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Fiorot FJ, Islabão AG, Pereira RM, Terreri MT, Saad-Magalhães C, Novak GV, Molinari BC, Sakamoto AP, Aikawa NE, Campos LM, Peracchi OA, Appenzeller S, Ferriani VP, Silva MF, Fonseca AR, Sztajnbok FR, Paim LB, Fraga MM, Okuda EM, Bica BE, Sena EG, Moraes AJ, Rolim AM, Spelling PF, Scheibel IM, Cavalcanti AS, Matos EN, Robazzi TC, Guimarães LJ, Santos FP, Ramos VC, Carneiro-Sampaio M, Bonfá E, Silva CA. Disease presentation of 1312 childhood-onset systemic lupus erythematosus: influence of ethnicity. Clin Rheumatol 2019; 38:2857-2863. [PMID: 31209708 DOI: 10.1007/s10067-019-04631-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 01/24/2019] [Revised: 04/24/2019] [Accepted: 05/31/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate the influence of ethnicity in presentation of childhood-onset systemic lupus erythematosus (cSLE) patients. METHODS This multicenter study included cSLE patients (American College of Rheumatology criteria) followed in 27 Pediatric Rheumatology services of Brazil. Ethnicities were classified in four groups according to the parents' and all four grandparents' self-reported ethnicity. The statistical analysis was performed using the Bonferroni's correction (p < 0.0027). RESULTS According to ethnic groups, 1537 cSLE patients were classified in Caucasian (n = 786), African-Latin American (n = 526), Asian (n = 8), and others/unknown (n = 217). Comparisons between 1312 African-Latin American and Caucasian revealed similar median age at cSLE diagnosis [12.2(2.6-18) vs. 12.1(0.3-18) years, p = 0.234], time interval to diagnosis [0.25(0-12) vs. 0.3(0-10) years, p = 0.034], and SLEDAI-2K score [14(0-55) vs. 14(0-63), p = 0.781] in both groups. The mean number of diagnostic criteria according to SLICC (6.47 ± 1.911 vs. 5.81 ± 1.631, p < 0.0001) and frequencies of maculopapular lupus rash (8% vs. 3%, p < 0.0001), palate oral ulcers (17% vs. 11%, p = 0.001), tongue oral ulcers (4% vs. 1%, p = 0.001), and nonscarring alopecia (29% vs. 16%, p < 0.0001) were significantly higher in African-Latin American, whereas malar rash (45% vs. 58%, p < 0.0001) was more frequent in Caucasian. The presence of anti-phospholipid antibody (23% vs. 12%, p < 0.0001), low complement levels (58% vs. 41%, p < 0.0001), and isolated direct Coombs test (10% vs. 5%, p = 0.001) was also significantly higher in the former group. CONCLUSIONS Our study demonstrated that disease presentation severity of African-Latin American cSLE patients is comparable with Caucasian. Mucocutaneous manifestations and autoantibodies profile were the only distinctive features of the former group. The unique mixed background of Brazilian patients probably minimized race diversity spectrum of these patients. Key Points • Our study demonstrated that disease presentation severity of African-Latin American cSLE patients is comparable with Caucasian. • Mucocutaneous manifestations and autoantibodies profile were the only distinctive features of African-Latin American cSLE patients. • African-Latin American cSLE patients had more often anti-phospholipid antibodies and hypocomplementemia. • The unique mixed background of Brazilian patients probably minimized race diversity spectrum of these patients.
