Endothelial function analysis and atherosclerotic risk factors in adolescents with systemic lupus erythematosus.

UNLABELLED: Atherosclerosis is considered an important cause of morbidity and mortality in systemic lupus erythematosus (SLE). Endothelial dysfunction represents an important factor in the onset of atherosclerosis. OBJECTIVE: To assess endothelial function and the risk factors for atherosclerosis in adolescents with SLE. SUBJECTS: Thirty-five adolescents with SLE aged between 10-18 years and 27 age- and sex-matched controls. METHODS: Endothelial function was assessed using a high-resolution ultrasound device (Philips ATL, HDI-3000 model) with a linear array transducer (4.0-7.0 MHz). Measures of diameter and flow were performed at rest, during reactive hyperemia and after glyceryl trinitrate. Total cholesterol and fractions, triglycerides, creatinine, fasting glucose, anticardiolipin antibodies, lupus anticoagulant and plasma homocysteine, as well as, cumulative oral corticoid dose were considered in order to establish the risk factors for atherosclerosis. RESULTS: No significant difference was found between the two groups regarding endothelial function. Although dilation at 90" after cuff deflation had been smaller in patients than in controls, the difference was not statistically significant. Patients had higher levels of total cholesterol (p = 0.02), VLDL (p = 0.01), triglycerides (p = 0.01), and homocysteine (p < .001) compared with controls. Sixty eight percent of our patients showed hyperhomocysteinemia, yet, we did not find any correlation between these values and flow-mediated dilation. CONCLUSION: According to our results, adolescents with SLE do not present alterations in endothelial function as assessed by ultrasound. However, these patients did demonstrate risk factors such as dyslipidemia and hyperhomocysteinemia for the development of atherosclerosis.

Takayasu's arteritis in children and adolescents: report of three cases.

Takayasu's arteritis (TA) is a systemic vasculitis that affects mainly the aorta and its major branches. Despite being the third most frequent vasculitis in childhood, the occurrence of TA in the pediatric age group is scarce. We report three cases of TA in children, emphasizing signs and symptoms, angiographic alterations and therapeutics.

[Hyperhomocysteinemia in children and adolescents with systemic lupus erythematosus: evolutive evaluation]. / Hiperhomocisteinemia em crianças e adolescentes com lúpus eritematoso sistêmico: avaliação evolutiva.

INTRODUCTION: One of the mechanisms implicated in the pathogenesis of coronary heart disease in patients with juvenile systemic lupus erythematosus (SLE) is the hyperhomocysteinemia. Our aim was to follow patients with juvenile SLE and to identify the presence and the persistence of hyperhomocysteinemia. METHODS: We studied 18 patients with juvenile SLE (median age 13.5 y). A survey of demographic and clinic data was performed based on patients records. The plasma homocysteine concentration was performed twice with a median interval of 1.5 years (1.3-2.5) and association with nutritional status, disease activity, renal involvement and use of methotrexate was sought. The plasma homocysteine concentration was also evaluated in 59 healthy controls, sex and age-matched to the patients. RESULTS: Of the 18 patients with juvenile SLE, 16 (88.9%) were female and 13 (72.2%) had renal involvement. Five out of 18 patients (27.8%) persisted with increased concentration of plasma homocysteine (above the 90th percentile of the healthy group). The elevated concentration of homocysteine did not show statistically significant association neither with renal involvement (in the first dosage, p=0.676 and in the second, p=0.500), disease activity (in the first dosage, p=0.630 and in the second, p=0.182), overweight/obesity (in the first dosage, p=0.485 and in the second, p=0.288) nor with short stature (in the first dosage, p=0.202 and in the second, p=0.500). CONCLUSION: This study emphasizes the persistence of elevated concentration of homocysteine in some patients with juvenile SLE and the need for evaluations of therapeutic strategies and nutritional education aiming to reduce risk factors of cardiovascular disease.

Arterite de Takayasu na infância e na adolescência: relato de três casos / Takayasu's arteritis in children and adolescents: report of three cases

A arterite de Takayasu (AT) é uma vasculite sistêmica que acomete principalmente a aorta e seus ramos. Apesar de ser a terceira vasculite mais frequente na infância, sua ocorrência na faixa etária pediátrica é pouco descrita. Relatamos três casos de AT na faixa etária pediátrica com ênfase nas manifestações clínicas, alterações angiográficas e abordagem terapêutica.

Takayasu's arteritis (TA) is a systemic vasculitis that affects mainly the aorta and its major branches. Despite being the third most frequent vasculitis in childhood, the occurrence of TA in the pediatric age group is scarce. We report three cases of TA in children, emphasizing signs and symptoms, angiographic alterations and therapeutics.