Emotional, hyperactivity and inattention problems in adolescents with immunocompromising chronic diseases during the COVID-19 pandemic

Objective: To assess factors associated with emotional changes and Hyperactivity/Inattention (HI) motivated by COVID-19 quarantine in adolescents with immunocompromising diseases. Methods: A cross-sectional study included 343 adolescents with immunocompromising diseases and 108 healthy adolescents. Online questionnaires were answered including socio-demographic data and self-rated healthcare routine during COVID-19 quarantine and validated surveys: Strengths and Difficulties Questionnaire (SDQ), Pittsburgh Sleep Quality Index (PSQI), Pediatric Quality of Life Inventory 4.0 (PedsQL4.0). Results: The frequencies of abnormal emotional SDQ scores from adolescents with chronic diseases were similar to those of healthy subjects (110/343 [32%] vs. 38/108 [35%], p = 0.548), as well as abnormal hyperactivity/inattention SDQ scores (79/343 [23%] vs. 29/108 [27%], p = 0.417). Logistic regression analysis of independent variables associated with abnormal emotional scores from adolescents with chronic diseases showed: female sex (Odds Ratio [OR = 3.76]; 95% Confidence Interval (95% CI) 2.00‒7.05; p < 0.001), poor sleep quality (OR = 2.05; 95% CI 1.08‒3.88; p = 0.028) and intrafamilial violence during pandemic (OR = 2.17; 95% CI 1.12‒4.19; p = 0.021) as independently associated with abnormal emotional scores, whereas total PedsQL score was inversely associated with abnormal emotional scores (OR = 0.95; 95% CI 0.93‒0.96; p < 0.0001). Logistic regression analysis associated with abnormal HI scores from patients evidenced that total PedsQL score (OR = 0.97; 95% CI 0.95‒0.99; p = 0.010], changes in medical appointments during the pandemic (OR = 0.39; 95% CI 0.19-0.79; p = 0.021), and reliable COVID-19 information (OR = 0.35; 95% CI 0.16‒0.77; p = 0.026) remained inversely associated with abnormal HI scores. Conclusion: The present study showed emotional and HI disturbances in adolescents with chronic immunosuppressive diseases during the COVID-19 pandemic. It reinforces the need to promptly implement a longitudinal program to protect the mental health of adolescents with and without chronic illnesses during future pandemics

Esophageal abnormalities in juvenile localized scleroderma: is it associated with other extracutaneous manifestations?

Abstract Objective: To assess esophageal involvement (EI) in juvenile localized scleroderma (JLS) population and the possible association between this gastrointestinal manifestation and demographic data, clinical features, laboratory exams, treatments and outcomes. Methods: For a period of 30 years, 5881 patients with rheumatic diseases were followed in our Pediatric Rheumatology Division. EI was defined by the presence of symptoms (solid/liquid dysphagia, heartburn, esophageal regurgitation, nausea/vomiting and epigastralgia) and confirmed by at least one EI exam abnormality: barium contrast radiography, upper gastrointestinal endoscopy and 24-hour esophageal pH-monitoring. Results: JLS was observed in 56/5881 patients (0.9%), mainly linear morphea subtype. EI was observed in 23/56(41%) of JLS patients. Eight(35%) of 23 EI patients with JLS were symptomatic and presented heartburn(5/8), solid and liquid dysphagia(3/8), nausea and epigastralgia(1/8). The frequency of any cumulative extracutaneous manifestations (calcinosis, arthritis/arthralgia, central nervous system, interstitial pneumonitis, mesangial nephritis and/or arrhythmia) was significantly higher in JLS patients with EI compared to those without this complication (56% vs. 24%, p = 0.024). No differences were evidenced in demographic data, JLS subtypes and in each extracutaneous manifestation in both groups (p > 0.05). The frequency of methotrexate use was significantly higher in JLS patients with EI compared to those without (52% vs. 12%, p = 0.002). Autoantibody profile (antinuclear antibodies, anti-SCL-70, rheumatoid factor, anticentromere, anti-cardiolipin, anti-Ro/SSA and anti-La/SSB) was similar in both groups (p > 0.05). Conclusions: Our study demonstrated that EI was frequently observed in JLS patients, mainly in asymptomatic patients with linear subtype. EI occurred in JLS patients with other extracutaneous manifestations and required methotrexate therapy

Contraception for adolescents with chronic rheumatic diseases

ABSTRACT Contraception is an important issue and should be a matter of concern in every medical visit of adolescent and young patients with chronic rheumatic diseases. This narrative review discusses contraception methods in adolescents with juvenile systemic lupus erythematosus (JSLE), antiphospholipid syndrome (APS), juvenile idiopathic arthritis (JIA) and juvenile dermatomyositis (JDM). Barrier methods are safe and their use should be encouraged for all adolescents with chronic rheumatic diseases. Combined oral contraceptives (COC) are strictly prohibited for JSLE and APS patients with positive antiphospholipid antibodies. Reversible long-acting contraception can be encouraged and offered routinely to the JSLE adolescent patient and other rheumatic diseases. Progestin-only pills are safe in the majority of rheumatic diseases, although the main concern related to its use by adolescents is poor adherence due to menstrual irregularity. Depot medroxyprogesterone acetate injections every three months is a highly effective contraception strategy, although its long-term use is associated with decreased bone mineral density. COC or other combined hormonal contraceptive may be options for JIA and JDM patients. Oral levonorgestrel should be considered as an emergency contraception method for all adolescents with chronic rheumatic diseases, including patients with contraindication to COC

