Low serum concentrations of 25-hydroxyvitamin D in children and adolescents with systemic lupus erythematosus

We evaluated the concentrations of 25-hydroxyvitamin D [25(OH)D] in children and adolescents with juvenile systemic lupus erythematosus (JSLE) and associated them with disease duration and activity, use of medication (chloroquine and glucocorticoids), vitamin D intake, calcium and alkaline phosphatase levels, and bone mineral density. Thirty patients with JSLE were evaluated and compared to 30 healthy individuals, who were age and gender matched. Assessment was performed of clinical status, disease activity, anthropometry, laboratory markers, and bone mineral density. The 30 patients included 25 (83.3%) females and 16 (53.3%) Caucasians, with a mean age of 13.7 years. The mean age at diagnosis was 10.5 years and mean disease duration was 3.4 years. Mean levels of calcium, albumin, and alkaline phosphatase were significantly lower in patients with JSLE compared with controls (P<0.001, P=0.006, and P<0.001, respectively). Twenty-nine patients (97%) and 23 controls (77%) had 25(OH)D concentrations lower than 32 ng/mL, with significant differences between them (P<0.001). Fifteen patients (50%) had vitamin D levels <20 ng/mL and 14 had vitamin D levels between 20 and 32 ng/mL. However, these values were not associated with greater disease activity, higher levels of parathormone, medication intake, or bone mineral density. Vitamin D concentrations were similar with regard to ethnic group, body mass index, height for age, and pubertal stage. Significantly more frequently than in controls, we observed insufficient serum concentrations of 25(OH)D in patients with JSLE; however, we did not observe any association with disease activity, higher levels of parathormone, lower levels of alkaline phosphatase, use of medications, or bone mineral density alterations

Use of single photon emission computed tomography and magnetic resonance to evaluate central nervous system involvement in patients with juvenile systemic lupus erythematosus

The objective of the present study was to identify the single photon emission computed tomography (SPECT) and magnetic resonance (MR) findings in juvenile systemic lupus erythematosus (JSLE) patients with CNS involvement and to try to correlate them with neurological clinical history data and neurological clinical examination. Nineteen patients with JSLE (16 girls and 3 boys, mean age at onset 9.2 years) were submitted to neurological examination, electroencephalography, cerebrospinal fluid analysis, SPECT and MR. All the evaluations were made separately within a period of 15 days. SPECT and MR findings were analyzed independently by two radiologists. Electroencephalography and cerebrospinal fluid analysis revealed no relevant alterations. Ten of 19 patients (53%) presented neurological abnormalities including present or past neurological clinical history (8/19, 42%), abnormal neurological clinical examination (5/19, 26%), and abnormal SPECT or MR (8/19, 42% and 3/19, 16%, respectively). The most common changes in SPECT were cerebral hypoperfusion and heterogeneous distribution of blood flow. The most common abnormalities in MR were leukomalacia and diffuse alterations of white matter. There was a correlation between SPECT and MR (P<0.05). We conclude that SPECT and MR are complementary and useful exams in the evaluation of neurological involvement of lupus

