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Şener S, Batu ED, Kaya Akca Ü, Atalay E, Kasap Cüceoğlu M, Balık Z, Başaran Ö, Karagöz T, Özsürekçi Y, Bilginer Y, Özen S. Differentiating Multisystem Inflammatory Syndrome in Children from Kawasaki Disease During the Pandemic. Turk Arch Pediatr 2024; 59:150-156. [PMID: 38454223 PMCID: PMC11059258 DOI: 10.5152/turkarchpediatr.2024.23192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/27/2023] [Indexed: 03/09/2024]
Abstract
OBJECTIVE We aimed to delineate the distinctive characteristics that aid in distinguishing between Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C) with KD-like manifestations during the pandemic. MATERIALS AND METHODS We evaluated KD patients and MIS-C patients with KD-like symptoms admitted during the pandemic (between January 2021 and December 2022). RESULTS Thirty-three MIS-C patients and 15 KD patients were included. Kawasaki disease patients were younger than MIS-C patients (3.4 vs. 7.6 years). Rash (P = .044, 100% vs. 75.7%), oral mucosal changes (P = .044, 100% vs. 75.7%), and cervical lymphadenopathy (P = .001, 93.3% vs. 42.4%) were more common in KD. Multisystem inflammatory syndrome in children: patients had more hypotension (P = .002, 45.4% vs. 0), gastrointestinal (P .001, 72.7% vs. 13.3%), and respiratory symptoms (P = .044, 24.2% vs. 0). Multisystem inflammatory syndrome in children patients also had low lymphocyte and thrombocyte counts and elevated levels of d-dimer, ferritin, and cardiac parameters, unlike KD patients. Multisystem inflammatory syndrome in children patients exhibited a notable reduction in left ventricular systolic function in echocardiography. Another significant difference with regard to management was the anakinra treatment, which was prescribed for MIS-C patients. CONCLUSION Although MIS-C patients might display a clinical resemblance to KD, several features could help differentiate between MIS-C and classical KD. Specific clinical (hypotension, gastrointestinal, and respiratory symptoms) and laboratory (low lymphocyte and thrombocyte counts with higher C-reactive protein, ferritin, d-dimer, and cardiac parameters) features are characteristic of MIS-C. In addition, divergence in management strategies is evident between the 2 diseases, as biologic drugs were more prevalently employed in MIS-C patients than in classical KD patients.
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Affiliation(s)
- Seher Şener
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ezgi Deniz Batu
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ümmüşen Kaya Akca
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Erdal Atalay
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Müşerref Kasap Cüceoğlu
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Balık
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Özge Başaran
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tevfik Karagöz
- Division of Pediatric Cardiology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yasemin Özsürekçi
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yelda Bilginer
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seza Özen
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Kaya Akca Ü, Deniz Batu E, Tanalı G, Atalay E, Kasap Cüceoğlu M, Sener S, Balık Z, Bayındır Y, Aliyev E, Başaran Ö, Bilginer Y, Özen S, Ozen S. Patients Without a Rheumatic Disease Diagnosis in a Pediatric Rheumatology Unit: Retrospective Analysis and Comparison Between Pre-pandemic and Pandemic Periods. Turk Arch Pediatr 2023; 58:49-55. [PMID: 36598211 PMCID: PMC9885826 DOI: 10.5152/turkarchpediatr.2022.22192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Children with suspicious complaints of rheumatic diseases are generally referred to
a pediatric rheumatologist. We aimed to evaluate the profile of patients referred to the pediatric rheumatology unit and were not diagnosed with a rheumatic disease and to assess the
impact of the coronavirus disease-2019 pandemic on referral complaints. MATERIALS AND METHODS All new outpatients who applied to the pediatric rheumatology department between March 2019 and February 2021 and were not diagnosed with rheumatic disease
were included. We also compared the frequency of admission symptoms during the pre-pandemic (March 2019-February 2020) and pandemic periods (March 2020-February 2021). RESULTS A total of 1089 patients without a rheumatic disease diagnosis (568 female, 52.2%;
median age 10.0 years) were included in this study. The most common complaint for referral was prolonged or recurrent fevers (13.4%) followed by anti-nuclear antibody positivity
(13.1%), arthralgia (13.0%), skin findings (7.5%), and the presence of heterozygous mutations
in the Mediterranean fever gene (6.9%). During the pandemic year, the number of patients
referred for back pain increased significantly (P = .028). A total of 682 of 1089 patients were
consulted from other departments in our center (62.6%). Of these, the most frequent consultation request was from general pediatrics (43.6%). The rheumatic disease was excluded in 11.3%
of the patients. CONCLUSION Prolonged or recurrent fever and anti-nuclear antibody positivity were the most
frequent complaints of referrals to a pediatric rheumatology unit in patients who did not have
a rheumatic disease. The rate of back pain was more common in children during the pandemic
period.
