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Shen F, Xiao G, Chen R, Li X, Zhu Y, Wang X. Linear scleroderma in a child with central nervous system involvement: clinical and radiological features. Childs Nerv Syst 2022; 38:1041-1045. [PMID: 34448048 DOI: 10.1007/s00381-021-05300-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
Linear scleroderma is the most common type of localized scleroderma in children. Lesions rarely involve areas other than the skin, and nervous system involvement is even rare. We reported a case of a 6-year-old girl who was admitted to the hospital with recurrent seizures for 4 weeks. Before that, she had left frontal plaques for more than 1 year. Radiological imaging of the brain showed multiple abnormal lesions and skin biopsy of the plaques indicated scleroderma. After drug therapy, the girl had no recurrence of epilepsy, and no obvious abnormalities were found in the reexamination of neuroimaging. We performed further radiological examination on this patient and reviewed the literatures for this rare case.
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Affiliation(s)
- Fangjie Shen
- Department of Pediatric Neurosurgery, Xinhua Hospital Affiliated To Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China.,Department of Radiology, Ningbo First Hospital, Ningbo Hospital Affiliated To Zhejiang University, Zhejiang, 315000, Ningbo, China
| | - Gelei Xiao
- Department of Neurosurgery, Xiangya Hospital, Central South University, Hunan, 410008, Changsha, China
| | - Ruoping Chen
- Department of Pediatric Neurosurgery, Xinhua Hospital Affiliated To Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
| | - Xiangying Li
- Department of Pediatric Neurosurgery, Xinhua Hospital Affiliated To Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
| | - Yueniu Zhu
- Department of Pediatric Critical Care Medicine, Xinhua Hospital Affiliated To Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China.
| | - Xiaoqiang Wang
- Department of Pediatric Neurosurgery, Xinhua Hospital Affiliated To Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China.
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2
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Neuroimaging findings in rheumatologic disorders. J Neurol Sci 2021; 427:117531. [PMID: 34130065 DOI: 10.1016/j.jns.2021.117531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/12/2021] [Accepted: 06/02/2021] [Indexed: 01/06/2023]
Abstract
Patients with rheumatological diseases may present with neurological manifestations of peripheral and/or central nervous system (CNS). Symptoms may be related to underlying rheumatological disease or CNS effects of immune-modulating drugs. Early diagnosis and therapy may help prevent serious complications. Magnetic resonance imaging (MRI), given its excellent soft tissue details, is the preferred imaging modality when evaluating patients with rheumatological disease and suspected CNS involvement. We present a review of the neuroimaging manifestations of various rheumatic diseases with emphasis on the imaging findings on MRI.
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Abstract
Children with rheumatic disease have rare pulmonary manifestations that may cause significant morbidity and mortality. These children are often clinically asymptomatic until disease has significantly progressed, so they should be screened for pulmonary involvement. There has been recent recognition of a high mortality-related lung disease in systemic-onset juvenile idiopathic arthritis; risk factors include onset of juvenile idiopathic arthritis less than 2 years of age, history of macrophage activation syndrome, presence of trisomy 21, and history of anaphylactic reaction to biologic therapy. Early recognition and treatment of lung disease in children with rheumatic diseases may improve outcomes.
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Careta MF, Romiti R. Localized scleroderma: clinical spectrum and therapeutic update. An Bras Dermatol 2015; 90:62-73. [PMID: 25672301 PMCID: PMC4323700 DOI: 10.1590/abd1806-4841.20152890] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 10/11/2013] [Indexed: 12/31/2022] Open
Abstract
Scleroderma is a rare connective tissue disease that is manifested by cutaneous
sclerosis and variable systemic involvement. Two categories of scleroderma are known:
systemic sclerosis, characterized by cutaneous sclerosis and visceral involvement,
and localized scleroderma or morphea which classically presents benign and
self-limited evolution and is confined to the skin and/or underlying tissues.
Localized scleroderma is a rare disease of unknown etiology. Recent studies show that
the localized form may affect internal organs and have variable morbidity. Treatment
should be started very early, before complications occur due to the high morbidity of
localized scleroderma. In this review, we report the most important aspects and
particularities in the treatment of patients diagnosed with localized
scleroderma.
