We evaluated spine bone mineral density (BMD) in Brazilian children with juvenile systemic lupus erythematosus (JSLE) in order to detect potential predictors of reduction in bone mass. A cross-sectional study of BMD at the lumbar spine level (L2-L4) was conducted on 16 female JSLE patients aged 6-17 years. Thirty-two age-matched healthy girls were used as control. BMD at the lumbar spine was measured by dualenergy X-ray absorptiometry. Weight, height and pubertal Tanner stage were determined in patients and controls. Disease duration, mean daily steroid doses, mean cumulative steroid doses and JSLE activity measured by the systemic lupus erythematosus disease activity index (SLEDAI) were determined for all JSLE patients based on their medical charts. All parameters were used as potential determinant factors for bone loss. Lumbar BMD tended to be lower in the JSLE patients, however, this difference was not statistically significant (P = 0.10). No significant correlation was observed in JSLE girls between BMD and age, height, Tanner stage, disease duration, corticosteroid use or disease activity. We found a weak correlation between BMD and weight (r = 0.672). In the JSLE group we found no significant parameters to correlate with reduced bone mass. Disease activity and mean cumulative steroid doses were not related to BMD values. We did not observe reduced bone mass in female JSLE.
Objectives: To evaluate the dietary intake of children and adolescents with juvenile idiopathic arthritis (JIA) and juvenile systemic lupus erythematosus (JSLE) using a 24-hour diet recall and relating it to the patients' clinical and anthropometric characteristics and to the drugs used in their treatment.Methods: By means of a cross-sectional study, we assessed the 24-hour diet recalls of outpatients. Their nutritional status was classified according to the CDC (2000). The computer program NutWin UNIFESP-EPM was used for food intake calculation. The Recommended Dietary Allowances and the Brazilian food pyramid were used for quantitative and qualitative analysis.Results: Median age was 12 years for JIA patients and 16.5 years for JSLE patients. Among the JIA patients, 37.5% had active disease, and among the JSLE patients, 68.2% showed Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) > 4. Malnutrition was found in 8.3 and 4.5% of the JIA and JSLE patients, respectively, and obesity was present in 16.7 and 18.2%. For JIA patients, the excessive intake of energy, protein, and lipids was 12.5, 75, and 31.3%, respectively. For JSLE patients, the excessive intake of energy, protein, and lipids was 13.6, 86.4, and 36.4%, respectively. Low intake of iron, zinc, and vitamin A was found in 29.2 and 50, 87.5 and 86.4, and 87.5 and 95.2% of the JIA and JSLE patients, respectively. There was not a significant association between intake, disease activity, and nutritional status. Conclusion:Patients with rheumatic diseases have inadequate dietary intake. There is excessive intake of lipids and proteins and low intake of micronutrients. J Pediatr (Rio J)
Objective This study sought to evaluate the effects of a nutritional intervention on the lipid metabolism biomarkers associated with cardiovascular risk, and their variation over time, in juvenile systemic lupus erythematosus (JSLE) patients. This study also investigated the relationships between these biomarkers and dietary intake, nutritional status, disease variables, and medication used. Methods A total of 31 10- to 19-year-old female adolescents with JSLE for at least six months were analyzed. The participants were randomly allocated to two groups: nutritional intervention or control. The intervention group received verbal and printed nutritional instructions once per month over nine months. Before and after the intervention, the participants underwent assessments of anthropometry; dietary intake; physical activity; socioeconomic status; total cholesterol and fractions; triglycerides; apolipoprotein A (Apo A-I); apolipoprotein B (Apo B); paraoxonase (PON) activity (a) and amount (q); myeloperoxidase (MPO); and small, dense LDL-c (sdLDL) particles. Results After nine months, we found significant reductions in the calorie, carbohydrate, total fat, saturated fat, and trans fat intakes in the intervention compared with the control group over time. The PONa/HDL-c ratio increased by 3.18 U/ml/mg/dl in the intervention group and by 0.63 U/ml/mg/dl in the control group ( p = 0.037). Unlike the intervention group, the sdLDL levels of the control group worsened over time ( p = 0.018). Conclusion The present study detected a reduction in calorie and fat intake, which indicates an improvement of HDL-c function and possible protection against cardiovascular risk for the intervention group.
BackgroundVideocapillaroscopy (NVC) is a safe, non-invasive, and cost-effective tool useful in the detection of individuals who are at risk for developing autoimmune rheumatic diseases (ARDs). However, few studies have assessed the use of NVC in the pediatric population.Objectives1. to describe the normal patterns of NVC in healthy children and adolescents in different age groups; 2. to quantify the linear relationship between the age and the capillary dimensions, intercapillary distance and number of capillaries/mm; 3. to evaluate the inter and intraobserver concordance in capillary measurements.MethodsThis was a cross-sectional study including 100 healthy participants aged 5 to 18 years. NVC was performed using the stereomicroscope under 100x magnification. The capillary dimensions (capillary loop length, capillary width and intercapillary distance) and the number of capillaries/mm were evaluated. Three consecutive images were acquired in nine capillaries per individual, totalizing 900 capillaries examined and photographed. Four age groups were studied: 5-7 years (17); 8-10 years (24); 11-14 years (30) and 15-18 years (29). The intra and inter observer agreement were tested in 25% of subjects.ResultsThe capillary dimensions (mean ± SD) were: capillary loop length 278.6±60.3 μm, intercapillary distance 124.1±28.1 μm, capillary width 15.0±2.6 μm. The intercapillary distance was higher in girls (p=0.011). The intercapillary distance remained constant over time (p=0.088). Teenagers between 15 and 18 years had longer (318.7±64.4 μm) and more enlarged (16.2±3.3 μm) capillaries when compared to other age groups (p<0.001 and p=0.012 respectively). There was a significant increase in the number of capillaries/mm with age: 6.1 capillaries/mm (5-7 years); 7.0 (8 to 10 years); 8.0 (11-14 years) and 9.3 (15-18 years) (p<0.001). Additionally, there was a positive correlation between age and the number of capillaries/mm, capillary length, and capillary width (p<0.001, R=0.796; p<0.001, R=0.368; p=0.004, R=0.285, respectively). There was a good intra and interobserver concordance in all capillary measurements. Morphological abnormalities including enlarged capillary (capillary width percentile>97.5) and avascular areas (intercapillary distance percentile>97.5) were present in 11% and 10% of the capillaries respectively. A weak negative correlation was found between the intercapillary distance and the number of capillaries/mm (p=0.05; R=-0.20).ConclusionsThere is a wide variability in the capillary morphology among healthy individuals. There was a positive correlation between age and the number of capillaries/mm, capillary length, and capillary width. There was a significant difference in the capillary length and width between the older and younger participants. In addition, NVC has been showed to be a reproducible method.ReferencesCutolo M, Suli A, Smith V. How to perform and interpret capillaroscopy. Best Pract Res Clin Rheumatol. 2013; 27:237-48.Ingegnoli F, Herrick AL. Nailfold capillaroscopy in pediatrics. Arthritis Care Re...
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