title: Uveitis in childhood-onset systemic lupus erythematosus patients: a multicenter survey.
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.
authors.affiliation: 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.
authors.forename: Paola Pinheiro
authors.initials: PP
authors.lastname: Kahwage
authors.affiliation: Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.|Pediatric Allergy and Immunology Unit, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
authors.forename: Mariana Paes Leme
authors.initials: MP
authors.lastname: Ferriani
authors.affiliation: 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.
authors.forename: João M
authors.initials: JM
authors.lastname: Furtado
authors.affiliation: 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.
authors.forename: Luciana Martins
authors.initials: LM
authors.lastname: de Carvalho
authors.affiliation: 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.
authors.forename: Gecilmara Salviato
authors.initials: GS
authors.lastname: Pileggi
authors.affiliation: 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.
authors.forename: Francisco Hugo Rodrigues
authors.initials: FH
authors.lastname: Gomes
authors.affiliation: Pediatric Rheumatology Unit, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Terreri
authors.affiliation: Pediatric Rheumatology Unit, Faculdade de Medicina de Botucatu, Universidade Estadual de São Paulo (FMB-UNESP), São Paulo, Brazil.
authors.forename: Claudia Saad
authors.initials: CS
authors.lastname: Magalhães
authors.affiliation: Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
authors.forename: Rosa Maria Rodrigues
authors.initials: RM
authors.lastname: Pereira
authors.affiliation: Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.
authors.forename: Silvana Brasilia
authors.initials: SB
authors.lastname: Sacchetti
authors.affiliation: Rheumatology Unit, Faculdade de Ciências Médicas da Universidade de Campinas (FCM-UNICAMP), São Paulo, Brazil.
authors.forename: Roberto
authors.initials: R
authors.lastname: Marini
authors.affiliation: Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
authors.forename: Eloisa
authors.initials: E
authors.lastname: Bonfá
authors.affiliation: Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.|Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
authors.forename: Clovis Artur
authors.initials: CA
authors.lastname: Silva
authors.affiliation: 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. virginia.ferriani@gmail.com.
authors.forename: Virgínia Paes Leme
authors.initials: VP
authors.lastname: Ferriani
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D001938:Brazil / Q000453:epidemiology; D002648:Child; D015897:Comorbidity; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014605:Uveitis / Q000175:diagnosis / Q000453:epidemiology*
chemical_list: D008775:Methylprednisolone
keywords: Childhood-onset systemic lupus erythematosus; Cohort study; SLEDAI; Uveitis