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5
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Abstract
The array of paediatric pulmonary complications of the various rheumatologic disorders illustrates both the complexities and challenges of the underlying disorders and the continuing lack of detailed knowledge of the pathophysiology and optimal treatment paradigms in children. While the vertical transfer of information has made much progress from adult studies, such as with the diagnosis and management of pulmonary arterial hypertension, in many instances underlying disorders may differ between children and adults in important and fundamental respects. Recognition of pulmonary complications of rheumatic disorders in children is often more difficult and requires anticipation and a high index of suspicion. Further progress in understanding and treating the various paediatric disorders is hampered by the lack of paediatric-specific information. Crucial to further progress are the expansion of orphan childhood disease databases and research networks. In this way a comprehensive approach to determining basic natural history, risks and outcomes, and defining the next generation of therapies in a disease-specific and age-specific manner can be achieved.
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Amaral TN, Marques Neto JF, Lapa AT, Peres FA, Guirau CR, Appenzeller S. Neurologic involvement in scleroderma en coup de sabre. Autoimmune Dis 2012; 2012:719685. [PMID: 22319646 PMCID: PMC3272788 DOI: 10.1155/2012/719685] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 12/04/2011] [Indexed: 11/17/2022] Open
Abstract
Localized scleroderma is a rare disease, characterized by sclerotic lesions. A variety of presentations have been described, with different clinical characteristics and specific prognosis. In scleroderma en coup de sabre (LScs) the atrophic lesion in frontoparietal area is the disease hallmark. Skin and subcutaneous are the mainly affected tissues, but case reports of muscle, cartilage, and bone involvement are frequent. These cases pose a difficult differential diagnosis with Parry-Romberg syndrome. Once considered an exclusive cutaneous disorder, the neurologic involvement present in LScs has been described in several case reports. Seizures are most frequently observed, but focal neurologic deficits, movement disorders, trigeminal neuralgia, and mimics of hemiplegic migraines have been reported. Computed tomography and magnetic resonance imaging have aided the characterization of central nervous system lesions, and cerebral angiograms have pointed to vasculitis as a part of disease pathogenesis. In this paper we describe the clinical and radiologic aspects of neurologic involvement in LScs.
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Affiliation(s)
- Tiago Nardi Amaral
- Rheumatology Division, Faculty of Medical Science, State University of Campinas, 13083-970 Campinas, SP, Brazil
| | - João Francisco Marques Neto
- Rheumatology Division, Faculty of Medical Science, State University of Campinas, 13083-970 Campinas, SP, Brazil
| | - Aline Tamires Lapa
- Postgraduate Program in Child and Adolescent Health, Faculty of Medical Science, State University of Campinas, 13083-970 Campinas (UNICAMP), Brazil
| | - Fernando Augusto Peres
- Rheumatology Lab, Faculty of Medical Science, State University of Campinas, 13083-970 Campinas, SP, Brazil
| | - Caio Rodrigues Guirau
- Rheumatology Lab, Faculty of Medical Science, State University of Campinas, 13083-970 Campinas, SP, Brazil
| | - Simone Appenzeller
- Rheumatology Division, Faculty of Medical Science, State University of Campinas, 13083-970 Campinas, SP, Brazil
- Rheumatology Lab, Faculty of Medical Science, State University of Campinas, 13083-970 Campinas, SP, Brazil
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Johnson JN, Kvistad BS, Reed AM, Porter CBJ, O'Leary PW, Driscoll DJ. Cardiac transplantation in a pediatric patient with systemic sclerosis. CONGENIT HEART DIS 2011; 8:E1-4. [PMID: 21801316 DOI: 10.1111/j.1747-0803.2011.00554.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Diffuse cutaneous systemic sclerosis (SSc) is rare in children, but has a poor prognosis when cardiomyopathy is present. METHODS We reviewed the case of a 14-year-old female with progressive skin thickening/tightness and dyspnea on exertion who was diagnosed with SSc. RESULTS Our patient was found to have severe restrictive cardiomyopathy with poor left ventricular systolic function (ejection fraction = 20%), unresponsive to the immunosuppression used to treat her SSc. There was no evidence of pulmonary fibrosis. The patient underwent orthotopic cardiac transplantation, with improvement in systemic symptoms. Two years after transplantation, she had elevated filling pressures during a surveillance catheterization, with no evidence of cellular rejection or coronary artery vasculopathy. Four months later, she developed severe ventricular dysfunction and dyspnea, despite a negative biopsy and negative C4d immunofluorescence staining. Her immunosuppression was intensified with improvement of cardiac function. Despite this, 1 month later she had sudden pulseless cardiac arrest from which she could not be revived. The family declined an autopsy. DISCUSSION We report a 14-year-old female with SSc who had cardiac transplantation. The etiology behind her recurrent restrictive physiology, cardiac dysfunction, and subsequent cardiac arrest remains unclear.
