All jSLE patients who visited the outpatient departments of three Dutch university hospitals for at least 6 months were included. Data were retrospectively collected from each patient visit and hospitalization. Patient characteristics, clinical and laboratory findings categorized in organ systems, flare rate, medication use and disease course were analysed. Included were 35 patients (female 77%; White 47%) with a total follow-up of 142 years. Median age at diagnosis was 12.8 years. Flare rate was 0.45/ patient-year. An organ system not earlier involved was affected in 34% of flares. Identifiable disease activity patterns were: chronic active (49%), relapse remitting (14%) and long quiescence (37%), with no significant difference in organ involvement at diagnosis. Positive anti-Sm and non-White ethnicity were significantly associated with a chronic active pattern. In 14 patients with severe symptoms at diagnosis, treatment with intravenous cyclophosphamide and/or biologics and/or intravenous methylprednisone in the first 6 months resulted in a long quiescence pattern in seven patients. In conclusion, distinct disease activity patterns are identifiable in children. Suppression of disease with early aggressive treatment may decrease the rate of progression.
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Affiliation(s)
- M H Otten
- Department of Pediatrics/Pediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
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Papadimitraki ED, Isenberg DA. Childhood- and adult-onset lupus: an update of similarities and differences. Expert Rev Clin Immunol 2010; 5:391-403. [PMID: 20477036 DOI: 10.1586/eci.09.29] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Systemic lupus erythematosus (SLE) is a multifactorial autoimmune rheumatic disease. Although its highest prevalence is among women of childbearing age, the disease is not confined within this population. A total of 15-20% of cases of SLE are diagnosed in children younger than 16 years (childhood-onset lupus). Although there have been few studies directly comparing childhood- to adult-onset lupus, there is substantial evidence to suggest that pediatric lupus patients display some differences in their disease profile compared with adult-onset populations. Overall, an increased male-to-female ratio, a higher prevalence of nephritis and CNS involvement necessitating a more sustained need for steroids and immnosuppressive drugs, and a higher prevalence of progression to end-stage renal disease are distinguishing features of childhood-onset lupus. In contrast, a higher prevalence of pulmonary involvement, arthritis and discoid lupus are reported in adult-onset SLE patients. Furthermore, childhood-onset lupus patients may experience a serious negative impact on their psychosocial and physical development, issues that pose extra challenges to healthcare providers. Growth delay, osteoporosis, the psychological effect of steroid-induced alterations of the physical image, and often poor treatment compliance are the issues that need to be addressed in pediatric lupus populations. In this review, we compare the epidemiological, clinical and laboratory features, and treatment options of childhood- and adult-onset lupus, and comment on the applicability of the instruments that measure activity, severity and cumulative disease damage in childhood-onset disease. In addition, we highlight special issues of concern for pediatric lupus patients, discussing the significance in the transition from pediatric to adult rheumatology care.
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Affiliation(s)
- Eva D Papadimitraki
- Department of Rheumatology, 3rd floor, University College Hospital, 250 Euston Road, London NW1 2PG, UK
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Abdwani R, Mani R. Anti-CD20 monoclonal antibody in acute life threatening haemolytic anaemia complicating childhood onset SLE. Lupus 2009; 18:460-4. [PMID: 19318402 DOI: 10.1177/0961203308098360] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Haematological involvement occurs frequently in childhood onset systemic lupus erythematosus (SLE) with autoimmune haemolytic anaemia occurring in 10%. Conventional treatment includes high-dose steroids. Second line agents used in refractory cases include azathioprine, mycophenolate mofetil, cyclosporine and cyclophosphamide. Rituximab, anti-CD20 monoclonal antibody, is emerging in the treatment of SLE refractory to conventional therapy. We report the successful use of anti-CD20 therapy in the treatment of acute life threatening haemolytic anaemia, complicating childhood onset SLE. We propose that earlier introduction of rituximab may reduce the side effects related to other cytotoxic therapy mainly steroids and cyclophosphamide. However, in view of controversies in the reported side effects of rituximab in childhood onset SLE, multicentred randomised controlled trials are required to determine the long-term efficacy, safety and optimal dosing of rituximab in childhood onset SLE.
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Affiliation(s)
- R Abdwani
- Sultan Qaboos University Hospital - Child Health, Al Khod, Oman.
