Usefulness of the lupus low disease activity state as a treatment target in childhood-onset SLE

Cody, Ellen; Wilson, Barbara G.; Ogbu, Ekemini A.; Huggins, Jennifer; Chen, Chen; Qiu, Tingting; Ting, Tracy V.; Flores, Francisco; Huang, Bin; Brunner, Hermine I.

doi:10.1136/lupus-2022-000884

Cited by 4 publications

(1 citation statement)

References 42 publications

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“…Absence of nephritis was the only independent predictor of achieving LLDAS with one year of treatment [35]. Indeed, longitudinal data from 165 cSLE patients showed that LLDAS was the preferred T2T goal and minimized the risk of damage, although it was the most difficult to accomplish and sustain [36]. A Turkish study verified that almost 10% of cSLE had serological activity at the onset of remission, defined by modified definition of remission in SLE (DORIS) criteria.…”

Section: Treat-to-target Approachmentioning

confidence: 99%

Updates in the care and management of children and adolescents with systemic lupus erythematosus

Silva,

Aikawa,

Bonfa

2024

Current Opinion in Rheumatology

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Purpose of review This narrative review offers an update of the most important recent articles published in the previous year of childhood-onset systemic lupus erythematosus (cSLE), focusing on care and management. Recent findings Age-related disparities may play a significant role in the clinical and laboratory characteristics of cSLE, as well as its performance in distinct classification criteria. Monogenic lupus is associated with higher disease damage scores and mortality rate compared to sporadic cSLE. Adolescent face unique challenges, with comorbid psychiatric diagnosis, low resilience and nonadherence posing relevant challenges. A recent international task force has outlined pivotal principles and points-to-consider for treat-to-target (T2T) in cSLE patients. While the past year did yield new randomized controlled trial for cSLE treatment, publications focused on broader management strategies, including the impact of ultraviolet radiation exposure, immunization, and strict blood pressure control. Additionally, case reports and series have evaluated the efficacy/safety profiles of both available and emerging treatments. Summary Current studies highlighted the various facets of cSLE, epidemiology, clinical, laboratory, classification criteria, adolescent issues, prognosis, surveillance, T2T approach and drug management. Despite notable progress, the scarcity of randomized trials emphasizes the need to delineate safer and more efficacious treatment modalities in cSLE.

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Section: Treat-to-target Approachmentioning

confidence: 99%

Updates in the care and management of children and adolescents with systemic lupus erythematosus

Silva,

Aikawa,

Bonfa

2024

Current Opinion in Rheumatology

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Implementation of the Lupus Low Disease Activity State in Pediatric Rheumatology Care: The Role of the Visual Analog Scale

Ogbu,

Sagcal‐Gironella,

Eberhard

et al. 2024

ACR Open Rheumatology

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ObjectiveWe compared the measurement properties of a traditional physician global assessment of disease activity (PhGA) 10‐cm visual analog scale (PhGA0–10) with that of the three‐point numeric scale (PhGA0–3) in childhood‐onset systemic lupus erythematosus (cSLE) as part of the childhood Lupus Low Disease Activity State (cLLDAS).MethodsWe used a secondary data analysis from a convenience sample of 100 patients with cSLE followed every three months for up to seven visits. Ratings of PhGA0–10, PhGA0–3, parent assessment of patient well‐being (ParGA) (range: 0= very poorly, 10 = very well), disease activity as measured by the SLE disease activity index 2000 (SLEDAI‐2k), Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA) SLEDAI, and the British Isles International Lupus Activity Group index (BILAG; A = 9, B = 3, C = 1, D/E = 0) were compared. After linear transformation of PhGA0–10 to a 0 to 3 range (tPhGA0–10), the frequency of PhGA0–3 ≤1 was assessed to estimate the impact of scale type on the scoring of the cLLDAS.ResultsIn 600 visits, the median (range) scores of PhGA0–10, PhGA0–3, SLEDAI‐2k, SELENA‐SLEDAI, and BILAG were 2 (0–10), 1(0–3), 4 (0–28), 4 (0–32), and 2 (0–28), respectively. PhGA0–10 and PhGA0–3 ratings were strong to moderately correlated with (r = 0.73; P < 0.0001) and with more variability for PhGA0–3 ≥2. SELENA‐SLEDAI and SLEDAI‐2k scores were moderately correlated with PhGA0–10 (r = 0.56/0.54; P < 0.0001). ParGA values were weakly correlated with all other measures considered (all r = −0.19 to −0.34). There were 490 of 600 visits with PhGA0−3 ≤1 and 497 of 600 visits with tPhGA0−10 ≤1 (κ (SE) =0.59 (0.04), McNemar P = 0.4).ConclusionPhGA0–3 and PhGA0–10 have comparable measurement properties and yield almost identical cLLDAS rates when used in cSLE.