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Affiliation(s)
- Ümmüşen Kaya Akca
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ezgi Deniz Batu
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gizem Tanalı
- Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Erdal Atalay
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Muserref Kasap Cüceoğlu
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seher Sener
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Balık
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yağmur Bayındır
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Emil Aliyev
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Özge Başaran
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yelda Bilginer
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seza Özen
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey,Corresponding author:Seza Özen ✉
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Demir S, Keskin A, Sağ E, Kaya Akca Ü, Atalay E, Cüceoğlu MK, Batu Akal ED, Özen S, Bilginer Y. The challenges in diagnosing pediatric primary antiphospholipid syndrome. Lupus 2022; 31:1269-1275. [PMID: 35746827 DOI: 10.1177/09612033221108853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pediatric primary antiphospholipid syndrome (APS) is a very rare disease with significant distinctions from the APS in adults. Herein, we present our experience in the diagnosis and treatment of six pediatric primary APS patients, who met the updated Sapporo criteria for the APS diagnosis. One of them was also diagnosed as having probable catastrophic APS (CAPS) due to the involvement of three different organ systems simultaneously. Besides vascular involvement, four patients had thrombocytopenia, one had psychiatric disorder, and one had chorea and valvular heart disease. All patients received immunosuppressive treatment along with long-term anticoagulation therapy. Specific neurologic and hematologic manifestations that are not part of the classification criteria can be seen in children with primary APS. Therefore, using the adult criteria for diagnosing pediatric APS may result in missed or delayed diagnoses in children.
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Affiliation(s)
- Selcan Demir
- Department of Pediatric Rheumatology, Faculty of Medicine, 37515Hacettepe University, Ankara, Turkey
| | - Armağan Keskin
- Department of Pediatrics, Faculty of Medicine, 37515Hacettepe University, Ankara, Turkey
| | - Erdal Sağ
- Department of Pediatric Rheumatology, Faculty of Medicine, 37515Hacettepe University, Ankara, Turkey
| | - Ümmüşen Kaya Akca
- Department of Pediatric Rheumatology, Faculty of Medicine, 37515Hacettepe University, Ankara, Turkey
| | - Erdal Atalay
- Department of Pediatric Rheumatology, Faculty of Medicine, 37515Hacettepe University, Ankara, Turkey
| | - Müşerref Kasap Cüceoğlu
- Department of Pediatric Rheumatology, Faculty of Medicine, 37515Hacettepe University, Ankara, Turkey
| | - Ezgi Deniz Batu Akal
- Department of Pediatric Rheumatology, Faculty of Medicine, 37515Hacettepe University, Ankara, Turkey
| | - Seza Özen
- Department of Pediatric Rheumatology, Faculty of Medicine, 37515Hacettepe University, Ankara, Turkey
| | - Yelda Bilginer
- Department of Pediatric Rheumatology, Faculty of Medicine, 37515Hacettepe University, Ankara, Turkey
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Gurlevik SL, Ozsurekci Y, Sağ E, Derin Oygar P, Kesici S, Akca ÜK, Cuceoglu MK, Basaran O, Göncü S, Karakaya J, Cengiz AB, Özen S. The difference of the inflammatory milieu in MIS-C and severe COVID-19. Pediatr Res 2022; 92:1805-1814. [PMID: 35352005 PMCID: PMC8963396 DOI: 10.1038/s41390-022-02029-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 02/23/2022] [Accepted: 02/26/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Coronavirus disease 19 (COVID-19) may have a severe course in children. Multisystem inflammatory syndrome in children (MIS-C) is the post-COVID complication characterized by an exaggerated inflammation, observed in children. However, data on the underlying pathophysiology are sparse. We therefore aimed to assess the cytokine and chemokine profiles of children with MIS-C and compare these to life-threatening severe SARS-CoV-2 and healthy controls (HCs) to shed light on disease pathophysiology. METHODS Samples of 31 children with MIS-C, 10 with severe/critical COVID-19 and 11 HCs were included. Cytokine and chemokine profiles were studied and compared in between groups. RESULTS Most cytokines and chemokines related to IL-1 family and IFN-γ pathway (including IL-18 and MIG/CXCL9) and IL-17A were significantly higher in the MIS-C group when compared to the severe/critical COVID-19 group and HCs. IP-10/CXCL10 and IL-10 were higher in both MIS-C patients and severe/critical COVID-19 compared to HCs. CONCLUSION Our results suggest that IL-1 and IFN-γ pathways play an important role in the pathophysiology of MIS-C. IMPACT This study defines a pattern of distinctive immune responses in children with MIS-C and in patients with severe/critical COVID-19. As the COVID-19 pandemic continues, biomarkers to identify MIS-C risk are needed to guide our management that study results may shed light on it.