Features of 847 childhood-onset systemic lupus erythematosus patients in three age groups at diagnosis: a brazilian multicenter study

To evaluate demographic data and clinical and laboratory features at disease diagnosis in 3 different age groups of childhood-onset systemic lupus erythematosus (SLE): group A, early-onset (0.05). However, the frequency of fever (78% versus 61% versus 47%; P2 kg (19% versus 28% versus 36%; P=0.017), photosensitivity (34% versus 41% versus 51%; P=0.006), leukopenia <4,000/mm(3) (14% versus 25% versus 30%; P=0.048), and lymphopenia <1,500/mm(3) (22% versus 41% versus 47%; P=0.011) was significantly lower in group A. Our large multicenter study identified the finding that the initial appearance of childhood-onset SLE is characterized by comparable high frequency of internal organ involvement and some distinct clinical and laboratory features in early-onset and adolescent groups681117361741CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQ305068/2014-8; 301805/2013-0; 303422/2015-7-1AFederico Foundation; Nucleo de Apoio a Pesquisa Saude da Crianca e do Adolescente da USP (grant NAP-CriAd

Anti-RO/SSA and anti-La/SSB antibodies: Association with mild lupus manifestations in 645 childhood-onset systemic lupus erythematosus

Background: To our knowledge there are no studies assessing anti-Ro/SSA and anti-La/SSB autoantibodies in a large population of childhood-systemic lupus erythematosus (cSLE) patients. Methods: This was a retrospective multicenter cohort study performed in 10 Pediatric Rheumatology services, Sao Paulo state, Brazil. Anti-Ro/SSA and anti-La/SSB antibodies were measured by enzyme linked immunosorbent assay (ELISA) in 645 cSLE patients. Results: Anti-Ro/SSA and anti-La/SSB antibodies were evidenced in 209/645 (32%) and 102/645 (16%) of cSLE patients, respectively. Analysis of cSLE patients with and without anti-Ro/SSA antibodies revealed higher frequencies of malar rash (79% vs. 71%, p = 0.032), photosensitivity (73% vs. 65%, p = 0.035), cutaneous vasculitis (43% vs. 35%, p = 0.046) and musculoskeletal involvement (82% vs. 75%, p = 0.046) in spite of long and comparable disease duration in both groups (4.25 vs. 4.58 years, p = 0.973). Secondary Sjogren syndrome was observed in only five patients with this antibody (2.5% vs. 0%, p = 0.0035), two of them with concomitant anti-La/SSB. The presence of associated autoantibodies: anti-Sm (50% vs. 30%, p < 0.0001), anti-RNP (39% vs. 21%, p < 0.0001) and anti-ribossomal P protein (46% vs. 21%, p = 0.002) was also significantly higher in patients with anti-Ro/SAA antibodies. Further evaluation of cSLE patients with the presence of anti-La/SSB antibodies compared to those without these autoantibodies showed that the frequency of alopecia (70% vs. 51%, p = 0.0005), anti-Sm (59% vs. 31%, p < 0.0001) and anti-RNP (42% vs. 23%, p < 0.0001) were significantly higher in the former group. Conclusions: Our large multicenter cohort study provided novel evidence in cSLE that anti-Ro/SSA and/or anti-La/SSB antibodies were associated with mild manifestations, particularly cutaneous and musculoskeletal. Secondary Sjogren syndrome was rarely observed in these patients, in spite of comparable frequencies of anti-Ro/SSA and/or anti-La/SSB reported for adult SLE. (C) 2016 Elsevier B.V. All rights reserved.Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq)Federico FoundationNucleo de Apoio a Pesquisa "Sande da Crianca e do Adolescente" da USP (NAP-CriAd)Univ Sao Paulo, Fac Med, Childrens Inst, Pediat Rheumatol Unit, BR-05508 Sao Paulo, BrazilUniv Sao Paulo, Fac Med, Div Rheumatol, BR-05508 Sao Paulo, BrazilUniv Fed Sao Paulo, Pediat Rheumatol Unit, Sao Paulo, BrazilSao Paulo State Univ, UNESP, Div Pediat Rheumatol, Fac Med Botucatu, Sao Paulo, SP, BrazilInnandade Santa Casa de Misericordia Sao Paulo, Pediat Rheumatol Unit, Sao Paulo, BrazilUniv Estadual Campinas, UNICAMP, Pediat Rheumatol Unit, Campinas, SP, BrazilUniv Sao Paulo, Ribeirao Preto Med Sch, Pediat Rheumatol Unit, BR-05508 Sao Paulo, BrazilHosp Infantil Darcy Vargas, Pediat Rheumatol Unit, Sao Paulo, BrazilHosp Menino Jesus, Pediat Rheumatol Unit, Sao Paulo, BrazilPontifical Catholic Univ Sorocaba, Sao Paulo, BrazilUniv Fed Sao Paulo, Pediat Rheumatol Unit, Sao Paulo, BrazilCNPq: 301805/2013-0CNPq: 303752/2015-7CNPq: 301479/2015-1CNPQ: 305068/2014-8CNPQ: 303422/2015-7Web of Scienc