Childhood onset systemic lupus erythematosus: how is it different from adult <scp>SLE</scp>?

Aggarwal, Amita; Srivastava, Puja

doi:10.1111/1756-185x.12419

Cited by 79 publications

(84 citation statements)

References 74 publications

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“…Patients with a history of renal and neuropsychiatric manifestations had a younger age of onset of SLE. Other studies have also shown that renal and neurological manifestations are more common in SLE patients with a younger age of disease onset [17, 18]. …”

Section: Discussionmentioning

confidence: 99%

Characterisation of Patients with Systemic Lupus Erythematosus in Malta: A Population Based Cohort Cross-Sectional Study

Magro

Borg

2018

BioMed Research International

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Systemic Lupus Erythematosus (SLE) is a multisystemic autoimmune disorder. The aim of this study was to characterise the SLE patients living in Malta in order to estimate the prevalence and incidence of SLE and characterise the clinical presentation as well as identify any unmet needs. 107 SLE patients who fulfilled SLICC classification criteria were identified. These were invited to participate in the study by means of an interview, blood and urine tests, and filling of the following questionnaires: Fatigue Severity Scale (FSS), visual analogue scale (VAS) for fatigue, Hospital Anxiety and Depression Scale (HADS), VAS for pain, Pittsburgh Sleep Quality Index (PSQI), and modified Health Assessment Questionnaire (mHAQ). The estimated prevalence of SLE in Malta is 29.3 patients per 100,000 and the estimated incidence is 1.48 per 100,000 per year. 93.5% of SLE patients were female, and the mean age at diagnosis was 33.1 years. 60.8% were overweight or obese and body mass index (BMI) had a significant positive correlation with daily dose of prednisolone (R=0.177, p=0.046). 20.7% and 3.3% had a moderate and high disease activity, respectively, as measured by SLEDAI-2K. Disease activity had a significant positive correlation with functional disability measured by mHAQ (R=0.417, p<0.001). 56.5% had an abnormal level of fatigue (FSS >3.7) and 57.6% had a high level of anxiety (HADS ≥8). This study has identified a number of unmet needs of SLE patients, including obesity, uncontrolled disease activity, fatigue, and anxiety.

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Section: Discussionmentioning

confidence: 99%

Characterisation of Patients with Systemic Lupus Erythematosus in Malta: A Population Based Cohort Cross-Sectional Study

Magro

Borg

2018

BioMed Research International

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“…Unfortunately, poor adherence is associated with lower health-related quality of life, increased health care utilization, health care costs, and unnecessary medication changes [3][4][5]. Optimizing medication adherence in individuals with cSLE is critical because, compared with adult-onset SLE patients, they have a more severe and prolonged disease course with more disease-related organ damage [6].…”

Section: Introductionmentioning

confidence: 99%

Feasibility and acceptability of an innovative adherence intervention for young adults with childhood-onset systemic Lupus Erythematosus

et al. 2020

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Background: In Childhood-Onset Systemic Lupus Erythematosus (cSLE), poor medication adherence rates are very high. Interventions targeting this problem in cSLE are limited thus effective interventions are needed. The objective of this study is to examine the feasibility and acceptability an intervention (automated digital reminders + personalized prescribed treatment plan (pPTP)) to improve medication adherence in young adults with cSLE over 3 months. Method: This is a proof-of-concept randomized controlled study. All participants received SimpleMed+ pillboxes that track adherence. The treatment group received a pPTP, and in month 2, preselected digital reminders for missed doses. Reminders were discontinued after 30 days and adherence data collected. Data analysis was done using t-tests. Results: Twenty-one participants were approached and nineteen consented to participate, yielding a recruitment rate of 86%. Participants were on average 20.5 years, mostly black (58%) and female (84%). Of the nineteen consented, eleven were randomized to control (57%) and eight to treatment (42%) groups respectively. All participants in the treatment group rated the pillbox as easy to use, notably; none reported boredom with the pillbox or reminders. Also, 88% of participants in the treatment group rated the pillbox as helpful, however, only 50% reported the pPTP taught them new information about lupus or made them more interested in their lupus management. Conclusions: This is the first use of an electronic pillbox to track adherence to multiple medications in cSLE. The high rating of the pillbox makes it an acceptable method of measuring adherence. Feasibility and acceptability ratings for the intervention were mixed suggesting a there is a subset of cSLE patients for whom this intervention would be beneficial. Future research should focus on a larger trial.

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“…Fever is a common symptom in pediatric SLE, and it is di cult to distinguish between an SLE are and febrile infection [7]. Some infections may produce systemic manifestations mimicking SLE, either superimposed upon or triggering a are [8].…”

Section: Introductionmentioning

confidence: 99%

Differential Parameters between Activity Flare and Acute Infection in Pediatric Patients with Systemic Lupus Erythematosus

Luo

Yang

Lin

et al. 2020

Preprint

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Background: Systemic lupus erythematosus (SLE) is a systemic autoimmune disease. SLE patients are vulnerable to infections. Infections might mimic and even trigger SLE flares. To distinguish acute infection from activity flare always remains a clinical challenge.We aim to explore the approach to differentiate active infection from disease activity in pediatric SLE patients.Methods: Fifty pediatric SLE patients presenting with 185 clinical episodes were collected.The associations betweenrelevant data encompassing both clinical and laboratory parameters and the outcome groups were analyzed using generalized estimating equations (GEEs)facilitatingthe analysis of data collected in longitudinal and repeated-measures designs.We also used a multinomial logistic regression model for simultaneous prediction of different outcome groups. Finally, we ran the GLIMMIX procedure to track trends of changes in parameters over time.Results: These 185 episodes were divided into 4 outcome groups: infected-active (n=102), infected-inactive (n=11), noninfected-active (n=59), and noninfected-inactive (n=13) episodes. Multivariate GEE analysis showed that SDI, SLEDAI-2K, neutrophil‐to‐lymphocyte ratio (NLR), hemoglobin, platelet, RDW-to-platelet ratio (RPR), and C3 are predictive of flare (combined calculated AUC of 0.8964 and with sensitivity of 82.2 % and specificity of 90.9%). Multivariate GEE analysis showed that SDI, fever temperature, CRP, procalcitonin, lymphocyte percentage, NLR, hemoglobin, and renal score in SLEDAI-2k are predictive of infection (combinedcalculated AUC of 0.7886 and with sensitivity of 63.5% and specificity of 89.2%). We developed regression equations for simultaneous prediction of 4 different outcome groups.We could differentiate noninfected-active from infected-active episodes by different change patterns of ESR, NLR, lymphocyte, C3, and C4 over time.Conclusions: The proposed approach could differentiateflares from infections in pediatric SLE patients. Combination of parameters from four different domains simultaneously, including inflammation (CRP, ESR, PCT), hematology (Lymphocyte percentage, NLR, PLR), complement (C3, C4), and clinical status (SLEDAI, SDI), is effective to make appropriate judgement and treatment decisions.

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Childhood onset systemic lupus erythematosus: how is it different from adult SLE?

Cited by 79 publications

References 74 publications

Characterisation of Patients with Systemic Lupus Erythematosus in Malta: A Population Based Cohort Cross-Sectional Study

Characterisation of Patients with Systemic Lupus Erythematosus in Malta: A Population Based Cohort Cross-Sectional Study

Feasibility and acceptability of an innovative adherence intervention for young adults with childhood-onset systemic Lupus Erythematosus

Differential Parameters between Activity Flare and Acute Infection in Pediatric Patients with Systemic Lupus Erythematosus

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