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Batu ED, Günalp A, Şahin S, Özdel S, Kızıldağ Z, Pac Kısaarslan A, Bağrul İ, Kasap Cuceoglu M, Tanatar A, Sonmez HE, Sag E, Demir S, Çelikel E, Cağlayan S, Çelikel Acar B, Sözeri B, Aktay Ayaz N, Bilginer Y, Poyrazoğlu MH, Ünsal E, Kasapçopur Ö, Özen S. Pediatric mixed connective tissue disease versus other overlap syndromes: a retrospective multicenter cohort study. Rheumatol Int 2023; 43:1485-1495. [PMID: 36906866 DOI: 10.1007/s00296-023-05300-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/27/2023] [Indexed: 03/13/2023]
Abstract
Pediatric mixed connective tissue disease (MCTD) is a subgroup of overlap syndromes. We aimed to compare the characteristics and outcomes in children with MCTD and other overlap syndromes. All MCTD patients met either Kasukawa or Alarcon-Segovia and Villareal criteria. The patients with other overlap syndromes had the features of ≥ 2 autoimmune rheumatic diseases but did not meet MCTD diagnostic criteria. Thirty MCTD (F/M = 28/2) and thirty (F/M = 29/1) overlap patients were included (disease onset < 18 years). The most prominent phenotype at disease onset and the last visit was systemic lupus erythematosus (SLE) in the MCTD group; juvenile idiopathic arthritis and dermatomyositis/polymyositis, respectively, in the overlap group. At the last visit, systemic sclerosis (SSc) phenotype was more frequent among MCTD than overlap patients (60% vs. 33.3%; p = 0.038). The frequency of the predominant SLE phenotype had decreased (60% to 36.7%), while predominant SSc phenotype had increased (13.3% to 33.3%) during follow-up in MCTD patients. Weight loss (36.7% vs. 13.3%), digital ulcers (20% vs. 0), swollen hands (60% vs. 20%), Raynaud phenomenon (86.7% vs. 46.7%), hematologic involvement (70% vs. 26.7%), and anti-Sm positivity (29% vs. 3.3%) were more common, while Gottron papules (16.7% vs. 40%) were less frequent among MCTD than overlap patients (p < 0.05). A higher percentage of overlap patients achieved complete remission than MCTD patients (51.7% vs. 24.1%; p = 0.047). The disease phenotype and outcome differ between pediatric MCTD and other overlap syndromes where MCTD may be regarded as a more severe disease. Analyzing these patients could pave the way for early and effective treatment.
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Affiliation(s)
- Ezgi Deniz Batu
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
- Çocuk Romatoloji Bölümü, Hacettepe Üniversitesi İhsan Doğramacı Çocuk Hastanesi, Kat: 3 Sıhhiye, 06100, Ankara, Turkey.