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Affiliation(s)
- Jonathan N Johnson
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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8
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Longstanding epileptic encephalopathy and linear localized scleroderma: two distinct pathologic processes in an adolescent. Rheumatol Int 2008; 28:925-9. [PMID: 18278499 DOI: 10.1007/s00296-008-0541-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Accepted: 02/03/2008] [Indexed: 10/22/2022]
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10
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Rosenkranz ME, Agle LMA, Efthimiou P, Lehman TJA. Systemic and localized scleroderma in children: current and future treatment options. Paediatr Drugs 2006; 8:85-97. [PMID: 16608370 DOI: 10.2165/00148581-200608020-00002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Scleroderma is a group of rare and complex diseases with varied clinical manifestations. The most obvious manifestation of the diseases is skin hardening and sclerosis. Scleroderma can be divided into two main subgroups: systemic and localized. The systemic form, also known as systemic sclerosis, involves diffuse skin involvement and potentially severe visceral involvement. Localized scleroderma on the other hand is more common in children and usually confined to a specific region of the body with no internal organ involvement. The juvenile forms of systemic sclerosis and localized scleroderma are important conditions in children because of the clinical severity and substantial mortality of systemic scleroderma and the major growth defects associated with childhood-onset localized disease even if the active disease itself is self-limited. The pathogenic pathways of the various forms of scleroderma are only partially defined, but the main defect in scleroderma is abnormal collagen deposition leading to eventual fibrosis in the skin as well as multiple organ systems such as the heart and lungs in juvenile systemic sclerosis. Therapeutics are divided into three main subgroups for systemic sclerosis: antifibrotics, anti-inflammatories, and vasodilators. For localized disease, anti-inflammatories, vitamin D analogs, and UV irradiation have been investigated. However, the infrequency of scleroderma in the pediatric population plus the fact that this disease is very often self-limiting makes randomized controlled trials very difficult. It is for this reason that most data on treatment modalities for this disease have been extrapolated from studies in adult patients. There is no one therapy for systemic sclerosis or localized scleroderma that has proven to be very effective or significantly disease modifying. However, current therapeutic strategies must be initiated early in the disease course for maximum beneficial clinical effects. New interventions such as autologous stem cell transplant and cytokine-directed therapies are under investigation as potential treatments for this complex disease.
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Affiliation(s)
- Margalit E Rosenkranz
- Hospital for Special Surgery, Division of Pediatric Rheumatology, New York, New York, USA
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11
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Abstract
Connective tissue diseases are a heterogeneous group of chronic multisystem inflammatory disorders including systemic lupus erythematosus (SLE), progressive systemic sclerosis (PSS), dermato- (DM) and polymyositis (PM), mixed connective tissue disease (MCTD), and Sjögren's syndrome (SS). Patients can present with similar clinical features, particularly during the first onset of symptoms, which frequently makes the diagnosis of a specific disease difficult. The incidence of connective tissue diseases is much lower in children than adults; however, the clinical picture is more variable. Clinical signs, such as fatigue, fever, or weight loss, may precede any systemic organ involvement and in children, mucocutaneous manifestations develop most frequently during the varying disease course. This review summarizes recent information on epidemiology, clinical manifestations, diagnostic procedures, and treatment strategies of the different connective tissue diseases, concentrating on specific problems in childhood.
