title: Cardiovascular complications in paediatric-onset systemic lupus erythematosus in Saudi Arabian patients.
abstract: OBJECTIVE
  To assess the prevalence and types of cardiovascular complications in Saudi patients with paediatric-onset systemic lupus erythematosus (pSLE).
  
  
  METHODS
  Retrospective record review of pSLE patients following from January 2014 to September 2015 at the rheumatology clinic of King Abdul-Aziz University Hospital, Jeddah. Laboratory data such as C-reactive protein (CRP), antinuclear antibodies (ANA), anti-double stranded DNA antibody (anti-dsDNA), C3 and C4 complements, were collected. Cardiac evaluation included chest x-ray, electrocardiogram (ECG), and echocardiography, along with estimation of SLE activity by calculating the SLE Disease Activity Index (SLEDAI) score according to SELENA modification.
  
  
  RESULTS
  Forty-six cases of pSLE were included (91.3% females, mean±SD age at diagnosis=10.53±2.28 years). Prevalence of cardiac manifestations was 47.8%; the most frequent of which were valvular heart diseases diagnosed in 16 (34.8%) cases, followed by pericarditis in 6 (13%) cases. Of the 16 valvular diseases, tricuspid and pulmonary valves were involved in 9 and 8 cases, respectively. Cardiac involvement was silent in 36.4% and occurred as an initial presenting symptom of SLE in 9.1% cases. Biologically, patients with cardiac involvement had higher levels of CRP and anti dsDNA, and lower levels of complement C3 compared to patients with no cardiac involvement; while high SLE activity was the only significant predictor for cardiac involvement (beta=0.654; p=0.020).
  
  
  CONCLUSIONS
  Cardiac complications are common in Saudi children with pSLE and are asymptomatic in 1 out of 3 times. They are predicted by high SLE activity and associate with high anti-dsDNA and CRP and low C3 levels.
authors.affiliation: Department of Paediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. azcardio@hotmail.com, aazhar@kau.edu.sa.
authors.forename: Ahmad S
authors.initials: AS
authors.lastname: Azhar
authors.affiliation: Department of Paediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: Omneyah Mohamed
authors.initials: OM
authors.lastname: Awlia
authors.affiliation: Department of Paediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Muzaffer
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D001323:Autoantibodies / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D003176:Complement C3 / Q000032:analysis; D003181:Complement C4 / Q000032:analysis; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006349:Heart Valve Diseases / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D010493:Pericarditis / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D012529:Saudi Arabia / Q000453:epidemiology
chemical_list: D001323:Autoantibodies; D015415:Biomarkers; C038245:C3 protein, human; D003176:Complement C3; D003181:Complement C4; D018836:Inflammation Mediators; D002097:C-Reactive Protein