Abdominal manifestations in childhood-onset systemic lupus erythematosus
Identifieur interne : 001483 ( Istex/Curation ); précédent : 001482; suivant : 001484Abdominal manifestations in childhood-onset systemic lupus erythematosus
Auteurs : O. Richer [France] ; T. Ulinski [France] ; I. Lemelle [France] ; B. Ranchin [France] ; C. Loirat [France] ; J C Piette [France] ; P. Pillet [France] ; P. Quartier [France] ; R. Salomon [France] ; B. Bader-Meunier [France]Source :
- Annals of the Rheumatic Diseases [ 0003-4967 ] ; 2007-02.
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Abstract
Background: Childhood-onset lupus erythematosus is a rare disorder of unknown origin. Objectives: To describe the frequency of gastrointestinal manifestations at presentation of systemic lupus erythematosus SLE and at follow-up, and discuss the specific causes of these manifestations. Methods: Medical records of 201 patients with childhood-onset SLE followed up in French paediatric nephrological, haematological and rheumatological centres were reviewed and abstracted for gastrointestinal manifestations. Results: Gastrointestinal involvement was recorded in 39 (19%) children. The median (range) age at the time of initial gastrointestinal manifestations was 11.3 (4.5–16) years. Gastrointestinal symptoms were present at or occurred within 1 month after diagnosis in 32% patients. Abdominal pain was the most frequent symptom, present in 34 (87%) patients. It was mostly related to lupus involvement, especially ascites (n = 14) and pancreatitis (n = 12), more rarely to treatment-induced events (n = 1) or infection (n = 1) and never to events unrelated to SLE. Three children with surgical abdomen underwent a laparotomy before SLE was diagnosed, with a final diagnosis of lupus peritonitis and lupus acalculous cholecystitis. C reactive protein values were <40 mg/l in all but two patients who had surgical abdomen. Abdominal ultrasonography and computed tomography scans were abnormal in 58% and 83% of the evaluated patients, respectively. Corticosteroids, associated with intravenous cyclophospamide in eight patients, led to complete remission of gastrointestinal involvement in 30 of 31 treated patients. Conclusion: Gastrointestinal involvement is common in children with SLE, and is mainly due to primary lupus involvement. Corticoidsteroid treatment should be promptly considered in children with lupus presenting with abdominal pain after infectious disease; side effects of treatment and intestinal perforation have been excluded.
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DOI: 10.1136/ard.2005.050070
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Ulinski</name><affiliation wicri:level="1"><mods:affiliation>Department of Pediatric Nephrology, Hôpital Trousseau, Paris, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Pediatric Nephrology, Hôpital Trousseau, Paris</wicri:regionArea></affiliation></author><author><name sortKey="Lemelle, I" sort="Lemelle, I" uniqKey="Lemelle I" first="I" last="Lemelle">I. Lemelle</name><affiliation wicri:level="1"><mods:affiliation>Department of Pediatrics, Hôpital Brabois, Nancy, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Pediatrics, Hôpital Brabois, Nancy</wicri:regionArea></affiliation></author><author><name sortKey="Ranchin, B" sort="Ranchin, B" uniqKey="Ranchin B" first="B" last="Ranchin">B. 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Richer</name><affiliation wicri:level="1"><mods:affiliation>Department of Pediatrics, Hôpital de Bicêtre, Le Kremlin Bicêtre, Paris, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Pediatrics, Hôpital de Bicêtre, Le Kremlin Bicêtre, Paris</wicri:regionArea></affiliation></author><author><name sortKey="Ulinski, T" sort="Ulinski, T" uniqKey="Ulinski T" first="T" last="Ulinski">T. Ulinski</name><affiliation wicri:level="1"><mods:affiliation>Department of Pediatric Nephrology, Hôpital Trousseau, Paris, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Pediatric Nephrology, Hôpital Trousseau, Paris</wicri:regionArea></affiliation></author><author><name sortKey="Lemelle, I" sort="Lemelle, I" uniqKey="Lemelle I" first="I" last="Lemelle">I. Lemelle</name><affiliation wicri:level="1"><mods:affiliation>Department of Pediatrics, Hôpital Brabois, Nancy, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Pediatrics, Hôpital Brabois, Nancy</wicri:regionArea></affiliation></author><author><name sortKey="Ranchin, B" sort="Ranchin, B" uniqKey="Ranchin B" first="B" last="Ranchin">B. Ranchin</name><affiliation wicri:level="1"><mods:affiliation>Department of Pediatric Nephrology, Hôpital Edouard-Herriot, Lyon, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Pediatric Nephrology, Hôpital Edouard-Herriot, Lyon</wicri:regionArea></affiliation></author><author><name sortKey="Loirat, C" sort="Loirat, C" uniqKey="Loirat C" first="C" last="Loirat">C. 