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Robazzi TCMV, Alves C, Mendonça M. Acute suppurative thyroiditis as the initial presentation of juvenile systemic lupus erythematosus. J Pediatr Endocrinol Metab 2009; 22:379-83. [PMID: 19554814 DOI: 10.1515/jpem.2009.22.4.379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report an unusual case of acute suppurative thyroiditis associated with juvenile systemic lupus erythematosus (JSLE) onset. A 10 year-old girl presented with a painful voluminous swelling in the anterior cervical region with fever and dysphagia. She also had dysphonia, myalgia, swelling of the small joints of the hands, weight loss, and erythematous malar rash. Thyroid ultrasonography disclosed an ill-defined solid cystic area containing abundant echoes in suspension suggestive of an abscess in both lobes compatible with suppurative bacterial thyroiditis. Fine-needle aspiration biopsy showed a secretion with positive culture for Staphylococcus aureus. Endoscopic evaluation did not demonstrate pyriform sinus fistula. The child had no previous thyroid disease. Hormonal evaluation showed thyrotrophin (TSH) 13 microIU/ml and free thyroxine (FT4) 0.4 ng/dl. After laboratory confirmation of JSLE, high dose 'pulse' therapy was performed with methylprednisolone (30 mg/kg/day for 3 days), followed by prednisone (2 mg/kg/day). The acute thyroiditis was treated with oxacillin, metronidazole and amikacin which ameliorated the symptoms of infection followed by normalization of thyroid function with levothyroxine. In spite of the known association between autoimmune diseases and thyroid disorders, the coexistence of suppurative thyroiditis and JSLE is rare, generally occurring during the course of lupus and not at diagnosis.
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Affiliation(s)
- Teresa C M V Robazzi
- Pediatric Rheumatology Service, Hospital Universitário Professor Edgard Santos, Faculty of Medicine, Federal University ofBahia, Salvador, Bahia, Brazil.
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Medeiros PB, Febrônio MV, Bonfá E, Borba EF, Takiuti AD, Silva CAA. Menstrual and hormonal alterations in juvenile systemic lupus erythematosus. Lupus 2009; 18:38-43. [PMID: 19074167 DOI: 10.1177/0961203308094652] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Menstrual cycles of 30 patients with juvenile systemic lupus erythematosus (JSLE) were compared with 30 age-matched controls. The mean age of patients with JSLE and controls was similar (17.4 +/- 3.2 vs 17.06 +/- 2.08 years, P = 0.66). The mean menarche age was higher in JSLE than controls (13.13 +/- 1.4 vs 11.56 +/- 1.5 years, P = 0.0008). On the contrary, the mean maternal menarche age was similar in both groups (P = 0.62). Menstrual abnormalities and longer length cycles were more frequently observed in JSLE than controls (63% vs 10%, P = 0.0001; 23% vs 0%, P = 0.0105, respectively). The median of follicle stimulating hormone was significantly higher in patients with JSLE compared with controls (4.6 vs 3.4 IU/L, P = 0.0207), and the median of progesterone was lower (32.5 vs 70 ng/mL, P = 0.0033). The median of luteinizing hormone was lower in patients with JSLE with menstrual abnormalities versus normal cycles (2.9 vs 5.5 IU/L, P = 0.019) and both had a high percentage of decreased progesterone levels (63% vs 73%, P = 0.70). Our findings support the notion that menstrual disturbances are frequent and may be associated with pituitary dysfunction leading to a decreased progesterone production. We also reported that in spite of premature ovarian failure being a rare event in JSLE the follicular reserve seems to be low regardless of intravenous cyclophosphamide treatment.
