title: Characterization of chronic arthritis in a multicenter study of 852 childhood-onset systemic lupus erythematosus patients.
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.
authors.affiliation: Pediatric Rheumatology Unit, Universidade Federal de São Paulo, Rua Borges Lagoa 802, São Paulo, SP, 04083-001, Brazil.
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Sakamoto
authors.affiliation: Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, Brazil.|Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, Brazil.
authors.forename: Clovis Artur
authors.initials: CA
authors.lastname: Silva
authors.affiliation: Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, Brazil.
authors.forename: Mariana Paes Leme
authors.initials: MP
authors.lastname: Ferriani
authors.affiliation: Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, Brazil.
authors.forename: Rosa Maria Rodrigues
authors.initials: RM
authors.lastname: Pereira
authors.affiliation: Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, Brazil.
authors.forename: Eloisa
authors.initials: E
authors.lastname: Bonfá
authors.affiliation: Pediatric Rheumatology Division, São Paulo State University (UNESP) - Faculdade de Medicina de Botucatu, São Paulo, Brazil.
authors.forename: Claudia
authors.initials: C
authors.lastname: Saad-Magalhães
authors.affiliation: Pediatric Rheumatology Unit, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.
authors.forename: Eunice
authors.initials: E
authors.lastname: Okuda
authors.affiliation: Pediatric Rheumatology Unit, State University of Campinas (UNICAMP), São Paulo, Brazil.
authors.forename: Simone
authors.initials: S
authors.lastname: Appenzeller
authors.affiliation: Pediatric Rheumatology Unit, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
authors.forename: Francisco Hugo
authors.initials: FH
authors.lastname: Gomes
authors.affiliation: Pediatric Rheumatology Unit, Universidade Federal de São Paulo, Rua Borges Lagoa 802, São Paulo, SP, 04083-001, Brazil.
authors.forename: Ana Luiza Garcia
authors.initials: AL
authors.lastname: Cunha
authors.affiliation: Pediatric Rheumatology Unit, Universidade Federal de São Paulo, Rua Borges Lagoa 802, São Paulo, SP, 04083-001, Brazil.
authors.forename: Mirna Henriques Tomich
authors.initials: MH
authors.lastname: Salume
authors.affiliation: Pediatric Rheumatology Unit, Universidade Federal de São Paulo, Rua Borges Lagoa 802, São Paulo, SP, 04083-001, Brazil.
authors.forename: Daniela Petry
authors.initials: DP
authors.lastname: Piotto
authors.affiliation: Pediatric Rheumatology Unit, Universidade Federal de São Paulo, Rua Borges Lagoa 802, São Paulo, SP, 04083-001, Brazil. teterreri@terra.com.br.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Terreri
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001168:Arthritis / Q000175:diagnosis / Q000453:epidemiology*; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology*; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Childhood; Childhood-onset systemic lupus erythematosus; Chronic arthritis; Jaccoud’s arthropathy; Rhupus; Systemic lupus erythematosus