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Uveitis in childhood-onset systemic lupus erythematosus patients: a multicenter survey

Clinical Rheumatology volume 36, pages 547–553 (2017)Cite this article

Abstract

The aim of this study is to assess uveitis prevalence in a large cohort of childhood-onset systemic lupus erythematosus (cSLE) patients. A retrospective multicenter cohort study including 852 cSLE patients was performed in ten pediatric rheumatology centers (Brazilian cSLE group). An investigator meeting was held and all participants received database training. Uveitis was diagnosed through clinical assessment by the uveitis expert ophthalmologist of each center. Patients with and without uveitis were assessed for lupus clinical/laboratory features and treatments. Uveitis was observed in 7/852 cSLE patients (0.8%). Two of them had ocular complications: cataract and irreversible blindness in one patient and retinal ischemia with subsequent neovascularization and unilateral blindness in another. Uveitis was identified within the first 6 months of cSLE diagnosis in 6/7 patients (86%). Comparison of a subgroup of cSLE patients with (n = 7) and without uveitis (n = 73) and similar length of disease duration showed that patients with uveitis had increased SLEDAI-2K score (19 vs. 6; p < 0.01). In addition, fever (71 vs. 12%; p < 0.01), lymphadenopathy (29 vs. 1.4%; p = 0.02), arthritis (43 vs. 7%; p = 0.02), and use of intravenous methylprednisolone (71 vs. 22%; p = 0.01) were higher in cSLE patients with uveitis, as compared to those without this manifestation, respectively. Presence of fever was significantly associated with uveitis, independently of SLEDAI scores or use of intravenous methylprednisolone pulses, as shown by adjusted regression analysis (adjusted prevalence ratio 35.7, 95% CI 2.4–519.6; p < 0.01). Uveitis was a rare and initial manifestation of active cSLE patients. Early recognition is essential due to the possibility of irreversible blindness.

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Acknowledgements

The authors would like to give their gratitude to Ulysses Doria-Filho and Davi Casale for the statistical analysis. The authors thank the ophthalmologists for evaluating the patients and the colleagues from the following pediatric rheumatology centers for including their patients in the present study: Adriana Almeida de Jesus, Adriana Maluf Elias Sallum, Cristina Miuki Abe Jacob, Gabriela Blay, Gabriella Erlacher Lube de Almeida, Gabriela Nunes Leal, Heloisa Helena de Souza Marques, João Domingos Montoni da Silva, Joaquim Carlos Rodrigues, Juliana Caíres de Oliveira Achili Ferreira, Kátia Kozu, Laila Pinto Coelho, Lucia Maria Arruda Campos, Luciana dos Santos Henriques, Marco Felipe Castro da Silva, Magda Carneiro-Sampaio, Maria Helena Vaisbich, Nadia Emi Aikawa, Roberta Cunha Gomes, Victor Leonardo Saraiva Marques, and Werther Brunow de Carvalho from the Pediatric Rheumatology Unit, FMUSP; Ana Paula Sakamoto, Andreia Simões Lopes, Claudio Arnaldo Len, Daniela Petry Piotto, Giampaolo Faquin, Gleice Clemente, Maria Odete Esteves Hilário, Melissa Fraga, Octavio Augusto Bedin Peracchi, and Vanessa Bugni, from the Pediatric Rheumatology Unit, UNIFESP; Juliane A Paupitz and Glauce Leão Lima, from the Division of Rheumatology, FMUSP ; Priscila R. Aoki, Juliana de Oliveira Sato, Silvana Paula Cardin, and Taciana Albuquerque Pedrosa Fernandes from UNESP; Andressa Guariento, Eunice Okuda, Maria Carolina dos Santos, and Natali Weniger Spelling Gormenzano from Irmandade da Santa Casa de Misericórdia de São Paulo; Marisa Centeville, Renata Barbosa, and Simone Appenzeller from FC-UNICAMP; Cassia Maria Barbosa, Jonatas Libório, Luciana Tudech, and Pedro Paulo from Hospital Infantil Darcy Vargas; and Simone Lotufo and Tânia Caroline Monteiro de Castro from Hospital Municipal Infantil Menino Jesus.

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Affiliations

  1. Department of Pediatrics, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Av. Bandeirantes, 3900 - Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil

    Paola Pinheiro Kahwage, Luciana Martins de Carvalho, Gecilmara Salviato Pileggi, Francisco Hugo Rodrigues Gomes & Virgínia Paes Leme Ferriani

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

    Mariana Paes Leme Ferriani & Clovis Artur Silva

  3. Pediatric Allergy and Immunology Unit, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil

    Mariana Paes Leme Ferriani

  4. Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, Brazil

    João M. Furtado

  5. Pediatric Rheumatology Unit, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil

    Maria Teresa Terreri

  6. Pediatric Rheumatology Unit, Faculdade de Medicina de Botucatu, Universidade Estadual de São Paulo (FMB-UNESP), São Paulo, Brazil

    Claudia Saad Magalhães

  7. Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil

    Rosa Maria Rodrigues Pereira, Eloisa Bonfá & Clovis Artur Silva

  8. Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil

    Silvana Brasilia Sacchetti

  9. Rheumatology Unit, Faculdade de Ciências Médicas da Universidade de Campinas (FCM-UNICAMP), São Paulo, Brazil

    Roberto Marini

Authors
  1. Paola Pinheiro Kahwage
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  2. Mariana Paes Leme Ferriani
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  3. João M. Furtado
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  4. Luciana Martins de Carvalho
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  5. Gecilmara Salviato Pileggi
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  6. Francisco Hugo Rodrigues Gomes
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  7. Maria Teresa Terreri
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  8. Claudia Saad Magalhães
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  9. Rosa Maria Rodrigues Pereira
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  10. Silvana Brasilia Sacchetti
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  11. Roberto Marini
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  12. Eloisa Bonfá
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  13. Clovis Artur Silva
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  14. Virgínia Paes Leme Ferriani
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Corresponding author

Correspondence to Virgínia Paes Leme Ferriani.

Ethics declarations

The Committee for Research Ethics of each center approved the study.

Fundings

This study was supported by grants from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq 309520/2012-6 to VPLF, 303752/2015-7 to MTT, 301479/2015-1 to CSM, 301805/2013-0 to RMRP, 305068/2014-8 to EB, and 303422/2015-7 to CAS), Federico Foundation (to RMRP, EB and CAS), and by Núcleo de Apoio à Pesquisa “Saúde da Criança e do Adolescente” da USP (NAP-CriAd) to CAS.

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Kahwage, P.P., Ferriani, M.P.L., Furtado, J.M. et al. Uveitis in childhood-onset systemic lupus erythematosus patients: a multicenter survey. Clin Rheumatol 36, 547–553 (2017). https://doi.org/10.1007/s10067-016-3534-0

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  • DOI: https://doi.org/10.1007/s10067-016-3534-0

Keywords

  • Childhood-onset systemic lupus erythematosus
  • Cohort study
  • SLEDAI
  • Uveitis