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Affiliation(s)
- Sibel Lacinel Gurlevik
- grid.14442.370000 0001 2342 7339Department of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yasemin Ozsurekci
- grid.14442.370000 0001 2342 7339Department of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Erdal Sağ
- grid.413783.a0000 0004 0642 6432Pediatric Rheumatology Unit, Ankara Training and Research Hospital, Ankara, Turkey ,grid.14442.370000 0001 2342 7339Pediatric Rheumatology Unit, Translational Medicine Laboratories, Hacettepe University, Ankara, Turkey
| | - P. Derin Oygar
- grid.14442.370000 0001 2342 7339Department of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Selman Kesici
- grid.14442.370000 0001 2342 7339Department of Pediatric Intensive Care Unit, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ümmüşen Kaya Akca
- grid.14442.370000 0001 2342 7339Department of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Muserref Kasap Cuceoglu
- grid.14442.370000 0001 2342 7339Department of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ozge Basaran
- grid.14442.370000 0001 2342 7339Department of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sultan Göncü
- grid.14442.370000 0001 2342 7339Department of Pediatric Intensive Care Unit, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Jale Karakaya
- grid.14442.370000 0001 2342 7339Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ali Bülent Cengiz
- grid.14442.370000 0001 2342 7339Department of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Seza Özen
- Pediatric Rheumatology Unit, Translational Medicine Laboratories, Hacettepe University, Ankara, Turkey. .,Department of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
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Akca ÜK, Batu ED, Kısaarslan AP, Poyrazoğlu H, Ayaz NA, Sözeri B, Sağ E, Atalay E, Demir S, Karadağ ŞG, Demir F, Bilginer Y, Gümrük F, Özen S. Hematological involvement in pediatric systemic lupus erythematosus: A multi-center study. Lupus 2021; 30:1983-1990. [PMID: 34459313 DOI: 10.1177/09612033211038824] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Systemic lupus erythematosus (SLE) may present with features of several systems, including hematological manifestations. In this study, we aimed to evaluate the characteristics of hematological involvement and assess possible associations and correlations in pediatric SLE patients. Method: This is a retrospective multi-center study. The medical records of pediatric SLE patients followed between January 2000 and June 2020 were analyzed. All children fulfilled the criteria of the Systemic Lupus International Collaborating Clinics. Results: The study included 215 children with SLE, 118 of whom had hematological manifestations. Concomitant renal involvement and low C3 levels were significantly more frequent in patients with hematological involvement (p = 0.04, p = 0.008, respectively). Also, anti-cardiolipin, anti-beta-2-glycoprotein I (anti-β2 GP1), and anti-Sm antibody positivity, and the presence of lupus anticoagulant were more common in the group with hematological findings (p = 0.001 for anti-cardiolipin antibody positivity and p < 0.001 for the positivity of anti-β2 GP1 antibody, anti-Sm antibody, and lupus anticoagulant). The most common hematologic abnormality was anemia (n = 88, 74.5%), with autoimmune hemolytic anemia constituting the majority (n = 40). Corticosteroids followed by IVIG were the mainstay of treatment. In patients resistant to corticosteroid and IVIG treatments, the most preferred drug was rituximab. Low levels of C3, high SLEDAI score, high incidence of renal involvement, and positive antiphospholipid antibodies were associated with hematological involvement in the univariate analysis. The presence of antiphospholipid antibodies and high SLEDAI score were independently associated with hematological involvement in multivariate analysis (OR: 4.021; 95% CI: 2.041-7.921; p < 0.001 and OR: 1.136; 95% CI: 1.065-1.212; p < 0.001). Conclusion: Hematological abnormalities are frequently encountered in pediatric SLE. Positive antiphospholipid antibodies and high SLEDAI scores were associated with hematological involvement.