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Affiliation(s)
- K Gensch
- Hautklinik, Heinrich-Heine-Universität, Düsseldorf
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12
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Abstract
This article reviews the current use of the wide variety of imaging modalities now available, presenting the imaging features of common and important causes of acute and chronic rheumatic disorders including juvenile idiopathic arthritis, spondyloarthropathies/enthesitis-related arthritis, sepsis, autoimmune diseases, vasculitis, and osteoporosis.
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Affiliation(s)
- Paul Babyn
- Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8 Canada.
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13
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Appenzeller S, Montenegro MA, Dertkigil SSJ, Sampaio-Barros PD, Marques-Neto JF, Samara AM, Andermann F, Cendes F. Neuroimaging findings in scleroderma en coup de sabre. Neurology 2004; 62:1585-9. [PMID: 15136686 DOI: 10.1212/01.wnl.0000124518.25087.18] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To describe the neuroimaging and clinical findings in patients with localized scleroderma en coup de sabre (LScs). METHODS Patients with LScs were evaluated by high-resolution MRI and CT. The authors performed three-dimensional reconstructions of MRI and CT scans to evaluate brain and bone structures. RESULTS Nine patients with LScs were evaluated (five women), with ages ranging from 6 to 53 years (mean, 30.7 years). Brain CT showed bone deformities with thinning of the skull under the skin lesions in six patients. MRI scans showed focal atrophy and blurring of the gray-white matter interface localized under the skin lesion in all patients. In three patients it was associated with hyperintense signal on fluid-attenuated inversion recovery (FLAIR) and T2-weighted images. Follow-up MRI showed extension of the brain lesion in one patient; in the remaining patients, the lesion did not progress. Four of the nine patients had partial epilepsy. One had surgery for management of refractory seizures, and pathologic findings indicated a focal inflammatory process. CONCLUSION Localized scleroderma en coup de sabre is associated with focal, and in some progressive, brain lesions underlying the skin atrophy. Epilepsy, when present, is related to these brain lesions. Imaging findings and histopathology indicated that the process, most likely focal inflammatory, may be progressive.
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Affiliation(s)
- S Appenzeller
- Department of Internal Medicine, Rheumatology Unit, University of Campinas, SP, Brazil
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14
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Affiliation(s)
- Maria Bitsori
- Department of Paediatrics, University of Crete, Crete, Greece.
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15
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Grosso S, Fioravanti A, Biasi G, Conversano E, Marcolongo R, Morgese G, Balestri P. Linear scleroderma associated with progressive brain atrophy. Brain Dev 2003; 25:57-61. [PMID: 12536035 DOI: 10.1016/s0387-7604(02)00147-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Linear scleroderma (LS) is characterized by scleroatrophic lesions affecting limbs and legs, unilaterally. Neurological involvement may be associated with ipsilateral facial and skull involvement in disorders referred to clinically as LS 'en coup de sabre', and Parry-Romberg syndrome. We report a child with LS presenting with a severe neurological disorder characterized by epilepsy, progressive mental deterioration and a rapid process of atrophy involving the ipsilateral cerebral hemisphere, but not associated with an overlying facial structure involvement. Functional brain studies showed a reduction in the diameter of the left internal carotid and of the left middle cerebral artery. Our observations suggest that neuroimaging studies should be considered in all patients with linear scleroderma, and such studies become necessary when neurological symptoms occur.
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Affiliation(s)
- Salvatore Grosso
- Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Viale M. Bracci - Le scotte, 53100 Siena, Italy
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16
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Rosenkranz ME, Lehman TJA. Clinical trials for pediatric scleroderma. Curr Rheumatol Rep 2002; 4:449-51. [PMID: 12427357 DOI: 10.1007/s11926-002-0049-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Progressive systemic sclerosis (PSS), or scleroderma, is a rare disease in the pediatric population. Many children with PSS have significant involvement of their internal organs, which leads to decreased survival. Because of the infrequency of the condition and delayed diagnosis, there are no large studies to evaluate therapy for PSS in children. Treatment is controversial in the adult literature, and its applicability to children is unclear. Only through collaborative efforts will researchers be able to clearly delineate the etiopathogenesis of PSS, and gather information from multicenter studies to ultimately provide appropriate and effective care for children with PSS.