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Affiliation(s)
- P B Medeiros
- Paediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
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Neuropsychiatric manifestations and antiphospholipid antibodies in pediatric onset lupus: 14 years of experience from a tertiary center of North India. Rheumatol Int 2009; 29:1455-61. [PMID: 19306097 DOI: 10.1007/s00296-009-0887-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2008] [Accepted: 03/04/2009] [Indexed: 02/02/2023]
Abstract
The objective is to study the neuropsychiatric (NP) manifestations in pediatric onset systemic lupus erythematosus (SLE) at a tertiary care hospital of northwestern India applying American College of Rheumatology (ACR) case definitions in the context of occurrence of antiphospholipid antibodies (APLA). Data of 53 children with SLE were analyzed for NP syndromes. Tests for detection of APLA were performed as per international standards for quality control. Twenty-seven of the 53 (50.94%) children with lupus had at least one NP manifestation. The male to female ratio of our cohort of pediatric lupus was 1:2.8. However, there was significant male preponderance in patients with NPSLE as compared to patients without NPSLE (1:1.25 vs. 1:12; P < 0.0001). Majority of children with NPSLE (15/27, 55.5%) already had NP manifestations at the time of diagnosis and most of them (81.5%) had experienced more than one NP symptom. Headache was the commonest NP manifestation and was seen in 39.6% children with SLE followed by seizure disorder (35.8%) and cognitive dysfunction (16.9%). Tests for APLA were carried out in 37 of 53 (69.8%) patients with SLE and in 24 of 27 (88.8%) patients with NPSLE. While anticardiolipin antibodies were seen more frequently in children with NPSLE as compared to those without NPSLE (57.8 vs. 23%), lupus anticoagulant was more frequent in children without NPSLE (53.8 vs. 34.7%). However, these differences were statistically not significant. Eleven of the 27 children with NPSLE succumbed to their illness, primarily due to uncontrolled disease activity. Mean duration of follow-up of patients with NPSLE who are alive was 65.4 +/- 36.9 months. NP manifestations are common in pediatric onset lupus and contribute to significant morbidity. As compared to previously published literature, a significantly greater proportion of boys were affected. APLA were frequently detected in children with NPSLE. There is paucity of literature pertaining to NP manifestations of pediatric lupus in the context of APLA, especially with regard to antibodies to beta-2 glycoprotein I. To the best of our knowledge, this is the first detailed study on NP manifestations in childhood lupus from a developing country applying ACR case definitions.
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Juncal Gallego L, Almuíña Simón C, Muíños Esparza L, Díaz Soto R, Ramil Fraga C, Quiroga Ordóñez E. Lupus eritematoso sistémico con afectación neurológica fulminante. An Pediatr (Barc) 2009; 70:202-4. [DOI: 10.1016/j.anpedi.2008.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Revised: 09/10/2008] [Accepted: 09/14/2008] [Indexed: 11/28/2022] Open
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Roberts JE, Bezack BJ, Winger DI, Pollack S, Shah RA, Cataletto M, Katz DS, Montoya-Iraheta C, Schroeder SA, Quintos-Alagheband ML. Association between parapneumonic effusion and pericardial effusion in a pediatric cohort. Pediatrics 2008; 122:e1231-5. [PMID: 18984649 DOI: 10.1542/peds.2008-0171] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Associations between pleural and pericardial effusions have been described in malignancy and autoimmune disorders. Bacterial pneumonia is the most frequent cause of parapneumonic effusion; however, knowledge of the relationship between parapneumonic effusion and the presence of pericardial fluid in children is limited. We examined this relationship. METHODS We performed a retrospective chart review of pediatric patients who were admitted to our institution during a 6-year period with a diagnosis of either parapneumonic effusion or empyema and who had undergone an echocardiogram, a computed tomography scan of the thorax, or both. All demographic, clinical, radiographic, and laboratory data of these patients were collected, and statistical analysis was done with Student's t tests and chi2 analyses. RESULTS We reviewed the charts of 59 children with parapneumonic effusions. Forty-eight underwent 2-dimensional echocardiography, chest computed tomography scan, or both. Of these 48 patients, 54.2% (n=26) were found to have a concomitant pericardial effusion. The majority of patients with pericardial effusions had left-sided pleural disease. Patients with pericardial effusions had more symptomatic days before hospitalization, lower pleural fluid albumin levels, elevated serum white blood cell counts, elevated pleural fluid white blood cell and absolute neutrophil counts, and an increased incidence of surgical intervention. One patient had evidence of hemodynamic compromise that required pericardiocentesis. CONCLUSIONS We found a high incidence of pericardial effusions in pediatric patients with parapneumonic effusions. Leukocytosis, higher pleural fluid leukocyte and neutrophil counts, and a propensity for surgical intervention suggest a prognostic relationship between pericardial effusions and more severe parapneumonic disease. The majority of these pericardial collections resolve with treatment of the underlying pleural disease.
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Affiliation(s)
- Jon E Roberts
- Department of Pediatrics, Winthrop-University Hospital, 120 Mineola Blvd, Suite 210, Mineola, NY 11501, USA.