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Affiliation(s)
- Fernanda J Fiorot
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Aline G Islabão
- Pediatric Rheumatology Unit, Hospital Jose Alencar, Brasilia, Brazil
| | - Rosa M Pereira
- Division of Rheumatology Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Maria T Terreri
- Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Glaucia V Novak
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Beatriz C Molinari
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Ana P Sakamoto
- Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Nadia E Aikawa
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil.,Division of Rheumatology Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Lucia M Campos
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Octavio A Peracchi
- Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Simone Appenzeller
- Pediatric Rheumatology Unit, University of Campinas (UNICAMP), Campinas, Brazil
| | - Virgínia P Ferriani
- Pediatric Rheumatology Unit, Ribeirao Preto Medical School - University of Sao Paulo, Ribeirão Preto, Brazil
| | - Marco F Silva
- Pediatric Rheumatology Unit, Hospital Geral de Fortaleza, Fortaleza, Brazil
| | - Adriana R Fonseca
- Pediatric Rheumatology Unit, Rio de Janeiro Federal University (IPPMG-UFRJ), Rio de Janeiro, Brazil
| | - Flávio R Sztajnbok
- Pediatric Rheumatology Unit, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil
| | - Luciana B Paim
- Pediatric Rheumatology Unit, Albert Sabin Children's Hospital, Fortaleza, Brazil
| | - Melissa M Fraga
- Pediatric Rheumatology Unit, Hospital Darcy Vargas, Sao Paulo, Brazil
| | - Eunice M Okuda
- Pediatric Rheumatology Unit, Irmandade da Santa Casa de Misericórdia de Sao Paulo, Sao Paulo, Brazil
| | - Blanca E Bica
- Rheumatology Division - Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - Evaldo G Sena
- Pediatric Rheumatology Unit, Lauro Vanderley University Hospital, João Pessoa, Brazil
| | - Ana J Moraes
- Pediatric Rheumatology Unit, Federal University of Pará, Belém, Brazil
| | - Ana M Rolim
- Pediatric Rheumatology Unit, Obras Sociais Irmã Dulce, Salvador, Brazil
| | - Paulo F Spelling
- Pediatric Rheumatology Unit, Hospital Evangélico de Curitiba, Curitiba, Brazil
| | - Iloite M Scheibel
- Pediatric Rheumatology Unit, Hospital Criança Conceição, Porto Alegre, Brazil
| | - André S Cavalcanti
- Pediatric Rheumatology Unit, Federal University of Pernambuco, Recife, Brazil
| | - Erica N Matos
- Pediatric Rheumatology Unit, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Teresa C Robazzi
- Pediatric Rheumatology Unit, Federal University of Bahia, Salvador, Brazil
| | | | - Flávia P Santos
- Pediatric Rheumatology Unit, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Valeria C Ramos
- Pediatric Rheumatology Unit, Pontifícia Catholic University of Sorocaba, São Paulo, Brazil
| | - Magda Carneiro-Sampaio
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Eloisa Bonfá
- Division of Rheumatology Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Clovis A Silva
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil. .,Division of Rheumatology Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
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Novak GV, Molinari BC, Ferreira JC, Sakamoto AP, Terreri MT, Pereira RMR, Saad-Magalhães C, Aikawa NE, Campos LM, Len CA, Appenzeller S, Ferriani VP, Silva MF, Oliveira SK, Islabão AG, Sztajnbok FR, Paim LB, Barbosa CM, Santos MC, Bica BE, Sena EG, Moraes AJ, Rolim AM, Spelling PF, Scheibel IM, Cavalcanti AS, Matos EN, Robazzi TC, Guimarães LJ, Santos FP, Silva CT, Bonfá E, Silva CA. Characteristics of 1555 childhood-onset lupus in three groups based on distinct time intervals to disease diagnosis: a Brazilian multicenter study. Lupus 2018; 27:1712-1717. [PMID: 30020023 DOI: 10.1177/0961203318787037] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective The objective of this study was to compare demographic data, clinical/laboratorial features and disease activity at diagnosis in three different groups with distinct time intervals between onset of signs/symptoms and disease diagnosis. Methods A multicenter study was performed in 1555 childhood-onset systemic lupus erythematosus (American College of Rheumatology criteria) patients from 27 pediatric rheumatology services. Patients were divided into three childhood-onset systemic lupus erythematosus groups: A: short time interval to diagnosis (<1 month); B: intermediate time interval (≥1 and <3 months); and C: long time interval (≥3 months). An investigator meeting was held to define the protocol. Demographic data, SLICC classification criteria and SLEDAI-2 K were evaluated. Results The number of patients in each group was: A = 60 (4%); B = 522 (33.5%); and C = 973 (62.5%). The median age at diagnosis (11.1 (4.2-17) vs. 12 (1.9-17.7) vs. 12.5 (3-18) years, P = 0.025) was significantly lower in group A compared with groups B and C. The median number of diagnostic criteria according to SLICC (7 (4-12) vs. 6 (4-13) vs. 6 (4-12), P < 0.0001) and SLEDAI-2 K (18 (6-57) vs. 16 (2-63) vs. 13 (1-49), P < 0.0001) were significantly higher in group A than the other two groups. The frequency of oral ulcers in the palate (25% vs. 15% vs. 11%, P = 0.003), pleuritis (25% vs. 24% vs. 14%, P < 0.0001), nephritis (52% vs. 47% vs. 40%, P = 0.009), neuropsychiatric manifestations (22% vs. 13% vs. 10%, P = 0.008), thrombocytopenia (32% vs. 18% vs. 19%, P = 0.037), leucopenia/lymphopenia (65% vs. 46% vs. 40%, P < 0.0001) and anti-dsDNA antibodies (79% vs. 66% vs. 61%, P = 0.01) were significantly higher in group A compared with the other groups. In contrast, group C had a less severe disease characterized by higher frequencies of synovitis (61% vs. 66% vs. 71%, P = 0.032) and lower frequencies of serositis (37% vs. 33% vs. 25%, P = 0.002), proteinuria >500 mg/day (48% vs. 45% vs. 36%, P = 0.002) and low complement levels (81% vs. 81% vs. 71%, P < 0.0001) compared with groups A or B. Conclusions Our large Brazilian multicenter study demonstrated that for most childhood-onset systemic lupus erythematosus patients, diagnosis is delayed probably due to mild disease onset. Conversely, the minority has a very short time interval to diagnosis and a presentation with a more severe and active multisystemic condition.