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Affiliation(s)
- Margalit E Rosenkranz
- Division of Pediatric Rheumatology, Hospital for Special Surgery, Sanford Weill Medical College, Cornell University, 535 East 70th Street, New York, NY 10021, USA.
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17
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Nguyen XH, Hansen R, Valencia F. Severe ankle deformity secondary to pansclerotic morphea in a 9-year-old girl: correction involving arthrodesis and free flap coverage. Pediatr Dermatol 2002; 19:560-3. [PMID: 12437566 DOI: 10.1046/j.1525-1470.2002.00235.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Xuan H Nguyen
- Department of Dermatology, University of Arizona College of Medicine, Tucson 85719, USA
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18
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Ramos-e-Silva M, Tanus FH, Cestari TF. Cutaneous manifestation of internal diseases in infants and children. Clin Dermatol 2002; 20:51-66. [PMID: 11849895 DOI: 10.1016/s0738-081x(01)00229-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Marcia Ramos-e-Silva
- Sector of Dermatology, HUCFF-UFRJ and School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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19
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Abstract
Systemic scleroderma in children is very rare and is considered similar to adult-onset disease. In adults, new etiopathogenetic and therapeutic approaches have emerged in recent years. For instance, it has been shown that microchimerism could play a role in disease pathogenesis and that immunoablation followed by stem cell rescue could be of potential therapeutic benefit. There is also evidence that these new approaches can be of value for childhood-onset disease.
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Affiliation(s)
- A Martini
- Dipartimento di Scienze Pediatriche, Università di Pavia, IRCCS Policlinico S. Matteo, 27100, Pavia, Italy.
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20
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Fuller CC, Hartley B. Linear scleroderma: a Neuman nursing perspective. J Pediatr Nurs 2000; 15:168-74. [PMID: 10897554 DOI: 10.1053/jn.2000.6022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although quite a rare pediatric disease, linear scleroderma (LS), a chronic disease, may leave scarring and may have devastating effects on a child and family. This article provides an overview of the disease, presents a case history of a boy with LS, and discusses how nurses and other health-team members assisted the child and family in managing the illness. The description of the nursing care is based on the Neuman systems model and on the nursing diagnoses of fear, disturbed self-concept, and impaired physical mobility.
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Affiliation(s)
- C C Fuller
- Rheumatology Department, Hospital for Sick Children, Toronto, Canada
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21
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Foeldvari I, Zhavania M, Birdi N, Cuttica RJ, de Oliveira SH, Dent PB, Elborgh R, Falcini F, Ganser G, Girschick H, Häfner R, Joos R, Kuis W, Pelkonen P, Prieur AM, Rostropowicz-Denisiewicz K, Russo R, Savolainen A, Siamopoulou-Mayridou A, Zulian F. Favourable outcome in 135 children with juvenile systemic sclerosis: results of a multi-national survey. Rheumatology (Oxford) 2000; 39:556-9. [PMID: 10852989 DOI: 10.1093/rheumatology/39.5.556] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To increase the current knowledge of the outcome of juvenile systemic sclerosis (jSSc), which is currently limited. METHODS In order to investigate the patient outcome and prognostic factors, starting October 1994, we distributed questionnaires to 324 paediatric rheumatology centres. RESULTS Until 15 May 1998 responses from 46 centres were received, 34 of which returned completed questionnaires on a total of 135 patients. One hundred and twenty-two of the 135 patients were Caucasian, 100 were female. The mean age at disease onset was 8.8 yr (S.D. +/- 3.3 yr). The mean disease duration at the last follow-up was 5 yr(S.D. +/- 3.3 yr). At the last follow-up the disease was still active and required medication in 82 patients, 36 had inactive disease on medication, and 16 were in remission. Ninety per cent of the living patients were fully active in daily life at the last follow-up. Eight of the 135 patients had died. These patients had a median age at onset of the disease of 10.5 yr (range 6.7-15.8 yr). The median disease duration until death was 2 yr (range 1-8 yr). The causes of death were heart failure (five), renal failure (one), sepsis (one) and in one case the cause was not defined. The 1 yr survival rate was 99%, the 2 yr was 97% and the 4 yr was 95%. CONCLUSIONS At a mean follow-up of 5 yr, the current results show a favourable outcome in most patients with childhood onset jSSc and a significantly better survival than in the adult SSc patients.