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Jarvis JN. Commentary - ordering lab tests for suspected rheumatic disease. Pediatr Rheumatol Online J 2008; 6:19. [PMID: 19014701 PMCID: PMC2588570 DOI: 10.1186/1546-0096-6-19] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Accepted: 11/17/2008] [Indexed: 11/10/2022] Open
Abstract
One of the least-appreciated advances in pediatric rheumatology over the past 25 years has been the delineation of the many ways in which children with rheumatic disease differ from adults with the same illnesses. Furthermore, we are now learning that paradigms that are useful in evaluating adults with musculoskeletal complaints have limited utility in children. Nowhere is that more true than in the use of commonly used laboratory tests, particularly antinuclear antibody (ANA) and rheumatoid factor (RF) assays. This short review will provide the practitioner with the evidence base that supports a more limited use of ANA and RF testing in children.
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Affiliation(s)
- James N Jarvis
- Department of Pediatrics, Rheumatology Section, University of Oklahoma College of Medicine, Oklahoma City, OK 73104, USA.
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Abdwani R, Rizvi SG, El-Nour I. Childhood systemic lupus erythematosus in Sultanate of Oman: demographics and clinical analysis. Lupus 2008; 17:683-6. [PMID: 18625643 DOI: 10.1177/0961203307087611] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is a worldwide variation in the incidence of childhood manifestation of systemic lupus erythematosus, which may be related to environmental, genetic and geographical factors. The aim of the study is to describe for the first time the clinical and immunological characteristics of childhood onset systemic lupus erythematosus at diagnosis in the Sultanate of Oman. We retrospectively reviewed the records of 50 children with systemic lupus erythematosus fulfilling the American College of Rheumatology criteria between 1990 and 2006. There were 42 girls and eight boys. The mean age of disease onset was low at 8.6 years (SD 3.1). The female:male ratio was 5.3:1. The most frequent clinical manifestations at initial diagnosis were: articular (76%), cutaneous (70%), haematological (68%) and renal (64%) dominated by class IV nephritis, pulmonary (26%), neuropsychiatric (18%) and cardiac (10%). A positive antinuclear antibody (>1:80) was present in 94% at diagnosis. Positive anti-double stranded DNA was present in 82% and low complement levels were present in 84% at diagnosis. This is the first review of childhood onset systemic lupus erythematosus in the Sultanate of Oman.
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Affiliation(s)
- R Abdwani
- Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman.
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Brown ML, Chesney PJ, Ault BH, Delos Santos NM, Truong LD, Lohr KM, Myers LK. Fever and rash. Clin Pediatr (Phila) 2008; 47:610-4. [PMID: 18566359 DOI: 10.1177/0009922807312727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Monica L Brown
- Department of Pediatrics, University of Tennesee Health Science Center, Memphis, Tennessee 38163, USA.
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Poole BD, Scofield RH, Harley JB, James JA. Epstein-Barr virus and molecular mimicry in systemic lupus erythematosus. Autoimmunity 2008; 39:63-70. [PMID: 16455583 DOI: 10.1080/08916930500484849] [Citation(s) in RCA: 172] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Systemic lupus erythematosus (SLE or lupus) is a complex disease with a multifactoral etiology, with genetic, hormonal, and environmental influences. Molecular mimicry as a result of viral infection may contribute to the development of lupus. The pattern of autoantibody development in lupus is consistent with initiation through molecular mimicry, as the initial autoantigenic epitopes that have been observed are limited and cross-reactive with viral proteins. Autoantibody specificity may then later diversify to other autoantigens through B-cell epitope spreading. Epstein-Barr virus (EBV) is an excellent candidate to be involved in molecular mimicry in lupus. EBV infection has been associated with lupus through serological and DNA studies. Infection with EBV results in the production of the viral protein Epstein-Barr virus nuclear antigen-1 (EBNA-1), antibodies against which cross-react with lupus-associated autoantigens, including Ro, Sm B/B', and Sm D1, in lupus patients. The immune response against EBV, and EBNA-1 in particular, differs among lupus patients and healthy controls, with controls maintaining a limited humoral response and failing to produce long-standing cross-reactive antibodies. We hypothesize that the humoral immune response to EBNA-1 in susceptible individuals leads to the generation of cross-reactive antibodies. Through the process of epitope spreading, these cross-reactive antibodies target additional, non-cross reactive autoepitopes, spread to additional autoantigens, and become pathogenic, leading eventually to clinical lupus. This paper reviews some of the current literature supporting roles for EBV exposure and epitope spreading in SLE.