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Pillet</name><affiliation wicri:level="1"><mods:affiliation>Department of Pediatrics, Hôpital Pellegrin, Bordeaux, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Pediatrics, Hôpital Pellegrin, Bordeaux</wicri:regionArea></affiliation></author><author><name sortKey="Quartier, P" sort="Quartier, P" uniqKey="Quartier P" first="P" last="Quartier">P. Quartier</name><affiliation wicri:level="1"><mods:affiliation>Department of Pediatric Immuno-Hematology and Rheumatology, Hôpital Necker, Paris, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Pediatric Immuno-Hematology and Rheumatology, Hôpital Necker, Paris</wicri:regionArea></affiliation></author><author><name sortKey="Salomon, R" sort="Salomon, R" uniqKey="Salomon R" first="R" last="Salomon">R. Salomon</name><affiliation wicri:level="1"><mods:affiliation>Department of Pediatric Nephrology, Hôpital Necker, Paris, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Pediatric Nephrology, Hôpital Necker, Paris</wicri:regionArea></affiliation></author><author><name sortKey="Bader Meunier, B" sort="Bader Meunier, B" uniqKey="Bader Meunier B" first="B" last="Bader-Meunier">B. Bader-Meunier</name><affiliation wicri:level="1"><mods:affiliation>Department of Pediatrics, Hôpital de Bicêtre, Le Kremlin Bicêtre, Paris, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Pediatrics, Hôpital de Bicêtre, Le Kremlin Bicêtre, Paris</wicri:regionArea></affiliation></author></analytic><monogr></monogr><series><title level="j">Annals of the Rheumatic Diseases</title><title level="j" type="abbrev">Ann Rheum Dis</title><idno type="ISSN">0003-4967</idno><idno type="eISSN">1468-2060</idno><imprint><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><date type="published" when="2007-02">2007-02</date><biblScope unit="volume">66</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="174">174</biblScope></imprint><idno type="ISSN">0003-4967</idno></series><idno type="istex">76F60791C7F46ED41C336F979FCD3BE8F1372232</idno><idno type="DOI">10.1136/ard.2005.050070</idno><idno type="href">annrheumdis-66-174.pdf</idno><idno type="PMID">16818463</idno><idno type="local">0660174</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0003-4967</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>CIPO, chronic intestinal pseudo-obstruction</term><term>CRP, C reactive protein</term><term>ESR, erythrocyte sedimentation rate</term><term>Ig, Immunoglobulin</term><term>SLE, systemic lupus erythematosus</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background: Childhood-onset lupus erythematosus is a rare disorder of unknown origin. Objectives: To describe the frequency of gastrointestinal manifestations at presentation of systemic lupus erythematosus SLE and at follow-up, and discuss the specific causes of these manifestations. Methods: Medical records of 201 patients with childhood-onset SLE followed up in French paediatric nephrological, haematological and rheumatological centres were reviewed and abstracted for gastrointestinal manifestations. Results: Gastrointestinal involvement was recorded in 39 (19%) children. The median (range) age at the time of initial gastrointestinal manifestations was 11.3 (4.5–16) years. Gastrointestinal symptoms were present at or occurred within 1 month after diagnosis in 32% patients. Abdominal pain was the most frequent symptom, present in 34 (87%) patients. It was mostly related to lupus involvement, especially ascites (n = 14) and pancreatitis (n = 12), more rarely to treatment-induced events (n = 1) or infection (n = 1) and never to events unrelated to SLE. Three children with surgical abdomen underwent a laparotomy before SLE was diagnosed, with a final diagnosis of lupus peritonitis and lupus acalculous cholecystitis. C reactive protein values were <40 mg/l in all but two patients who had surgical abdomen. Abdominal ultrasonography and computed tomography scans were abnormal in 58% and 83% of the evaluated patients, respectively. Corticosteroids, associated with intravenous cyclophospamide in eight patients, led to complete remission of gastrointestinal involvement in 30 of 31 treated patients. Conclusion: Gastrointestinal involvement is common in children with SLE, and is mainly due to primary lupus involvement. Corticoidsteroid treatment should be promptly considered in children with lupus presenting with abdominal pain after infectious disease; side effects of treatment and intestinal perforation have been excluded.</div></front></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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