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Published on: June 28, 2021
Children systemic lupus erythematosus-associated pancreatitis
Dan Zhang1, Jianming Lai2, Gaixiu Su1
1Department of Rheumatology and Immunology, Children's Hospital of Capital Institute of Paediatrics, No.2 Yabao Road, Chaoyang District, Beijing, 100020, China.
Insights
Children with systemic lupus erythematosus (cSLE) who develop pancreatitis have a high fatality rate. Early recognition of symptoms like Raynaud's phenomenon and splenic infarction is crucial for timely intervention and improved outcomes.
Area of Science:
- Pediatrics
- Rheumatology
- Gastroenterology
Background:
- Pediatric systemic lupus erythematosus (cSLE) is a complex autoimmune disease with diverse clinical manifestations.
- Pancreatitis is a serious complication of cSLE, impacting patient prognosis and requiring specific diagnostic and therapeutic considerations.
Purpose of the Study:
- To identify key clinical features and prognostic factors associated with cSLE-related pancreatitis.
- To improve early recognition and management strategies for children diagnosed with cSLE-associated pancreatitis.
Main Methods:
- A retrospective analysis was conducted on 12 pediatric patients diagnosed with cSLE-associated pancreatitis between 2016 and 2021.
- Clinical data, disease activity scores (SLEDAI-2K), laboratory markers, and treatment modalities were compared between cases and controls.
Main Results:
- Patients with cSLE-associated pancreatitis exhibited significantly higher disease activity (SLEDAI-2K) and a greater prevalence of abdominal pain, vomiting, pleural effusion, Raynaud's phenomenon (RP), splenic infarction, and macrophage activation syndrome (MAS).
- Elevated serum ferritin, ALT, AST, LDH, amylase, and 24-h urine protein, along with reduced platelet counts, were significantly different between groups.
- Treatment often involved intensive therapies including methylprednisolone pulse, cyclophosphamide pulse, and therapeutic plasma exchange.
Conclusions:
- cSLE-associated pancreatitis carries a high mortality rate.
- Clinical indicators such as RP, splenic infarction, pleural effusion, and MAS should alert clinicians to the potential for pancreatitis in cSLE patients.
- Prompt treatment of the underlying cSLE is essential for improving the prognosis of associated pancreatitis.
Objective:
To early recognise and improve the prognosis of children systemic lupus erythematosus (cSLE)-associated pancreatitis by summarising and analysing clinical features and prognosis data from 12 cases.
Methods:
Retrospective analysis of clinical data from 12 cases of cSLE-associated pancreatitis diagnosed and treated from January 2016 to December 2021 at hospitals such as Children's Hospital of Capital Institute of Paediatrics.
Results:
The median SLEDAI-2K score for disease activity was 18.00 (range 12.25-21.00) in the case group and 10.00 (range 7.00-18.00) in the control group, with a statistically significant difference (P < 0.05) between the two groups. The case group had a higher proportion of abdominal pain, vomiting, abdominal distension, pleural effusion, Raynaud's phenomenon (RP), splenic infarction, and concurrent macrophage activation syndrome (MAS) than the control group, with a statistically significant difference (P < 0.05). Serum ferritin (SF), alanine transaminase (ALT), aspartate transaminase (AST), lactate dehydrogenase (LDH), amylase, and increased 24-h urine protein levels were statistically different between the two groups (P < 0.05); platelet counts (PLT) reduction was also statistically different (P < 0.05). The case group had a higher proportion of methylprednisolone pulse therapy, cyclophosphamide pulse therapy during remission induction, and therapeutic plasma exchange than the control group, with a statistically significant difference (P < 0.05) between the two.
Conclusion:
CSLE-associated pancreatitis has a high fatality rate. The presence of RP, splenic infarction, pleural effusion, and MAS warrants attention from clinicians regarding the possibility of pancreatitis. Once pancreatitis is detected, the primary disease needs active treatment for better prognosis.
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