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

Rheumatology International volume 36, pages 1641–1648 (2016)Cite this article

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.

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Acknowledgments

Our gratitude to Ulysses Doria-Filho for the statistical analysis. The authors thank the following Pediatric Rheumatology Divisions and colleagues for including their patients: Pediatric Rheumatology Unit, FMUSP (Adriana Almeida de Jesus, Adriana Maluf Elias Sallum, Cristina Miuki Abe Jacob, Gabriela Blay, Gabriela Nunes Leal, Gabriella Erlacher Lube de Almeida, Heloisa Helena de Souza Marques, João Domingos Montoni da Silva, Joaquim Carlos Rodrigues, Juliana Caíres de Oliveira Achili Ferreira, Laila Pinto Coelho, Luciana dos Santos Henriques, Maria Helena Vaisbich, Nadia Emi Aikawa, Lucia Maria Arruda Campos, Victor Marques, Werther Brunow de Carvalho); Pediatric Rheumatology Unit, UNIFESP (Anandreia Simões Lopes, Aline Nicácio Alencar, Claudio Arnaldo Len, Giampaolo Faquin, Gleice Clemente, Luis Eduardo Coelho Andrade, Maria Odete Esteves Hilário, Melissa Mariti Fraga, Octavio Augusto Bedin Peracchi, Vanessa Bugni); Division of Rheumatology, FMUSP (Juliane A. Paupitz, Glauce Leão Lima); UNESP (Priscila R. Aoki, Juliana de Oliveira Sato, Silvana Paula Cardin, Taciana Albuquerque Pedrosa Fernandes); Irmandade da Santa Casa de Misericórdia de São Paulo (Andressa Guariento, Maria Carolina dos Santos, Natali Weniger Spelling Gormenzano); State University of Campinas (Maraísa Centeville, Renata Barbosa); Ribeirão Preto Medical School—University of São Paulo (Gecilmara Salviatto Pileggi, Paola Pontes Pinheiro, Virginia Paes Leme Ferriani); Hospital Infantil Darcy Vargas (Jonatas Libório, Luciana Tudech Pedro Paulo); Hospital Municipal Infantil Menino Jesus (Simone Lotufo, Tânia Caroline Monteiro de Castro) and Pontifical Catholic University of Sorocaba (Valéria C. Ramos).

Funding

This study was supported by grants from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq 303422/2015-7 to Clovis Artur Silva, 301805/2013-0 to Rosa Maria Rodrigues Pereira, 305068/2014-8 to Eloisa Bonfá, 301479/2015 to Claudia Saad-Magalhães and 303752/2015-7 to Maria Teresa Terreri), Federico Foundation (to Clovis Artur Silva, Rosa Maria Rodrigues Pereira and Eloisa Bonfá) and by Núcleo de Apoio à Pesquisa “Saúde da Criança e do Adolescente” of USP (NAP-CriAd) to Clovis Artur Silva.

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Affiliations

  1. Pediatric Rheumatology Unit, Universidade Federal de São Paulo, Rua Borges Lagoa 802, São Paulo, SP, 04083-001, Brazil

    Ana Paula Sakamoto, Ana Luiza Garcia Cunha, Mirna Henriques Tomich Salume, Daniela Petry Piotto & Maria Teresa Terreri

  2. Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, Brazil

    Clovis Artur Silva & Mariana Paes Leme Ferriani

  3. Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, Brazil

    Clovis Artur Silva, Rosa Maria Rodrigues Pereira & Eloisa Bonfá

  4. Pediatric Rheumatology Division, São Paulo State University (UNESP) – Faculdade de Medicina de Botucatu, São Paulo, Brazil

    Claudia Saad-Magalhães

  5. Pediatric Rheumatology Unit, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil

    Eunice Okuda

  6. Pediatric Rheumatology Unit, State University of Campinas (UNICAMP), São Paulo, Brazil

    Simone Appenzeller

  7. Pediatric Rheumatology Unit, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil

    Francisco Hugo Gomes

Authors
  1. Ana Paula Sakamoto
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  2. Clovis Artur Silva
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  3. Mariana Paes Leme Ferriani
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  4. Rosa Maria Rodrigues Pereira
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  5. Eloisa Bonfá
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  6. Claudia Saad-Magalhães
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  7. Eunice Okuda
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  8. Simone Appenzeller
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  9. Francisco Hugo Gomes
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  10. Ana Luiza Garcia Cunha
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  11. Mirna Henriques Tomich Salume
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  12. Daniela Petry Piotto
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  13. Maria Teresa Terreri
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Corresponding author

Correspondence to Maria Teresa Terreri.

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Conflict of interest

Ana Paula Sakamoto declares she has no conflict of interest. Clovis Artur Silva declares he has no conflict of interest. Mariana Paes Leme Ferriani declares she has no conflict of interest. Rosa Maria Rodrigues Pereira declares she has no conflict of interest. Eloisa Bonfá declares she has no conflict of interest. Claudia Saad-Magalhães declares she has no conflict of interest. Eunice Okuda declares she has no conflict of interest. Simone Appenzeller declares she has no conflict of interest. Francisco Hugo Gomes declares he has no conflict of interest. Ana Luiza Garcia Cunha declares she has no conflict of interest. Mirna Henriques Tomich Salume declares she has no conflict of interest. Daniela Petry Piotto declares she has no conflict of interest. Maria Teresa Terreri declares she has no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

In all the participant centers, the Committee for Research Ethics stated that informed consent was not necessary.

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Sakamoto, A.P., Silva, C.A., Ferriani, M.P.L. et al. Characterization of chronic arthritis in a multicenter study of 852 childhood-onset systemic lupus erythematosus patients. Rheumatol Int 36, 1641–1648 (2016). https://doi.org/10.1007/s00296-016-3564-6

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  • DOI: https://doi.org/10.1007/s00296-016-3564-6

Keywords

  • Childhood
  • Chronic arthritis
  • Rhupus
  • Jaccoud’s arthropathy
  • Childhood-onset systemic lupus erythematosus
  • Systemic lupus erythematosus