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Objective:To compare the performance among the American College of Rheumatology (ACR) 1997, the Systemic Lupus International Collaborating Clinics (SLICC) 2012 and the 2019 European League Against Rheumatism (EULAR)/ACR criteria, in a childhood-onset systemic lupus erythematosus(CSLE) cohort.Methods:A medical chart review study was conducted of 182 cases of SLE patients and 163 controls with defined rheumatic diseases in pediatrics department of Renji Hospital, Shanghai Jiaotong University School Medicine, from January 2013 to May 2017, to establish each ACR1997, SLICC2012 and 2019EULAR/ACR criterion.The performance of the three criteria was statistically analyzed.Results:(1) Comparing the patients with SLE and controls, the difference in fever(21.4% vs.8.0%), skin lesions(54.9% vs.31.9%), nonscarring alopecia(3.8% vs.0), renal disorder(41.2% vs.5.5%), neurologic disorder(7.7% vs.1.8%), hematologic disorder [leukopenia(32.4% vs.1.8%), thrombocytopenia(31.9% vs.0)], low complement(83.5% vs.12.9%), anti-nuclear antibody(98.4% vs.23.3%), anti-dsDNA antibody(94.0% vs.8.6%), anti-Sm antibody(19.2% vs.0%), and antiphospholipid antibodies(16.5% vs.3.7%)had statistical significance (all P<0.05). But the difference in oral ulcers, synovitis, serositis and positive Coombs test had no statistical significance (all P>0.05). (2) Sensitivities of ACR1997, SLICC2012 and 2019EULAR/ACR criteria were 67.0%(122/182 cases), 95.6% (174/182 cases)and 97.8% (178/182 cases)( P<0.001), with specificities 99.4%(162/163 cases), 98.2% (160/163 cases)and 94.5%(154/163 cases) ( P=0.016), respectively.In terms of accuracy, the three classifications were 82.3%(284/345 cases), 96.8% (334/345 cases)and 96.2%(332/345 cases), respectively, the difference was statistically significant ( P<0.001). (3) Only 120 cases (65.9%) of patients with SLE met all 3 criteria.Eight cases of SLE patients who only met the 2019EULAR/ACR criteria exhibit high rate of single organ involvement (7 cases). Four cases of SLE patients were missed by the 2019EULAR/ACR, 3 cases of which were antinuclear antibody negative.(4) The SLICC2012 and 2019EULAR/ACR criteria had increased sensitivity for major organ damage than ACR1997.The total score of 2019 EULAR/ACR criteria correlated positively with SLE disease activity ( R2= 0.451, P<0.001). Conclusions:In this SLE population, the 2019EULAR/ACR criteria is more sensitive than ACR1997 and SLICC2012 criteria, allowing earlier classification and recognition of patients with single or major organ damage.Although the specificity is slightly lower than the previous two criteria, it is still worthy of clinical promotion.
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Objective@#To analyze the clinical features and factors associated with osteonecrosis in children with systemic lupus erythematosus (SLE).@*Methods@#A retrospective analysis of 15 SLE patients with osteonecrosis in Department of Pediatrics, Renji Hospital Affiliated to School of Medicine of Shanghai Jiaotong University from January 2013 to May 2017 was carried out.Forty-two SLE patients without osteonecrosis were selected as control group.The clinical, laboratory variables and the treatment were compared among SLE patients who were with and without osteonecrosis.@*Results@#(1) Fifteen patients developed osteonecrosis that constituted 8.6% of all the 175 hospitalized SLE patients during the same period.(2) Of 15 patients, 2 patients were male, 13 patients were female, who developed osteonecrosis with an average age of (13.9±2.7) years (range: 10-18 years old). The duration of SLE before the diagnosis of osteonecrosis ranged from 6 days to 141 months, the median was 10 months, and 80.0% (12/15 cases) was diagnosed with osteonecrosis within 2 years of SLE diagnosis.There were 36 joints involved in 15 patients, all of which were detected by magnetic resonance imaging(MRI). The knees were the most commonly involved joints(14/15 cases, 93.3%), followed by hip and ankle joints.(3) Univariate analysis revealed that the level of Triglyceride [(2.080±1.500) mmol/L vs.(1.350±0.945) mmol/L], maximum daily dose of glucocorticoid[(1.25±0.33) mg/kg vs.(1.07±0.22) mg/kg], positive rate of gene associated with glucocorticoid-induced osteonecrosis of femoral head(100.0% vs.54.8%)were significantly higher in SLE with osteonecrosis than those in controls(all P<0.05). While the level of 25(OH)D3[(21.37±11.29) μg/L vs.(31.45±17.73) μg/L] was significantly lower than that of controls(P<0.05). Multiple factor Logistic regression analysis showed that hypertriglyceridemia and daily maximum dose of glucocorticoid were the risk factors for osteonecrosis.@*Conclusions@#Osteonecrosis mostly occurred in children over 10 years old, knee joint involvement is the most common.The high-risk time of osteonecrosis is within 2 years of SLE diagnosis.Hypertriglyceridemia and daily ma-ximum dose of glucocorticoid are risk factors associated with osteonecrosis in children with SLE.
