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Sener S, Batu ED, Sahin S, Yildirim DG, Ekinci MK, Kisaoglu H, Karali Y, Demir S, Kaya Akca U, Gunalp A, Turkmen S, Kavrul Kayaalp G, Arslanoglu C, Torun R, Basaran O, Pac Kisaarslan A, Sozeri B, Aktay Ayaz N, Bakkaloglu SA, Kilic SS, Kalyoncu M, Bilginer Y, Unsal E, Kasapcopur O, Ozen S. Rhupus syndrome in children: A multi-center retrospective cohort study and literature review. Lupus 2024; 33:273-281. [PMID: 38226485 DOI: 10.1177/09612033231226353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
OBJECTIVE In this study, we aimed to evaluate the characteristics of pediatric rhupus patients including all the related series in the literature. METHODS Thirty pediatric patients with rhupus syndrome from 12 different centers in Turkey were included in this study. The literature was also reviewed for pediatric patients with rhupus syndrome. RESULTS The most prominent phenotype of these 30 patients was juvenile idiopathic arthritis (JIA) (60%) at the disease onset and SLE (73.3%) at the last visit. Major SLE-related organ involvements were skin (80%), hematological system (53.3%), and kidney (23.3%). Arthritis was polyarticular (73.3%), asymmetric (66.7%), and erosive (53.3%) in most patients. Hydroxychloroquine (100%), glucocorticoids (86.7%), and mycophenolate mofetil (46.7%) were mostly used for SLE, while glucocorticoids (76.6%), methotrexate (73.3%), and nonsteroidal anti-inflammatory drugs (NSAIDs) (57.6%) were mainly preferred for JIA. Our literature search revealed 20 pediatric patients with rhupus syndrome (75% were RF positive). The most prominent phenotype was JIA (91.7%) at the disease onset and SLE (63.6%) at the last visit. Major SLE-related organ involvements were skin (66.7%), hematological system (58.3%), and kidney (58.3%). Arthritis was polyarticular (77.8%), asymmetric (63.6%), and erosive (83.3%) in most patients. Glucocorticoid (100%), hydroxychloroquine (76.9%), and azathioprine (46.2%) were mostly used for SLE, while methotrexate (76.9%) and NSAIDs (46.2%) were mainly preferred for the JIA phenotype. CONCLUSION Our study is the largest cohort in the literature evaluating pediatric rhupus cases. Most of the pediatric patients had polyarticular, asymmetric, and erosive arthritis, as well as organ involvements associated with SLE, including the skin, hematological system, and kidney.
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Affiliation(s)
- Seher Sener
- Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine Ankara, Turkey
| | - Ezgi Deniz Batu
- Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine Ankara, Turkey
| | - Sezgin Sahin
- Department of Pediatrics, Department of Pediatric Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Deniz Gezgin Yildirim
- Department of Pediatrics, Department of Pediatric Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Miray Kisla Ekinci
- Department of Pediatrics, Department of Pediatric Rheumatology, Adana City Training and Research Hospital, Adana, Turkey
| | - Hakan Kisaoglu
- Department of Pediatrics, Department of Pediatric Rheumatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Yasin Karali
- Department of Pediatrics, Division of Immunology and Rheumatology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Selcan Demir
- Department of Pediatrics, Department of Pediatric Rheumatology, Eskisehir Osmangazi University, Ankara, Turkey
| | - Ummusen Kaya Akca
- Department of Pediatrics, Division of Pediatric Rheumatology, Aydin Gynecology and Children's Hospital, Aydın, Turkey
| | - Aybuke Gunalp
- Department of Pediatrics, Department of Pediatric Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Seyma Turkmen
- Department of Pediatrics, Division of Pediatric Rheumatology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Gulsah Kavrul Kayaalp
- Department of Pediatrics, Department of Pediatric Rheumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Ceyda Arslanoglu
- Department of Pediatrics, Division of Pediatric Rheumatology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Ruya Torun
- Department of Pediatrics, Department of Pediatric Rheumatology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Ozge Basaran
- Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine Ankara, Turkey
| | - Aysenur Pac Kisaarslan
- Department of Pediatrics, Division of Pediatric Rheumatology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Betul Sozeri