| | - Aybüke Günalp
- Cerrahpasa Medical School, Department of Pediatrics, Division of Rheumatology, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Sezgin Şahin
- Cerrahpasa Medical School, Department of Pediatrics, Division of Rheumatology, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Semanur Özdel
- Dr. Sami Ulus Maternity and Child Health and Diseases Research and Training Hospital, Department of Pediatrics, Division of Rheumatology, University of Health Sciences, Ankara, Turkey
| | - Zehra Kızıldağ
- Department of Pediatrics, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | - Aysenur Pac Kısaarslan
- Faculty of Medicine, Department of Pediatrics, Division of Rheumatology, Erciyes University, Kayseri, Turkey
| | - İlknur Bağrul
- Dr. Sami Ulus Maternity and Child Health and Diseases Research and Training Hospital, Department of Pediatrics, Division of Rheumatology, University of Health Sciences, Ankara, Turkey
| | - Muserref Kasap Cuceoglu
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ayşe Tanatar
- Faculty of Medicine, Department of Pediatrics, Division of Rheumatology, Istanbul University, Istanbul, Turkey
| | - Hafize Emine Sonmez
- Faculty of Medicine, Department of Pediatrics, Division of Rheumatology, Kocaeli University, Kocaeli, Turkey
| | - Erdal Sag
- Ankara Research and Training Hospital, Department of Pediatrics, Division of Rheumatology, University of Health Sciences, Ankara, Turkey
| | - Selcan Demir
- Department of Pediatrics, Division of Rheumatology, Erzurum Regional Research and Training Hospital, Erzurum, Turkey
| | - Elif Çelikel
- Ankara City Hospital, Department of Pediatrics, Division of Rheumatology, University of Health Sciences, Ankara, Turkey
| | - Sengul Cağlayan
- Umraniye Research and Training Hospital, Department of Pediatrics, Division of Rheumatology, University of Health Sciences, Istanbul, Turkey
| | - Banu Çelikel Acar
- Ankara City Hospital, Department of Pediatrics, Division of Rheumatology, University of Health Sciences, Ankara, Turkey
| | - Betül Sözeri
- Umraniye Research and Training Hospital, Department of Pediatrics, Division of Rheumatology, University of Health Sciences, Istanbul, Turkey
| | - Nuray Aktay Ayaz
- Faculty of Medicine, Department of Pediatrics, Division of Rheumatology, Istanbul University, Istanbul, Turkey
| | - Yelda Bilginer
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - M Hakan Poyrazoğlu
- Faculty of Medicine, Department of Pediatrics, Division of Rheumatology, Erciyes University, Kayseri, Turkey
| | - Erbil Ünsal
- Department of Pediatrics, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | - Özgür Kasapçopur
- Cerrahpasa Medical School, Department of Pediatrics, Division of Rheumatology, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Seza Özen
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Liu M, Zhang L, Wang Y, Hu W, Wang C, Wen Z. Mesangial cell: A hub in lupus nephritis. Front Immunol 2022; 13:1063497. [PMID: 36591251 PMCID: PMC9795068 DOI: 10.3389/fimmu.2022.1063497] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
Lupus nephritis (LN) is a severe renal disease caused by the massive deposition of the immune complexes (ICs) in renal tissue, acting as one of the significant organ manifestations of systemic lupus erythematosus (SLE) and a substantial cause of death in clinical patients. As mesangium is one of the primary sites for IC deposition, mesangial cells (MCs) constantly undergo severe damage, resulting in excessive proliferation and increased extracellular matrix (ECM) production. In addition to playing a role in organizational structure, MCs are closely related to in situ immunomodulation by phagocytosis, antigen-presenting function, and inflammatory effects, aberrantly participating in the tissue-resident immune responses and leading to immune-mediated renal lesions. Notably, such renal-resident immune responses drive a second wave of MC damage, accelerating the development of LN. This review summarized the damage mechanisms and the in situ immune regulation of MCs in LN, facilitating the current drug research for exploring clinical treatment strategies.
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Affiliation(s)
- Mengdi Liu
- Jiangsu Key Laboratory of Infection and Immunity, Institutes of Biology and Medical Sciences, Soochow University, Suzhou, China
| | - Lei Zhang
- Jiangsu Key Laboratory of Infection and Immunity, Institutes of Biology and Medical Sciences, Soochow University, Suzhou, China
| | - Yixin Wang
- Jiangsu Key Laboratory of Infection and Immunity, Institutes of Biology and Medical Sciences, Soochow University, Suzhou, China
| | - Weijie Hu
- Jiangsu Key Laboratory of Infection and Immunity, Institutes of Biology and Medical Sciences, Soochow University, Suzhou, China
| | - Chunhong Wang
- Cyrus Tang Hematology Center, State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, China,*Correspondence: Zhenke Wen, ; Chunhong Wang,
| | - Zhenke Wen
- Jiangsu Key Laboratory of Infection and Immunity, Institutes of Biology and Medical Sciences, Soochow University, Suzhou, China,*Correspondence: Zhenke Wen, ; Chunhong Wang,
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