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Affiliation(s)
- G V Novak
- 1 Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - B C Molinari
- 1 Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - J C Ferreira
- 1 Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - A P Sakamoto
- 2 Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - M T Terreri
- 2 Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - R M R Pereira
- 3 Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - C Saad-Magalhães
- 4 Pediatric Rheumatology Division, Sao Paulo State University (UNESP), Botucatu, Brazil
| | - N E Aikawa
- 1 Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- 3 Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - L M Campos
- 1 Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - C A Len
- 2 Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - S Appenzeller
- 5 Pediatric Rheumatology Unit, University of Campinas (UNICAMP), Campinas, Brazil
| | - V P Ferriani
- 6 Pediatric Rheumatology Unit, University of Sao Paulo, Ribeirão Preto, Brazil
| | - M F Silva
- 7 Pediatric Rheumatology Unit, Hospital Geral de Fortaleza, Fortaleza, Brazil
| | - S K Oliveira
- 8 Pediatric Rheumatology Unit, Rio de Janeiro Federal University (IPPMG-UFRJ), Rio de Janeiro, Brazil
| | - A G Islabão
- 9 Pediatric Rheumatology Unit, Hospital Jose Alencar, Brasília, Brazil
| | - F R Sztajnbok
- 10 Pediatric Rheumatology Unit, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil
| | - L B Paim
- 11 Pediatric Rheumatology Unit, Albert Sabin Children's Hospital, Fortaleza, Brazil
| | - C M Barbosa
- 12 Pediatric Rheumatology Unit, Hospital Darcy Vargas, Sao Paulo, Brazil
| | - M C Santos
- 13 Pediatric Rheumatology Unit, Irmandade da Santa Casa de Misericórdia de Sao Paulo, Sao Paulo, Brazil
| | - B E Bica
- 14 Rheumatology Division, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - E G Sena
- 15 Pediatric Rheumatology Unit, Lauro Vanderley University Hospital, João Pessoa, Brazil
| | - A J Moraes
- 16 Pediatric Rheumatology Unit, Federal University of Pará, Belém, Brazil
| | - A M Rolim
- 17 Pediatric Rheumatology Unit, Obras Sociais Irmã Dulce, Salvador, Brazil
| | - P F Spelling
- 18 Pediatric Rheumatology Unit, Hospital Evangélico de Curitiba, Curitiba, Brazil
| | - I M Scheibel
- 19 Pediatric Rheumatology Unit, Hospital Criança Conceição, Porto Alegre, Brazil
| | - A S Cavalcanti
- 20 Pediatric Rheumatology Unit, Federal University of Pernambuco, Recife, Brazil
| | - E N Matos
- 21 Pediatric Rheumatology Unit, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - T C Robazzi
- 22 Pediatric Rheumatology Unit, Federal University of Bahia, Salvador, Brazil
| | - L J Guimarães
- 23 Pediatric Rheumatology Unit, University of Brasilia, Brasília, Brazil
| | - F P Santos
- 24 Pediatric Rheumatology Unit, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - C T Silva
- 25 Pediatric Rheumatology Unit, Hospital Municipal Piedade, Rio de Janeiro, Brazil
| | - E Bonfá
- 3 Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - C A Silva
- 1 Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- 3 Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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