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Child-onset systemic lupus erythematosus is associated with a higher incidence of myopericardial manifestations compared to adult-onset disease.
Lupus 2018; 27(13):2146-2154L

Abstract

OBJECTIVES

There are no population-based estimates of the incidence or risk factors for acute cardiac manifestations in children with systemic lupus erythematosus (SLE) to guide screening and diagnostic imaging practices. We estimated the incidence and prevalence of acute cardiac manifestations of child-onset SLE compared to adult-onset SLE and identified factors associated with cardiac diagnoses.

METHODS

We identified children (5-17 years) and adults (18-64 years) with incident SLE (≥3 International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) code 710.0, > 30 days apart) using Clinformatics® DataMart (OptumInsight, Eden Prairie, MN) deidentified United States administrative claims (2000-2013). We calculated incidence and prevalence of three outcomes: ≥ 1 diagnosis code for (1) pericarditis and/or myocarditis, (2) endocarditis, or (3) valvular insufficiency. Negative binomial regression was used to identify characteristics associated with cardiac diagnoses in children and determine whether SLE onset in childhood vs adulthood was independently associated with cardiac involvement.

RESULTS

There were 297 children and 6927 adults with new-onset SLE. A total of 17.8% of children had ICD-9 CM codes for acute cardiac diagnoses, the incidence of which were highest in the first year after SLE diagnosis (12.2 per 100 person-years). African American race (incidence rate ratio (IRR) 6.6, 95% confidence interval (CI) (2.9, 15.0), p < 0.01) and nephritis (IRR 7.0, 95% CI (2.6, 18.6), p < 0.01) were associated with acute cardiac diagnoses in children. Child-onset disease was independently associated with a 4.4-fold higher rate of pericarditis or myocarditis compared to adult-onset SLE after adjustment for other disease and demographic characteristics (95% CI (2.4, 8.0), p < 0.01).

CONCLUSION

This study establishes baseline estimates of the incidence and prevalence of pericarditis and myocarditis in child-onset SLE, which is substantially higher than that of adult-onset SLE. Prospective echocardiographic evaluations are needed to validate incidence measures and characterize the natural history of acute cardiac manifestations in child-onset SLE, as well as identify risk factors for poor cardiac outcomes to inform screening and management.

Authors+Show Affiliations

1 Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. 2 Division of Pediatric Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.1 Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.3 Division of Pediatric Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. 5 Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.2 Division of Pediatric Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. 4 Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. 5 Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.2 Division of Pediatric Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. 4 Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. 6 Center for Pharmacoepidemiology Research and Training at the University of Pennsylvania, Philadelphia, PA, USA.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

30318995

Citation

Chang, J C., et al. "Child-onset Systemic Lupus Erythematosus Is Associated With a Higher Incidence of Myopericardial Manifestations Compared to Adult-onset Disease." Lupus, vol. 27, no. 13, 2018, pp. 2146-2154.
Chang JC, Xiao R, Mercer-Rosa L, et al. Child-onset systemic lupus erythematosus is associated with a higher incidence of myopericardial manifestations compared to adult-onset disease. Lupus. 2018;27(13):2146-2154.
Chang, J. C., Xiao, R., Mercer-Rosa, L., Knight, A. M., & Weiss, P. F. (2018). Child-onset systemic lupus erythematosus is associated with a higher incidence of myopericardial manifestations compared to adult-onset disease. Lupus, 27(13), pp. 2146-2154. doi:10.1177/0961203318804889.
Chang JC, et al. Child-onset Systemic Lupus Erythematosus Is Associated With a Higher Incidence of Myopericardial Manifestations Compared to Adult-onset Disease. Lupus. 2018;27(13):2146-2154. PubMed PMID: 30318995.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Child-onset systemic lupus erythematosus is associated with a higher incidence of myopericardial manifestations compared to adult-onset disease. AU - Chang,J C, AU - Xiao,R, AU - Mercer-Rosa,L, AU - Knight,A M, AU - Weiss,P F, Y1 - 2018/10/14/ PY - 2018/10/16/pubmed PY - 2019/1/4/medline PY - 2018/10/16/entrez KW - Pediatric systemic lupus erythematosus KW - cardiovascular diseases KW - systemic lupus erythematosus SP - 2146 EP - 2154 JF - Lupus JO - Lupus VL - 27 IS - 13 N2 - OBJECTIVES: There are no population-based estimates of the incidence or risk factors for acute cardiac manifestations in children with systemic lupus erythematosus (SLE) to guide screening and diagnostic imaging practices. We estimated the incidence and prevalence of acute cardiac manifestations of child-onset SLE compared to adult-onset SLE and identified factors associated with cardiac diagnoses. METHODS: We identified children (5-17 years) and adults (18-64 years) with incident SLE (≥3 International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) code 710.0, > 30 days apart) using Clinformatics® DataMart (OptumInsight, Eden Prairie, MN) deidentified United States administrative claims (2000-2013). We calculated incidence and prevalence of three outcomes: ≥ 1 diagnosis code for (1) pericarditis and/or myocarditis, (2) endocarditis, or (3) valvular insufficiency. Negative binomial regression was used to identify characteristics associated with cardiac diagnoses in children and determine whether SLE onset in childhood vs adulthood was independently associated with cardiac involvement. RESULTS: There were 297 children and 6927 adults with new-onset SLE. A total of 17.8% of children had ICD-9 CM codes for acute cardiac diagnoses, the incidence of which were highest in the first year after SLE diagnosis (12.2 per 100 person-years). African American race (incidence rate ratio (IRR) 6.6, 95% confidence interval (CI) (2.9, 15.0), p < 0.01) and nephritis (IRR 7.0, 95% CI (2.6, 18.6), p < 0.01) were associated with acute cardiac diagnoses in children. Child-onset disease was independently associated with a 4.4-fold higher rate of pericarditis or myocarditis compared to adult-onset SLE after adjustment for other disease and demographic characteristics (95% CI (2.4, 8.0), p < 0.01). CONCLUSION: This study establishes baseline estimates of the incidence and prevalence of pericarditis and myocarditis in child-onset SLE, which is substantially higher than that of adult-onset SLE. Prospective echocardiographic evaluations are needed to validate incidence measures and characterize the natural history of acute cardiac manifestations in child-onset SLE, as well as identify risk factors for poor cardiac outcomes to inform screening and management. SN - 1477-0962 UR - https://www.unboundmedicine.com/medline/citation/30318995/Child_onset_systemic_lupus_erythematosus_is_associated_with_a_higher_incidence_of_myopericardial_manifestations_compared_to_adult_onset_disease_ L2 - http://journals.sagepub.com/doi/full/10.1177/0961203318804889?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -