Background In pediatric rheumatology, features of the initial period of systemic lupus erythematosus (SLE) and clinical types, depending on which principles and tactics of therapy should be based, remain undifferentiated.
Objectives To study the variants of the clinical manifestations of SLE in children at an early stage of the disease
Methods The basis of this work was aimed to survey results and data of archival materials of 153 SLE patients observed in the clinic of the Scientific Center of Pediatrics and Pediatric Surgery, the Republic of Kazakhstan.
Results We noted lupus carditis most commonly in the debute of the disease – 129 children (84.3%), and generalized vasculitis – 128 (83.7%) cases, followed by nephritis – 78 (51.0%), polyserositis – 72 (48.4%) and cerebrovascular – 47 (31.0%) children. Less relatively marked was a detection of secondary antiphospholipid syndrome – 40 (26.1%) children. In distribution of SLE patients over the age, main group consisted of 12 years and older aged children (60.1%) and younger than 12 years children (39.9%). While in children under the age of 12 years, the first manifestations of the disease in almost half of the cases, along with fever, dermatitis and arthritis were cardio, polyserositis and cerebrovascular (42,1% ± 3,65, 48,6% ± 3,26 and 49,1% ± 3,11, respectively), lupus nephritis (LN), generalized vasculitis (GV) and secondary APS (61,5% ± 3,25, 66,7% ± 8,55 and 70% ± 8,24, respectively, p<0.05). Diagnosis of carditis (78.29% ± 2,18), polyserositis (94,44% ± 1,09) in patients older than 12 years were significantly more determined in the first year of the disease. While considering the remaining forms of the disease (SLE with APS, GV and VN), diagnosis from the first signs of the disease in the first year was 35.0 ± 3,35, 50% ± 8,42 and 56,41% ± 2,41, respectively, (p<0.01 - 0.05), which complicates the course and outcome of the disease.
Precede factors were - ARI (42.6%), hyperinsolation (28.7%), sore throat (11.6%), other factors of 3.9%, not connection was in 17 (13.1%) cases. In SLE mainly affecting the kidneys, one of the main trigger factors were acute respiratory infections (51.2%), followed by photosensitivity (23.0%), purulent tonsillitis as a prior factor was found in 10 children less frequently representing 12.8%, other factors were important in 2.7% of cases, and not established causes composed 10.3%. In polyserositis, a prior factor in the development of the disease in half of the cases was an acute viral infection (52.8%) and purulent infection and insolation was revealed equally often (21.1% and 20.8%, respectively). The prior factor in CNS in almost half of the patients (43.9%) was acute respiratory infection, and in third of the children - hyperinsolations (19.1%).
In patients with secondary APS and generalized vasculitis (GV), viral (62.5% (APS), 62.5% (GV)) and purulent infection (25.0% (APS), 33.3% (GV)) had fundamental importance. Hypothermia, physical and emotional overloads, vaccinations were noted among the other factors.
Conclusions Clinical variants of the disease were established: with primary lesions of a heart and/or kidney, with generalized vasculitis and antiphospholipid syndrome. For carditis, polyserositis and nephritis main prior factors have been infection and hyperinsolation. For generalized vasculitis (95.8%) and a secondary APS (87.5%) infection was more important in triggering the disease.
Disclosure of Interest None declared
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