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Dyslipidemia and metabolic syndrome in childhood-onset systemic lupus erythematosus: is it time to screen?

Nuntasri,

Charuvanij,

Lomjansook

et al. 2024

Lipids Health Dis

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Background Childhood-onset systemic lupus erythematosus (cSLE) is associated with significant morbidity and mortality. Dyslipidemia and metabolic syndrome are recognized risk factors for premature atherosclerosis. This study aimed to determine the prevalence of dyslipidemia and metabolic syndrome, and to explore the relationships between lipid profiles, anthropometry, and disease status in cSLE. Methods This cross-sectional study was conducted at a university-based tertiary referral center from April 2023-March 2024. Patients aged 10–19 years with cSLE diagnosed before 18 years and at least 1 year follow-up were enrolled, excluding those with other autoimmune disorders, chronic kidney disease, infections, receiving lipid lowering drugs prior, and pregnancy. Demographic data, metabolic laboratory tests, disease status, dietary intake, anthropometry, and body composition via bioelectric impedance analysis were evaluated. The prevalence of dyslipidemia and metabolic syndrome were documented. Variables were compared between patients with and without dyslipidemia. Correlations between lipid profiles, metabolic laboratory variables, and SLE disease-related variables were explored. Results A total of 132 cSLE patients (94.7% female, mean age 11.6 ± 2.6 years) were included. Dyslipidemia was present in 48.5%, hypertriglyceridemia being the most common (28.8%); metabolic syndrome and hyperuricemia were present in 3.8% and 20.5%, respectively. Patients with dyslipidemia were significantly younger at cSLE diagnosis, had higher percentage of hypertension and active features of organ involvement, lower percentage of Lupus Low Disease Activity State, more use of mycophenolate mofetil and antihypertensive medications, higher uric acid level, higher waist circumference, body mass index, body mass index z-score, and fat mass (P < 0.05). Triglycerides, low-density lipoprotein cholesterol, and total cholesterol correlated positively with urine protein-to-creatinine ratio (r = 0.472, 0.469, and 0.591, respectively; P < 0.001) and negatively with serum albumin (r = -0.372, -0.506, and − 0.528, respectively; P < 0.001). Total cholesterol and low-density lipoprotein cholesterol correlated positively with cumulative prednisolone equivalent dose (rho = 0.350 and rho = 0.351, respectively, P < 0.001). Conclusions Nearly half of cSLE patients had dyslipidemia, especially those with younger age at diagnosis, higher body mass index, proteinuria, and suboptimal-controlled disease. Metabolic syndrome and hyperuricemia were present. Lipid profile assessment in early adolescents is recommended to identify metabolic comorbidities in cSLE.

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Usefulness of the lupus low disease activity state as a treatment target in childhood-onset SLE

Cited by 4 publications

References 42 publications

Updates in the care and management of children and adolescents with systemic lupus erythematosus

Updates in the care and management of children and adolescents with systemic lupus erythematosus

Implementation of the Lupus Low Disease Activity State in Pediatric Rheumatology Care: The Role of the Visual Analog Scale

Dyslipidemia and metabolic syndrome in childhood-onset systemic lupus erythematosus: is it time to screen?

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