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Affiliation(s)
- Brian D Poole
- Oklahoma Medical Research Foundation, 825 NE 13th Street, Oklahoma, OK 73104, USA
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Uziel Y, Gorodnitski N, Mukamel M, Padeh S, Brik R, Barash J, Mevorach D, Berkun Y, Tauber T, Press J, Harel L, Navon P, Rubenstein M, Naparstek Y, Hashkes PJ. Outcome of a national Israeli cohort of pediatric systemic lupus erythematosus. Lupus 2007; 16:142-6. [PMID: 17402372 DOI: 10.1177/0961203306075385] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to describe the clinical manifestations and outcomes of a national cohort of childhood systemic lupus erythematosus (cSLE). All cases of cSLE registered in the Israeli national registry of children with rheumatic diseases between 1987-2003 were examined for disease activity and damage by the SLE disease activity index (SLEDAI) and SLE collaborating clinics/American College of Rheumatology (SLICC/ACR) damage index. Demographic, clinical, laboratory and treatment factors were analysed for their effect on the outcome. One-hundred and two patients were identified, 81% females, with a mean age at diagnosis of 13.3 +/- 2.6 years. The mean SLEDAI score was 17.2 +/- 9.0 (range 2-60). Fifty four patients were followed for at least five years. The mean SLEDAI decreased to 7.6 +/- 6.3 (0-29) and the mean SLICC/ACR damage index was 0.7 +/- 1.6 (0-8). Five patients developed chronic renal failure. No patients died. No factors were found to be significantly associated with the outcome except the initial SLEDAI score. The five-year outcome of our national cSLE cohort was good; with relatively low activity and minimal damage in most patients. The initial SLEDAI predicted the development of late damage.
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Affiliation(s)
- Y Uziel
- Department of Pediatrics, Meir Medical Center, Tel Aviv University Kfar-Saba, Isreal.
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Abstract
Systemic lupus erythematosus (SLE) is a multisystem inflammatory disease that is often difficult to diagnose in the emergency department. It is an autoimmune disease with great variability in presentation and course. Moreover, the atypical or incomplete presentation is common in children and can result in delay in diagnosis. Consideration of the possibility of SLE is important when evaluating a patient with symptoms and/or signs suggesting multisystem disease. The emergency physician must maintain a high degree of suspicion for the early diagnosis and management of this important condition. We present 3 children who presented to emergency department with different initial manifestations of SLE.
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Affiliation(s)
- Muhammad Waseem
- Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, NY 10451, USA.
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Kim JT, Nam YM, Lee JS, Kim DS. A clinical study of systemic lupus erythematosus in children. KOREAN JOURNAL OF PEDIATRICS 2007. [DOI: 10.3345/kjp.2007.50.1.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ji Tae Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University Medical Center, Seuol, Korea
| | - Young Mee Nam
- Department of Pediatrics, Severance Children's Hospital, Yonsei University Medical Center, Seuol, Korea
| | - Jae Seung Lee
- Department of Pediatrics, Severance Children's Hospital, Yonsei University Medical Center, Seuol, Korea
| | - Dong Soo Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University Medical Center, Seuol, Korea
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40
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Wagner N, Dannecker G. Systemischer Lupus erythematodes. Monatsschr Kinderheilkd 2006. [DOI: 10.1007/s00112-006-1441-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Pediatric systemic lupus erythematosus (pSLE) is a chronic mutisystemic autoimmune disease with complex clinical manifestations. Although the presentation, clinical manifestations, immunological findings and treatment issues of pSLE are similar to those of adult SLE patients, there are special issues which need to be considered when dealing with SLE in children. During the last decade survival has improved remarkably as a result of earlier diagnosis, recognition of milder disease and better approaches to therapy. However, pSLE remains a potentially serious condition. Although the pathogenesis of SLE remains poorly understood, susceptibility involves a combination of environmental, hormonal and genetic factors. Better understanding of SLE pathogenesis will hopefully lead to more specific and less toxic therapies for this disease.
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Affiliation(s)
- D Stichweh
- Baylor Institute for Immunology Research, Dallas, Texas 75204, USA
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