Alhomaidah Doha, Alsagheir Afaf, Al-Mayouf Sulaiman M
Pediatric Endocrinology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Pediatric Rheumatology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Int J Pediatr Adolesc Med. 2016 Sep;3(3):119-122. doi: 10.1016/j.ijpam.2016.04.002. Epub 2016 May 24.
To examine the frequency of endocrinopathies in children with systemic lupus erythematosus (SLE) and juvenile idiopathic arthritis (JIA).
A cross-sectional study.
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, Hb, IGF, IGF, LH, and FSH.
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 IGF, IGF). 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).
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.
研究系统性红斑狼疮（SLE）和幼年特发性关节炎（JIA）患儿内分泌疾病的发生频率。
一项横断面研究。
对2013年9月至2015年4月期间在利雅得法赫德国王专科医院及研究中心就诊的沙特SLE和JIA患儿进行了研究。所有纳入研究的患者均完成了临床评估，包括自身免疫性疾病家族史、生长参数和坦纳分期等信息，以及以下检查：维生素D指标（甲状旁腺激素和25-羟基维生素D水平）、促甲状腺激素（TSH）、游离甲状腺素（FT4）、总三碘甲状腺原氨酸（T3）、甲状腺球蛋白抗体、甲状腺过氧化物酶抗体、随机血糖、血红蛋白（Hb）、胰岛素样生长因子（IGF）、促黄体生成素（LH）和促卵泡生成素（FSH）。
本研究共纳入42例患者，其中22例为JIA，20例为SLE。参与者的平均年龄为12.2±5.3岁，平均病程为3.2±3.4年。患者群体中女性占主导（SLE患者17例，JIA患者13例）。15例患者（35.7%）有自身免疫性疾病家族史。最常检测到的内分泌疾病是维生素D缺乏（35%）和甲状腺疾病（31%）。8例JIA患者和7例SLE患者维生素D水平较低；10例患者出现甲状旁腺功能亢进。13例患者（8例SLE，5例JIA）出现甲状腺功能障碍，2例患者促甲状腺激素（TSH）和游离甲状腺素（FT4）正常，但甲状腺自身抗体呈阳性。此外，7例患者出现亚临床甲状腺功能减退（TSH升高，FT4正常），4例患者出现明显甲状腺功能减退（TSH升高，FT4降低）。7例患者（4例SLE和3例JIA）因生长激素缺乏（IGF降低）导致身材矮小。2例患者青春期延迟，伴有LH水平降低。JIA患者（4例）比SLE患者（1例）更常出现糖尿病。
我们的研究结果表明，在诊断为JIA和SLE的儿童中，内分泌疾病并存并不罕见。甲状腺功能异常在诊断为SLE和JIA的儿童中经常出现，且发生率相似。因此，在评估儿童SLE和JIA时，考虑筛查内分泌疾病，即甲状腺疾病，是值得的。