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Affiliation(s)
- Ümmüşen Kaya Akca
- Department of Pediatrics, Division of Rheumatology, 37515Hacettepe University64005Faculty of Medicine, Ankara, Turkey
| | - Ezgi Deniz Batu
- Department of Pediatrics, Division of Rheumatology, 37515Hacettepe University64005Faculty of Medicine, Ankara, Turkey
| | - Ayşenur Pac Kısaarslan
- Department of Pediatrics, Division of Rheumatology, 64212Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Hakan Poyrazoğlu
- Department of Pediatrics, Division of Rheumatology, 64212Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatrics, Division of Rheumatology, 64041Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Betül Sözeri
- Department of Pediatrics, Division of Rheumatology, 64041Umraniye Training and Research Center, University of Health Sciences, Istanbul, Turkey
| | - Erdal Sağ
- Department of Pediatrics, Division of Rheumatology, 37515Hacettepe University64005Faculty of Medicine, Ankara, Turkey
| | - Erdal Atalay
- Department of Pediatrics, Division of Rheumatology, 37515Hacettepe University64005Faculty of Medicine, Ankara, Turkey
| | - Selcan Demir
- Department of Pediatrics, Division of Rheumatology, 37515Hacettepe University64005Faculty of Medicine, Ankara, Turkey
| | - Şerife Gül Karadağ
- Department of Pediatrics, Division of Rheumatology, 64041Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ferhat Demir
- Department of Pediatrics, Division of Rheumatology, 64041Umraniye Training and Research Center, University of Health Sciences, Istanbul, Turkey
| | - Yelda Bilginer
- Department of Pediatrics, Division of Rheumatology, 37515Hacettepe University64005Faculty of Medicine, Ankara, Turkey
| | - Fatma Gümrük
- Department of Pediatrics, Division of Hematology, 37515Hacettepe University64005Faculty of Medicine, Ankara, Turkey
| | - Seza Özen
- Department of Pediatrics, Division of Rheumatology, 37515Hacettepe University64005Faculty of Medicine, Ankara, Turkey
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Kaya Akca Ü, Atalay E, Kasap Cüceoğlu M, Şener S, Balık Z, Başaran Ö, Batu ED, Karadağ Ö, Özen S, Bilginer Y. IgG4-related disease in pediatric patients: a single-center experience. Rheumatol Int 2021; 42:1177-1185. [PMID: 33978820 DOI: 10.1007/s00296-021-04885-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/30/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Immunoglobulin G4-related disease (IgG4-RD) is a systemic, immune-mediated, and fibroinflammatory disease that can affect almost any organ system. We aimed to present our single-center experience of pediatric patients with IgG4-RD, a rare disease in children. METHODS Pediatric patients diagnosed with IgG4-RD at the Hacettepe University between June 2014 and September 2020 were evaluated retrospectively. Patients with definite, probable, or possible diagnosis of IgG4-RD were included. RESULTS A total of eight patients with a median age of 13.4 (IQR 9.5-15.0) years were included in the study. Clinical presentations were IgG4-related ophthalmic disease in six patients, IgG4-related lymphadenopathy in one patient, and IgG4-related sialadenitis and lymphadenopathy of several lymph nodes accompanied by pancreatitis, ulcerative colitis, and pulmonary manifestations in one patient. Elevated serum IgG4 was detected in three of eight patients (37.5%). The main histopathological feature was fibrosis and lymphoplasmacytic infiltrates. Corticosteroids were used as first-line treatment in almost all patients with or without steroid-sparing agents. Azathioprine, methotrexate and rituximab were used as steroid-sparing agents. Relapse occurred in two of seven patients. Radiotherapy was used as the last resort in one patient with severe orbital disease. CONCLUSION IgG4 RD mainly presents with orbital manifestations in pediatric population but has wide phenotypic clinical variability. Although rare, early recognition and treatment are essential for a better outcome in these patients.
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Affiliation(s)
- Ümmüşen Kaya Akca
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Erdal Atalay
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Müşerref Kasap Cüceoğlu
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seher Şener
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Balık
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Özge Başaran
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ezgi Deniz Batu
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ömer Karadağ
- Department of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seza Özen
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yelda Bilginer
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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