Psychiatric Illness of Systemic Lupus Erythematosus in Childhood: Spectrum of Clinically Important Manifestations

Abstract

Современные международные рекомендации по диагностике и лечению системной красной волчанки с ювенильным дебютом Каледа М.И., Никишина И.П.Системная красная волчанка (СКВ) с дебютом в детском и подростковом возрасте представляет существен-ную проблему в практике педиатров и ревматологов ввиду диагностических сложностей, особенностей тече-ния и большей вероятности неблагоприятного прогноза. До 20% больных СКВ заболевают в возрасте млад-ше 18 лет. Только у 13% пациентов с ювенильным дебютом во взрослом состоянии имеется безмедикамен-тозная ремиссия при более низком, чем в популяционном контроле, качестве жизни. Статья посвящена об-суждению последних международных рекомендаций по диагностике, мониторингу и лечению СКВ у детей и подростков, опубликованных в 2017 г., с комментариями, основанными на данных литературы и на прак-тическом опыте ведения подобных пациентов. Ключевые слова: системная красная волчанка; клинические рекомендации; детский возраст. Для ссылки: Каледа МИ, Никишина ИП. Современные международные рекомендации по диагностике и ле-чению системной красной волчанки с ювенильным дебютом. Научно-практическая ревматология. 2018;56(4):405-415. CURRENT INTERNATIONAL GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF JUVENILE-ONSET SYSTEMIC LUPUS ERYTHEMATOSUSKaleda M.I., Nikishina I.P.Systemic lupus erythematosus (SLE) with its onset in childhood or adolescence is a significant problem in the practice of pediatricians and rheumatologists due to diagnostic difficulties, clinical features, and the greater likelihood of unfavorable prognosis. About 20% of SLE patients fall ill at the age of 18 years. Only 13% of patients with juvenile-onset SLE have a drug-free remission in adulthood and have a lower quality of life than population controls. The paper discusses the latest international guidelines for the diagnosis, monitoring, and treatment of SLE in children and adolescents, which were published in 2017, with comments based on the data available in the literature and on practical experiences in managing these patients.

Identifying Differences in Risk Factors for Depression and Anxiety in Pediatric Chronic Disease: A Matched Cross-Sectional Study of Youth with Lupus/Mixed Connective Tissue Disease and Their Peers with Diabetes

“…Controlling for race/ethnicity may have therefore created an artificially lower risk in the SLE/MCTD subjects. Second, our SLE/MCTD cohort may have had a lower risk for CNS inflammation than typical cohorts, 4, 36 due to low disease activity and damage levels, in the setting of milder disease manifestations or aggressive treatment in those with more severe disease. Interestingly, only 6% of the SLE/MCTD subjects had confirmed CNS involvement, none of which had depression or anxiety, and it is possible that aggressive immunosuppression due to their presentation with CNS disease mitigated development of an inflammation-mediated mental health condition.…”

Depression and anxiety and their association with healthcare utilization in pediatric lupus and mixed connective tissue disease patients: a cross-sectional study

“…Nassi et al reported suicidal ideation in up to 19% of their pediatric SLE patients [47]. Lim et al reported suicidal ideation in 34% of 53 pediatric patients with neuropsychiatric SLE, and 20% of those with ideation attempted suicide [48]. In contrast, Kohut et al reported no suicidal ideation in a cohort 38 children and adolescents with SLE, of which 26% had depression symptoms [9].…”

An update on childhood-onset systemic lupus erythematosus

“…Lim et al [13] found psySLE features in 53/447 patients (12%) of their cSLE cohort. All patients had cognitive dysfunction, manifested mainly by altered concentration ability and impaired short-term memory and schooling.…”