Erratum To: Hereditary Autoinflammatory Syndromes: A Brazilian Multicenter Study

[No abstract available]1

Vaccination Practice In Children With Rheumatic Disease

Evaluate clinical practice through assessment of vaccination card and recommendation of specific vaccines in pediatric patients with rheumatic diseases in use of different drugs and reveal the possible association between vaccination frequency and time of the clinical practice of pediatric rheumatologists in the state of São Paulo. Material and Methods: A questionnaire was sent to pediatric rheumatologists of the Departamento de Reumatologia da Sociedade de Pediatria de São Paulo. This instrument included questions about practice time on Pediatric Rheumatology, vaccination of patients with juvenile systemic lupus erythematosus (JSLE), juvenile idiopathic arthritis (JIA), juvenile dermatomyositis (JDM), and immunization according to the treatments used. Results: Vaccination card was seen by 100% of the professionals at the first visit and by 36% annually. Vaccines of live agents were not recommended for patients with JSLE, JIA, and JDM in 44%, 64%, and 48%, respectively. The professionals were divided into two groups: Group A (≤ 15 years of practice, n = 12) and B (≥ 16 years, n = 13). No statistical difference was observed in the use of live agent vaccine and vaccines with inactivated agents or protein components in the two treatment groups (P > 0.05). Moreover, the groups had similar opinion regarding severity of immunosuppression in patients with JSLE, JIA, and JDM (with or without activity) and treatment used (P > 0.05). Conclusions: The frequency of immunization by pediatric rheumatologists in São Paulo is low, especially after the first visit, and not influenced by time of professional practice.504356361Len, C.A., Terreri, M.T., Hilário, M.O., Lúpus eritematoso sistêmico juvenil e infecção (2002) Rev Bras Reumatol, 42 (4), pp. 218-222Facó, M.M., Leone, C., Campos, L.M., Febrônio, M.V., Marques, H.H., Silva, C.A., Risk factors associated with the death of patients hospitalized for juvenile systemic lupus erythematosus (2007) Braz J Med Biol Res, 40 (7), pp. 993-1002Facó, M.M., Nukumizu, L.A., Pantoja, A.J., Barros, P.C., Troster, E.J., Silva, C.A., Avaliação dos óbitos e necropsias em pacientes internados em um Serviço de Reumatologia Pediátrica por um período de dez anos (2005) Rev Bras Reumatol, 45 (2), pp. 55-63O'neill, S.G., Isenberg, D.A., Immunizing patients with systemic lupus erythematosus: A review of effectiveness and safety (2006) Lupus, 15 (11), pp. 778-783Gluck, T., Muller-Ladner, U., Vaccination in patients with chronic rheumatic or autoimmune diseases (2008) Clin Infect Dis, 46 (9), pp. 1459-1465Conti, F., Rezai, S., Valesini, G., Vaccination and autoimmune rheumatic diseases (2008) Autoimmunity Reviews, 8 (2), pp. 124-128Maillefert, J.F., Sibilia, J., Toussirot, E., Vignon, E., Eschard, J.P., Lorcerie, B., Rheumatic disorders developed after hepatitis B vaccination (1999) Rheumatology, 38 (10), pp. 978-983. , OxfordSilva, C.A., Terreri, M.T., Barbosa, C.M., Hilário, M.O., Pillegi, G.S., Ferriani, V.P., Consenso de imunização para crianças e adolescentes com doenças reumáticas (2009) Rev Bras Reumatol, 49 (5), pp. 562-589Davies, K., Woo, P., Immunization in rheumatic diseases of childhood: An audit of the clinical practice of British Paediatric Rheumatology Group members and a review of the evidence (2002) Rheumatology (Oxford), 41, pp. 937-941Hochberg, M.C., Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus (1997) Arthritis Rheum, 40 (9), p. 1725Petty, R.E., Southwood, T., Manners, P., Baum, J., Glass, D.N., Goldenberg, J., International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: Second revision, Edmonton, 2001 (2004) J Rheumatol, 31 (2), pp. 390-392Bohan, A., Peter, J.B., Polymyositis and dermatomyositis (1975) N Engl J Med, 292 (7), p. 344Delbecq, A.L., van de Ven, A.H., Gustafson, D.H., (1975) Group Technique For Program Planning - a Guide to Nominal Group and Delphi Processes, , Glenview, Illinois. Scott, Foresman and CompanyCommittee of Infectious Diseases (2005) Varicella-zoster Infections Circunstances, pp. 672-686. , American Academy of Pediatrics, In: LK P (ed.)r. Red Book. 27 ed. Elk Grove Village, ILCush, J.J., Calabrese, L., Kavanaugh, A., Herpes zoster (shingles) vaccine guidelines for immunosuppressed patients (2008) American College of Rheumatology: Hotline, p. 1Marie, I., Infections in polymyositis and in dermatomyositis (2009) Presse Med, 38 (2), pp. 303-316Snowden, N., (2007) Immunisation of Immunosuppressed Patients With Rheumatic Diseases, , www.arc.org.uk/arthinfo/medpub/6632/6632.asp, citedLuz, K.R., Souza, D.C., Ciconelli, R.M., Vacinação em pacientes imunossuprimidos e com doenças reumatológicas auto-imunes (2007) Rev Bras Reumatol, 47 (2), pp. 106-113(2006) Secretaria De Vigilância Em Saúde, Departamento De Vigilância E Epidemiologia, Programa Nacional De Imunizações, , http://www.cve.saude.sp.gov.br/, Brasil. Ministério da Saúde, Manual dos Centros de Referência para Imunobiológicos Especiais (Cries), Acesso em 20 de março de 2009Neves, P.S., Facó, M.M., Sallum, A.M.E., Campos, L.M.A., Rossi Jr., A., Silva, C.A., Herpes zoster em pacientes com lúpus eritematoso sistêmico juvenil (2007) Rev Bras Reumatol, 47 (2), pp. 135-139Bricks, L.F., Silva, C.A., Uso e abuso de anti-inflamatórios não hormonais: Parte I (2005) Pediatria, 27 (2), pp. 114-125. , São PauloBricks, L.F., Silva, C.A., Toxicidade dos anti-inflamatórios não hormonais (AINH) (2005) Pediatria, 27 (3), pp. 181-193. , São PauloSilva, C.A., Silva, C.H., Robazzi, T.C., Lotito, A.P., Mendroni Jr., A., Jacob, C.M., Macrophage activation syndrome associated with systemic juvenile idiopathic arthritis (2004) J Pediatr, 80 (6), pp. 517-522. , Rio JPileggi, G.C., Souza, C.B.S., Ferriani, V.P.L., Safety and immunogenicity of varicella vaccine in patients with juvenile rheumatic diseases using methotrexate and glucocorticoids (2010) Arthritis Care Res, , Hoboken, in pressMota, L.M., Oliveira, A.C., Lima, R.A., Santos-Neto, L.L., Tauil, P.L., Vaccination against yellow fever among patients on imunossupressors with diagnoses of rheumatic diseases (2009) Rev Soc Bras Med Trop, 42 (1), pp. 23-2