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The bm12 Inducible Model of Systemic Lupus Erythematosus SLE in C57BL/6 Mice
Published on: November 1, 2015
Gastrointestinal system manifestations in juvenile systemic lupus erythematosus
Hafize Emine Sönmez1, Asuman Nur Karhan2, Ezgi Deniz Batu1
1Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Sıhhiye, 06100, Ankara, Turkey.
Insights
Gastrointestinal system (GIS) involvement affects over a quarter of pediatric patients with Systemic Lupus Erythematosus (SLE), often appearing at diagnosis. These GIS issues can stem from SLE itself or its treatments.
Area of Science:
- Pediatric Rheumatology
- Gastroenterology
- Autoimmune Diseases
Background:
- Systemic Lupus Erythematosus (SLE) is a complex autoimmune condition with potential multi-systemic involvement.
- Gastrointestinal (GI) manifestations in SLE can be diverse, ranging from direct disease effects to drug toxicity.
- Understanding pediatric SLE GI involvement is crucial for timely diagnosis and management.
Purpose of the Study:
- To characterize the spectrum and frequency of gastrointestinal (GI) manifestations in pediatric patients diagnosed with Systemic Lupus Erythematosus (SLE).
- To determine the proportion of pediatric SLE patients experiencing GI symptoms at disease onset.
- To differentiate between SLE-related GI issues, those associated with complications like macrophage activation syndrome, and drug-induced GI problems.
Main Methods:
- Retrospective review of medical records for 69 pediatric patients (≤18 years) diagnosed with SLE between January 2011 and January 2016.
- Inclusion criteria focused on patients fulfilling the Systemic Lupus International Collaborating Clinics (SLICC) criteria and presenting with GI manifestations.
- Categorization of GI manifestations based on their presumed etiology: direct SLE involvement, associated conditions, drug adverse events, or coincidental findings.
Main Results:
- Gastrointestinal (GI) manifestations were identified in 19 (27.5%) of the 69 pediatric SLE patients.
- In 13 of these patients (68.4%), GI issues were present at the time of SLE diagnosis.
- Specific GI findings included autoimmune hepatitis (n=8), lupus enteritis (n=1), hepatomegaly/hypertransaminasemia due to macrophage activation syndrome (MAS) (n=3), hepatic steatosis (n=1), toxic hepatitis (n=3), azathioprine-induced cholestatic hepatitis (n=1), and corticosteroid-induced gastritis (n=1).
- One case of acute appendicitis occurred coincidentally.
Conclusions:
- Approximately one in five pediatric SLE patients experience GI manifestations.
- GI involvement can serve as an early or presenting sign of SLE in children.
- Recognizing the diverse range of GI manifestations is vital for comprehensive pediatric SLE care.
Abstract:
Systemic lupus erythematosus (SLE) is an autoimmune disease which may involve gastrointestinal system (GIS). The aim of this study was to present GIS manifestations of pediatric SLE patients. The medical files of 69 children with SLE followed between January 2011 and January 2016 were reviewed. All fulfilled the Systemic Lupus International Collaborating Clinics criteria. All patients (≤18 years of age) with GIS manifestations were included. GIS manifestations were observed in 19 (27.5%) out of 69 SLE patients and present at the time of SLE diagnosis in 13 (68.4%). The GIS manifestations due to SLE were autoimmune hepatitis (AIH) (n = 8) and lupus enteritis (n = 1). Manifestations associated with SLE were hepatomegaly and hypertransaminasemia due to macrophage activation syndrome (MAS) (n = 3) and hepatic steatosis (n = 1). GIS manifestations as a result of the adverse events of drugs were as follows: toxic hepatitis (n = 3; associated with methotrexate and nonsteroidal anti-inflammatory drugs in one, methotrexate in another, and azathioprine in another patient), azathioprine-induced cholestatic hepatitis (n = 1), and gastritis associated with corticosteroid (n = 1). In one patient, acute appendicitis occurred as a coincidence. In this study, one of every five pediatric SLE patients had GIS-related manifestations. GIS involvement may occur as an initial manifestation of the disease.
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