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Objective To analyze the clinical features and factors associated with osteonecrosis in children with systemic lupus erythematosus (SLE).Methods A retrospective analysis of 15 SLE patients with osteonecrosis in Department of Pediatrics,Renji Hospital Affiliated to School of Medicine of Shanghai Jiaotong University from January 2013 to May 2017 was carried out.Forty-two SLE patients without osteonecrosis were selected as control group.The clinical,laboratory variables and the treatment were compared among SLE patients who were with and without osteonecrosis.Results (1) Fifteen patients developed osteonecrosis that constituted 8.6％ of all the 175 hospitalized SLE patients during the same period.(2) Of 15 patients,2 patients were male,13 patients were female,who developed osteonecrosis with an average age of (13.9 ± 2.7) years (range:10-18 years old).The duration of SLE before the diagnosis of osteonecrosis ranged from 6 days to 141 months,the median was 10 months,and 80.0％ (12/15 cases) was diagnosed with osteonecrosis within 2 years of SLE diagnosis.There were 36 joints involved in 15 patients,all of which were detected by magnetic resonance imaging(MRI).The knees were the most commonly involved joints(14/15 cases,93.3％),followed by hip and ankle joints.(3) Univariate analysis revealed that the level of Triglyceride [(2.080 ± 1.500) mmol/L vs.(1.350 ± 0.945) mmol/L],maximum daily dose of glucocorticoid [(1.25 ± 0.33) mg/kg vs.(1.07 ± 0.22) mg/kg],positive rate of gene associated with glucocorticoid-induced osteonecrosis of femoral head (100.0％ vs.54.8％) were significantly higher in SLE with osteonecrosis than those in controls (all P ＜ 0.05).While the level of 25 (OH) D3 [(21.37 ± 11.29) μg/L vs.(31.45 ± 17.73) μg/L] was significantly lower than that of controls(P ＜ 0.05).Multiple factor Logistic regression analysis showed that hypertriglyceridemia and daily maximum dose of glucocorticoid were the risk factors for osteonecrosis.Conclusions Osteonecrosis mostly occurred in children over 10 years old,knee joint involvement is the most common.The high-risk time of osteonecrosis is within 2 years of SLE diagnosis.Hypertriglyceridemia and daily ma-ximum dose of glucocorticoid are risk factors associated with osteonecrosis in children with SLE.
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Systemic lupus erythematosus (SLE)isa chronic multisystem autoimmune disease.Osteonecrosis is a common complication of SLE and the main cause of disability.The clinical manifestations of osteonecrosis could be joint pain,difficulty in walking,or asymptomatic.The development of osteonecrosis is related to various factors.In addition to the long-term use of corticosteroids,the typical features of SLE,the administration of immunosuppressives and gene polymorphisms are also the main factors for the development of osteonecrosis in SLE.In order to improve the understanding of osteonecrosis in children with SLE,this article reviews the clinical manifestations,the risk factors and treatment of osteonecrosis in SLE.
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Mycoplasma pneumoniae (MP),a type of prokaryotes without cell wall between bacteria and viruses,is one of the most common agents of respiratory tract infection in children.However,it can also cause a wide range of extrapulmonary manifestations in the absence of any pulmonary symptoms.MP infection may present a variety of clinical manifestations,involving cardiovascular,neurological,digestive,hematological,mucocutaneous and other symptoms.This article reviews the progress of extrapulmonary manifestations of MP infection to improve the comprehension for diagnosis.