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Affiliation(s)
- I Foeldvari
- University Children's Hospital, Hamburg, Germany
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22
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Abstract
This review article describes the imaging finding of the connective tissue disorders in children. The radiological features of the following conditions are described; the spondyloarthropathics, systemic lupus erythematosus (SLE), dermatomyositis, scleroderma, the vasculitides, Kawasaki disease, synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO), and focal myositis. The features on several integrated imaging techniques are described.
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Affiliation(s)
- R Hanlon
- Royal Liverpool Children's NHS Trust, UK
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23
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24
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Español T, Pascual C, Huguet P, Caragol I, Hernandez M, Bertran JM. Circumscribed scleroderma in congenital rubella syndrome with hypogammaglobulinemia. Allergy 1998; 53:1005-6. [PMID: 9821485 DOI: 10.1111/j.1398-9995.1998.tb03806.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- T Español
- Immunology Unit, Hospitals Vall d'Hebron, Barcelona, Spain. terespa hg.vhebron.es
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25
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Abstract
Collagen vascular diseases seen in children include systemic, discoid and neonatal lupus, dermatomyositis, scleroderma, juvenile rheumatoid arthritis, and, in rare cases, Sjogren's syndrome. Although these diseases are uncommon in children, when seen, they are associated with significant morbidity. This review describes the clinical features of each condition and provides an overview of treatment options now available. These include numerous systemic treatments which can be used as steroid-sparing agents.
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Affiliation(s)
- T N DeSilva
- Department of Dermatology, University of Pittsburgh Medical Center, Pennsylvania, USA
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26
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Abstract
Scleroderma is a diverse group of conditions which have in common fibrosis of skin and other tissues. Although less common in children than in adults, these conditions are an important cause of morbidity and occasional mortality when they occur in the pediatric population. Children are more likely than adults to develop localized forms of scleroderma, and because of the impact on growth, these can result in major facial or limb asymmetry, flexion contractures, and disability. Management approaches must take into consideration the effect of medications on the child (for example, growth failure and osteoporosis from corticosteroids) as well as the psychosocial impact of chronic illness and physical deformity on the child and family. This article describes the types of scleroderma identified in children, reviews epidemiologic and etiologic factors, and discusses management options. Because this is a rare group of diseases managed by both dermatologists and rheumatologists, large series of patients are rare, and controlled studies of management are not available.
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MESH Headings
- Adolescent
- Adult
- Age of Onset
- Child
- Child, Preschool
- Diagnosis, Differential
- Female
- Humans
- Incidence
- Male
- Prognosis
- Scleroderma, Localized/diagnosis
- Scleroderma, Localized/epidemiology
- Scleroderma, Localized/physiopathology
- Scleroderma, Localized/therapy
- Scleroderma, Systemic/diagnosis
- Scleroderma, Systemic/epidemiology
- Scleroderma, Systemic/physiopathology
- Scleroderma, Systemic/therapy
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Affiliation(s)
- H Emery
- Department of Pediatrics, University of California at San Francisco, 94143-0105, USA
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27
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Abstract
The study of critical care issues in pediatric rheumatology is in its infancy, and the available literature is largely case studies and small retrospective series. A child's limited communication skills and the lack of understanding of disease consequences by both parent and child may cause both overuse and underuse of emergency services. To the extent that small case experiences in children with rheumatic diseases do not adequately reflect possible disease presentations or diagnostic and treatment options, pediatric and adult rheumatologists, intensivists, and emergency physicians should readily turn as needed to larger reported experiences in adults with similar conditions.
