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Coexistence of endocrinopathies in children with rheumatic diseases
Doha Alhomaidah1, Afaf Alsagheir1, Sulaiman M Al-Mayouf2
1Pediatric Endocrinology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Insights
Endocrinopathies like vitamin D insufficiency and thyroid disease are common in children with juvenile idiopathic arthritis (JIA) and systemic lupus erythematosus (SLE). Screening for these conditions is recommended during their assessment.
Area of Science:
- Pediatric Endocrinology
- Rheumatology
- Autoimmune Diseases
Background:
- Systemic lupus erythematosus (SLE) and juvenile idiopathic arthritis (JIA) are chronic autoimmune conditions affecting children.
- Endocrine system complications can arise in children with autoimmune diseases, impacting their growth and overall health.
- Limited data exists on the specific frequency of endocrinopathies in pediatric SLE and JIA cohorts.
Purpose of the Study:
- To determine the prevalence of various endocrinopathies in children diagnosed with SLE and JIA.
- To identify specific endocrine disorders frequently associated with these pediatric autoimmune conditions.
- To evaluate the necessity of routine endocrine screening in children with SLE and JIA.
Main Methods:
- A cross-sectional study was conducted involving Saudi children diagnosed with SLE or JIA.
- Clinical evaluations included assessments of growth parameters, Tanner stage, and a comprehensive panel of endocrine function tests.
- Hormone levels measured included vitamin D profile, thyroid function tests (TSH, FT4, T3), autoantibodies, IGF-1, IGF-BP3, LH, and FSH, along with random blood sugar and HbA1c.
Main Results:
- The study included 42 children (22 JIA, 20 SLE), with a mean age of 12.2 years.
- The most common endocrinopathies were vitamin D insufficiency (35%) and thyroid disease (31%).
- Thyroid dysfunction was observed in 13 patients, growth hormone insufficiency in 7, and diabetes mellitus in 5 (4 JIA, 1 SLE).
Conclusions:
- Endocrinopathies frequently coexist with childhood SLE and JIA.
- Abnormal thyroid function is a common finding in both pediatric SLE and JIA patients.
- Routine screening for endocrinopathies, particularly thyroid disease, should be considered in the management of children with SLE and JIA.
Background And Objectives:
To examine the frequency of endocrinopathies in children with systemic lupus erythematosus (SLE) and juvenile idiopathic arthritis (JIA).
Design And Setting:
A cross-sectional study.
Patients And Methods:
A study was conducted in Saudi children with SLE and JIA who were seen at King Faisal Specialist Hospital and Research Centre, Riyadh, between September 2013 and April 2015. All enrolled patients completed the clinical evaluation, which included information about family history of autoimmune disease, growth parameters and tanner stage, as well as the following assessments: vitamin D profile (parathyroid hormone and 25-OH vitamin D levels), TSH, FT4 and total T3, thyroglobulin antibodies, thyroperoxidase antibodies, random blood sugar, HbA1C, IGF1, IGFBP-3, LH, and FSH.
Results:
A total of 42 patients, 22 with JIA and 20 with SLE, were included in the study. The mean participant age was 12.2 ± 5.3 years with a mean disease duration of 3.2 ± 3.4 years. Female gender was predominant (17 SLE, 13 JIA) in the patient population. Fifteen patients (35.7%) presented with a family history of autoimmune disease. The most frequently detected endocrinopathies were vitamin D insufficiency (35%) and thyroid disease (31%). Eight JIA patients and 7 SLE patients exhibited low vitamin D levels; 10 patients presented with hyperparathyroidism. Thyroid dysfunction was observed in 13 patients (8 SLE, 5 JIA), and 2 patients were found to be euthyroid (normal TSH, FT4) with positive thyroid autoantibodies. Furthermore, 7 patients presented with subclinical hypothyroidism (high TSH, normal FT4), and 4 patients presented with overt hypothyroidism (high TSH, low FT4). Seven patients (4 SLE and 3 JIA) presented with short stature due to growth hormone insufficiency (low IGF1, IGFBP-3). Two patients exhibited delayed puberty accompanied by low LH levels. Diabetes mellitus was more frequently observed in patients with JIA (4 patients) than in patients with SLE (1 patient).
Conclusion:
Our findings demonstrated that coexistence of endocrinopathies is not uncommon in children diagnosed with JIA and SLE. Abnormal thyroid function occurs frequently and at a similar rate in children diagnosed with SLE and JIA. Thus, screening for endocrinopathies, namely thyroid disease, during the assessment of childhood SLE and JIA is worth consideration.
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