Characterization of chronic arthritis in a multicenter study of 852 childhood-onset systemic lupus erythematosus patients

Abstract

Chronic arthritis (CA) is an unusual condition in childhood-onset systemic lupus erythematosus (cSLE) and data in children is very limited. The aim of the study is to assess CA in a large population of cSLE patients, in a multicenter cross-sectional study including 852 cSLE patients followed in ten Pediatric Rheumatology referral services in state of São Paulo, Brazil. CA was observed in 32/852 (3.7 %) cSLE patients mostly in hands and ankles. Chronic monoarthritis was diagnosed in four cSLE patients, oligoarthritis in nine and polyarthritis in 19. In the latter group, six had rhupus syndrome. Two oligoarticular patients had Jaccoud's arthropathy. CA was an isolated manifestation observed at disease onset in 13/32 (41 %) cSLE patients, and juvenile idiopathic arthritis (JIA) was the first diagnosis in 18/32 (56 %). The comparison of last visit of patients with CA and without this manifestation revealed higher frequency of splenomegaly (28 vs. 11 %, p = 0.002). The median of SLICC/ACR-DI score [1(0-9) vs. 0(0-7), p = 0.003] was significantly higher in CA patients compared to patients without this manifestation, likewise the frequency of musculoskeletal damage (31 vs. 9 % p = 0.001). Frequencies of treatment with nonsteroidal anti-inflammatory drugs (75 vs. 26 %, p < 0.0001), hydroxychloroquine sulfate (87 vs. 59 %, p = 0.001) and methotrexate (47 vs. 22 %, p = 0.001) were significantly higher in CA patients. This large multicenter study allowed us to characterize CA as a rare and early manifestation of cSLE, frequently mimicking JIA at disease onset. It is predominantly polyarticular, involving more often hands and ankles and it is associated with significant musculoskeletal accrual damage.

Epidemiology and management practices for childhood-onset systemic lupus erythematosus patients: a survey in Latin America

“…LA includes 33 countries and dependencies, a large population, two main languages (Spanish and Portuguese), with distinct socio-economic and political status. Two groups have reported data focused on epidemiology, clinical and laboratorial features of cSLE patients in LA: BRAC-SLE (Brazilian Childhood-onset SLE Registry Group) [2][3][4][5][6][7][8][9][10][11][12][13][14][15] and GLADEL (Grupo Latino Americano De Estudio del Lupus) [16][17][18][19].…”

Characteristics of 1555 childhood-onset lupus in three groups based on distinct time intervals to disease diagnosis: a Brazilian multicenter study

“…These findings may account for the delay in cSLE diagnosis, because a variety of other differential diagnoses of acute, intermittent or chronic arthritis, such as metabolic, infectious, malignancy and other autoimmune and autoinflammatory diseases should be excluded. 5,6,19 In fact, a longer referral to a pediatric rheumatologist was reported in a small group of cSLE patients, contrasting with juvenile idiopathic arthritis, Kawasaki disease and Henoch-Scho¨nlein purpura patients who were referred more promptly to this specialist. 12 A short time interval to diagnosis was rarely observed in the present study in cSLE patients.…”

Systemic Lupus Erythematosus: Clinical Recommendations. Part 2

“…Выбор тактики лечения пациента рекомендуется основывать на результатах мониторинга активности заболевания, оценке степени повреждения органов, наличии сопутствующих заболеваний (уровень достоверности доказательств 5*). # Федеральные клинические рекомендации размещены на сайте http://www.pediatr-russia.ru/sites/default/files/file/kr_skv.pdf 1 Назначение или коррекция лекарственной терапии Дозы, побочные эффекты и алгоритм ведения пациентов на фоне терапии иммуносупрессивными препаратами, используемыми для лечения системной красной волчанки (СКВ), представлены в табл. 2.…”

“…Всем больным СКВ с умеренно выраженной лихорадкой и/или поражением опорно-двигательного аппарата рекомендуется назначение нестероидных противовоспа-лительных препаратов [1] (уровень достоверности доказательств 3).…”