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Affiliation(s)
- J A Fitch
- Division of Pediatrics, Cleveland Clinic Foundation, Ohio, USA
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28
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Fujita Y, Yamamori H, Hiyoshi K, Inamo Y, Harada K, Fujikawa S. Systemic sclerosis in children: a national retrospective survey in Japan. ACTA PAEDIATRICA JAPONICA : OVERSEAS EDITION 1997; 39:263-7. [PMID: 9141269 DOI: 10.1111/j.1442-200x.1997.tb03596.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A retrospective questionnaire survey of pediatric departments, for childhood collagen disease from 1985 to 1994 was used to clarify the clinical features of scleroderma in Japan. In the primary survey, 0.9% of the children with a rheumatic condition and scleroderma. Answers to this questionnaire were received on 18 (localized 9; systemic 9) patients from 15 institutions. In order to examine systemic sclerosis (SSc), seven cases of SSc in Japanese articles during the same period as the questionnaire were added to these answers and compared to the Japanese epidemic study investigated by Fukuyama in 1974. There were 16 children, seven boys and nine girls, with SSc during the 10-year period in Japan. The mean age of onset of symptoms was 8.0 +/- 2.8 years and the age at diagnosis 10.1 +/- 3.0 years. Eighty percent of children had Raynaud's phenomenon at the onset of SSc, and skin and musculoskeletal involvement was highly recognized during the course of the disease. Atrophy of the frenulum linguae and lung fibrosis were commonly seen in SSc. In serological studies, 80% of children have antinuclear antibodies and approximately 50% of patients have anti-Scl-70 (topoisomelase I) antibodies at the onset and during the course of childhood SSc. The prognosis is poor, as remission occurred in only one child. The clinical symptoms and examination of serological autoimmune antibodies were supportive of an early diagnosis of SSc. When compared to the previous national survey of children with SSc, the present results showed that the male-to-female ratio was reduced, the age at onset was low, the positive incidence of serological autoimmune antibodies elevated, and the usage of vasodilators and nonsteroid anti-inflammatory drugs (NSAID) increased, with corticosteroids decreased. But, the positive percentage of clinical symptoms were not changed in both studies. For a complete retrospective nationwide epidemic survey carried out on children with scleroderma, especially SSc, it is important to include dermatology departments.
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Affiliation(s)
- Y Fujita
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
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Abstract
Systemic Lupus Erythematosus (SLE) of childhood is a complex and challenging disease which can occur at any age. Identification of disease early in it's course and aggressive, appropriate management leads to improved outcome for an individual child. The history of SLE indicates how much progress has been made in the last quarter century. A discussion of the etiopathogenesis of SLE demonstrates the complexity of the syndrome. This is followed by a description of clinical manifestations, including diagnostic criteria, differential diagnosis and suggested methods for eliciting important symptoms to make the diagnosis. Evaluation of specific organs is next reviewed highlighting critical organ manifestations that are significant for future prognosis. Treatment of SLE includes a variety of medications, including non-steroidal anti-inflammatory medications, steroids and immuno-suppressive drugs. Attention to physical activity, stress and nutrition is equally important. Signs and symptoms that indicate disease flare or infection are described. Lastly, related syndromes are reviewed.
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Affiliation(s)
- M S Klein-Gitelman
- Department of Pediatrics, Children's Memorial Hospital, Chicago, IL 60614, USA
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Athreya BH. Management of rheumatic diseases in children. Indian J Pediatr 1996; 63:305-21. [PMID: 10830006 DOI: 10.1007/bf02751523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Rheumatic diseases are one of the common groups of chronic diseases of childhood. They are multifactorial in origin and tend to involve multiple organ systems. Consequently management of these diseases requires the expertise of many health and allied health professionals. This review article focuses on the medical management of three of the relatively common diseases: juvenile rheumatoid arthritis (JRA), systemic lupus erythematozus (SLE) and dermatomyositis (DM).
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Affiliation(s)
- B H Athreya
- Thomas Jefferson University, Philadelphia, Pa., USA
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