- Department of Pediatrics, Division of Pediatric Rheumatology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatrics, Department of Pediatric Rheumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Sevcan Azime Bakkaloglu
- Department of Pediatrics, Department of Pediatric Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Sara Sebnem Kilic
- Department of Pediatrics, Division of Immunology and Rheumatology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Mukaddes Kalyoncu
- Department of Pediatrics, Department of Pediatric Rheumatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Yelda Bilginer
- Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine Ankara, Turkey
| | - Erbil Unsal
- Department of Pediatrics, Department of Pediatric Rheumatology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Ozgur Kasapcopur
- Department of Pediatrics, Department of Pediatric Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Seza Ozen
- Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine Ankara, Turkey
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Ozturk K, Caglayan S, Tanatar A, Baglan E, Yener Otar G, Kavrul Kayaalp G, Karadag SG, Demir F, Sonmez HE, Ozdel S, Cakan M, Aktay Ayaz N, Sozeri B. Low disease activity state in juvenile-onset systemic lupus erythematosus. Lupus 2021; 30:2144-2150. [PMID: 34723709 DOI: 10.1177/09612033211054399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To determine the rate of achieving The Lupus Low Disease Activity State (LLDAS) in children with systemic lupus erythematosus (SLE) for tracing pertinent treatment modalities. METHODS A total of 122 juvenile-onset SLE (jSLE) patients from six pediatric rheumatology centers in Turkey were enrolled in the study. LLDAS-50 was defined as encountering LLDAS for at least 50% of the observation time. According to the achievement of LLDAS-50, clinical features, immunological profiles, and treatments of patients with jSLE have been revealed. RESULTS LLDAS of any duration was achieved by 82% of the cohort. Although only 10.8% of the patients achieved remission, 68.9% reached LLDAS-50. A significant difference was found between patients who reached LLDAS-50 and those who did not, in terms of the time to reach low-dose corticosteroid treatment (p = 0.002), the presence of subacute cutaneous findings (p = 0.007), and the presence of proteinuria (p = 0.002). Both of the groups were under similar treatment approaches. However, the number of patients being treated with corticosteroids at the last visit was found to be significantly higher in patients who achieved LLDAS-50 (p<0.001). CONCLUSION Targeting LLDAS in jSLE, even with long-term, low-dose corticosteroid use, seems to be an achievable goal in clinical practice.
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Affiliation(s)
- Kubra Ozturk
- Department of Pediatric Rheumatology, Goztepe Prof. Dr Suleyman Yalcın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Senğul Caglayan
- Department of Pediatric Rheumatology, University of Health Sciences, Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Ayse Tanatar
- Department of Pediatric Rheumatology, 64041Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Esra Baglan
- Department of Pediatric Rheumatology, University of Health Sciences, 146993Dr Sami Ulus Maternity and Child Health and Diseases Research and Training Hospital, Ankara, Turkey
| | - Gulcin Yener Otar
- Department of Pediatric Rheumatology, Sanlıurfa Research and Training Hospital, Sanliurfa, Turkey
| | - Gulsah Kavrul Kayaalp
- Department of Pediatric Rheumatology, 64041Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Serife Gul Karadag
- Department of Pediatric Rheumatology, University of Health Sciences, Bakirkoy Dr Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Ferhat Demir
- Department of Pediatric Rheumatology, University of Health Sciences, Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Hafize Emine Sonmez
- Department of Pediatric Rheumatology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Semanur Ozdel
- Department of Pediatric Rheumatology, University of Health Sciences, 146993Dr Sami Ulus Maternity and Child Health and Diseases Research and Training Hospital, Ankara, Turkey
| | - Mustafa Cakan
- Department of Pediatric Rheumatology, University of Health Sciences, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, 64041Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Betul Sozeri
- Department of Pediatric Rheumatology, University of Health Sciences, Umraniye Research and Training Hospital, Istanbul, Turkey
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