Our objectives were to evaluate the oral health and the masticatory system of 48 juvenile systemic lupus erythematosus (JSLE) patients and to compare them with 48 healthy children and adolescents. Demographic data, clinical manifestations and therapies of JSLE were reviewed. The DMFT index (DMFTI), the plaque (PI) and the gingival bleeding (GI) indices, dental relationship, facial profile, clinical dysfunction and mandibular mobility indices were evaluated. The two groups were homogeneous regarding age, gender, Brazilian social-economic class and dental decay index (P > 0.05). Of note, the medians of the PI and the GI were higher in JSLE patients than in controls (61.5 versus 38.10, P = 0.003 and 26.0 versus 15.95, P = 0.014; respectively). Likewise, a linear statistical correlation was evidenced between the JSLE duration and the GI (P = 0.017, r = 0.11), cumulative dose of prednisone and the PI (P = 0.01, r = 0.385) and cumulative dose of prednisone and the GI ( P = 0.001, r = 0.471). The clinical dysfunction and mandibular mobility indices were higher in JSLE patients versus controls (P = 0.002, P = 0.025). Moreover, the median of the mandibular mobility index was higher in JSLE patients who used at least one immunosuppressive than on those who did not use this medication (P = 0.0001). These results suggest that JSLE patients had an inadequate oral hygiene, higher incidence of gingivitis and temporomandibular joint dysfunction.

Contraception is an important issue and should be a matter of concern in every medical visit of adolescent and young patients with chronic rheumatic diseases. This narrative review discusses contraception methods in adolescents with juvenile systemic lupus erythematosus (JSLE), antiphospholipid syndrome (APS), juvenile idiopathic arthritis (JIA) and juvenile dermatomyositis (JDM). Barrier methods are safe and their use should be encouraged for all adolescents with chronic rheumatic diseases. Combined oral contraceptives (COC) are strictly prohibited for JSLE and APS patients with positive antiphospholipid antibodies. Reversible long-acting contraception can be encouraged and offered routinely to the JSLE adolescent patient and other rheumatic diseases. Progestin-only pills are safe in the majority of rheumatic diseases, although the main concern related to its use by adolescents is poor adherence due to menstrual irregularity. Depot medroxyprogesterone acetate injections every three months is a highly effective contraception strategy, although its long-term use is associated with decreased bone mineral density. COC or other combined hormonal contraceptive may be options for JIA and JDM patients. Oral levonorgestrel should be considered as an emergency contraception method for all adolescents with chronic rheumatic diseases, including patients with contraindication to COC.

Fernandes EGC. Evaluation of influence of atmospheric pollution on the score of lupus erythematosus activity (sledai-2k) in children and adolescents.

Juvenile systemic lupus erythematosus (JSLE) is an autoimmune disorder affecting several organs and systems, with a wide range of manifestations that can involve the masticatory system and oral mucosa. 1,2 Orofacial involvement in JSLE has not been the focus of a large number of studies. In a recent study, we evaluated 48 patients with JSLE versus 48 age-and gender-matched healthy individuals, and we identified higher incidence of bacterial plaque and gingival bleeding in lupus patients. 3

O lúpus eritematoso neonatal (LEN) é uma doença rara que pode acometer vários órgãos, principalmente o coração e a pele. A doença pode ser considerada um modelo de autoimunidade adquirida, no qual a mãe assintomática ou com patologia reumatológica específica produz autoanticorpos (anti-SSA/Ro, anti-SSB/La e anti-RNP) que atravessam a barreira placentária, atingem a circulação fetal e exercem um papel importante na gênese da doença. Além dos autoanticorpos, estuda-se cada vez mais a possibilidade de os complexos de histocompatibilidade (HLA B8, DR3 e DQ2) estarem envolvidos em sua gênese juntamente com fatores ambientais. O LEN caracteriza-se principalmente por lesões cutâneas semelhantes ao lúpus subagudo, alterações hematológicas como anemia, neutropenia e trombocitopenia e manifestações hepáticas, todas elas benignas e transitórias, que na maioria das vezes regridem quando os anticorpos maternos saem da circulação fetal. A manifestação mais grave da doença é o bloqueio atrioventricular isolado, considerada a complicação mais temida e estudada da doença por ser, em muitos casos, irreversível, com altas taxas de morbimortalidade. O desafio é prever o risco gestacional de desenvolvimento da doença fetal, fazer o diagnóstico mais precoce possível e definir a melhor estratégia terapêutica intrauterina ou pós-natal.