We evaluated spine bone mineral density (BMD) in Brazilian children with juvenile systemic lupus erythematosus (JSLE) in order to detect potential predictors of reduction in bone mass. A cross-sectional study of BMD at the lumbar spine level (L2-L4) was conducted on 16 female JSLE patients aged 6-17 years. Thirty-two age-matched healthy girls were used as control. BMD at the lumbar spine was measured by dual-energy X-ray absorptiometry. Weight, height and pubertal Tanner stage were determined in patients and controls. Disease duration, mean daily steroid doses, mean cumulative steroid doses and JSLE activity measured by the systemic lupus erythematosus disease activity index (SLEDAI) were determined for all JSLE patients based on their medical charts. All parameters were used as potential determinant factors for bone loss. Lumbar BMD tended to be lower in the JSLE patients, however, this difference was not statistically significant (P = 0.10). No significant correlation was observed in JSLE girls between BMD and age, height, Tanner stage, disease duration, corticosteroid use or disease activity. We found a weak correlation between BMD and weight (r = 0.672). In the JSLE group we found no significant parameters to correlate with reduced bone mass. Disease activity and mean cumulative steroid doses were not related to BMD values. We did not observe reduced bone mass in female JSLE.

The objective of the present study was to identify the single photon emission computed tomography (SPECT) and magnetic resonance (MR) findings in juvenile systemic lupus erythematosus (JSLE) patients with CNS involvement and to try to correlate them with neurological clinical history data and neurological clinical examination. Nineteen patients with JSLE (16 girls and 3 boys, mean age at onset 9.2 years) were submitted to neurological examination, electroencephalography, cerebrospinal fluid analysis, SPECT and MR. All the evaluations were made separately within a period of 15 days. SPECT and MR findings were analyzed independently by two radiologists. Electroencephalography and cerebrospinal fluid analysis revealed no relevant alterations. Ten of 19 patients (53%) presented neurological abnormalities including present or past neurological clinical history (8/19, 42%), abnormal neurological clinical examination (5/19, 26%), and abnormal SPECT or MR (8/19, 42% and 3/19, 16%, respectively). The most common changes in SPECT were cerebral hypoperfusion and heterogeneous distribution of blood flow. The most common abnormalities in MR were leukomalacia and diffuse alterations of white matter. There was a correlation between SPECT and MR (P<0.05). We conclude that SPECT and MR are complementary and useful exams in the evaluation of neurological involvement of lupus.

OBJETIVO: Avaliar retrospectivamente as características clínicas dos pacientes com diagnóstico de espondiloartropatia. MÉTODOS: Foram analisados os prontuários de todos os pacientes com diagnóstico de espondiloartropatia seguidos no ambulatório de reumatologia pediátrica da UNIFESP-EPM no período de junho de 1982 a abril de 2000. Foram avaliados a idade de início e tempo de evolução da doença, manifestações clínicas, dados laboratoriais, achados radiológicos, tratamento e evolução. RESULTADOS: Dos 26 pacientes estudados, 10 (38,4%) apresentavam SEA, um (3,8%) espondiloartropatia indiferenciada (EAI), 10 (38,4%) EAJ, dois (7,7%) artropatia da DIIC, dois (7,7%) síndrome de Reiter e um (3,8%) artrite psoriásica. O início da doença variou de 1 a 15 anos (média de 9,2 anos). Os pacientes com síndrome de Reiter tiveram menor idade de início (média de 6,5 anos). Houve predomínio do sexo masculino (25 pacientes) e da raça caucasóide (15 pacientes). A maioria dos pacientes apresentou artrite periférica em membros inferiores (96,1%), entesite (61,5%) e HLA B27 positivo (14/23 - 60,9%). Dez pacientes (38,4%) apresentaram comprometimento axial. Quinze pacientes receberam diagnóstico de ARJ ou FR no início do quadro. CONCLUSÃO: Embora menos freqüentes do que a ARJ, as espondiloartropatias devem ser consideradas no diagnóstico diferencial das crianças e adolescentes, principalmente do sexo masculino, com artrite crônica.

OBJECTIVE: To evaluate retrospectively the clinical features of children and adolescents with spondiloarthropathies (Sps). METHODS: The charts of all Sps patients followed up in the outpatient Pediatric Rheumatology unit of UNIFESP-EPM, were analyzed from June 1982 to April 2000. The following demographic data were evaluated: age of onset, disease duration, clinical features, laboratory data, radiological findings, treatment and outcome. RESULTS: 10 out of 26 patients (38.4%) presented SEA, 1 patient (3.8%) undifferentiated spondiloarthrophaty, 10 (38.4%) JAS, 2 (7.7%) arthropathy related to inflammatory bowel disease, 2 (7.7%) Reiter's syndrome and 1 (3.8%) psoriatic arthritis. The average age at disease onset was 9.2 years (1 to 15 years). The patients with Reiter's syndrome presented lower age at onset (average age 6.5 years). Twenty-five out of 26 were males and 15 out of 26 were caucasians. Most patients presented peripheral arthritis in lower limbs (96.1%), enthesitis (61.5%) and positive HLA-B27 (14/23 -- 60.9%). Ten patients (38.4%) presented axial involvement. Fifteen patients had JRA or RF as diagnosis in the beginning of the disease. CONCLUSION: Although less frequent than JRA, the spondiloarthropathies must be considered in the differential diagnosis of children and adolescents, mainly among male patients with chronic arthritis.

The authors performed a study of bone mass in eutrophic Brazilian children and adolescents using dual-energy X-ray absorptiometry (DXA) in order to obtain curves for bone mineral content (BMC) and bone mineral density (BMD) by chronological age and correlate these values with weight and height. Healthy Caucasian children and adolescents, 120 boys and 135 girls, 6 to 14 years of age, residents of São Paulo, Brazil, were selected from the Pediatric Department outpatient clinic of Hospital São Paulo (Universidade Federal de São Paulo). BMC, BMD and the area of the vertebral body of the L2-L4 segment were obtained by DXA. BMC and BMD for the lumbar spine (L2-L4) presented a progressive increase between 6 and 14 years of age in both sexes, with a distribution that fitted an exponential curve. We identified an increase of mineral content in female patients older than 11 years which was maintained until 13 years of age, when a new decrease in the velocity of bone mineralization occurred. Male patients presented a period of accelerated bone mass gain after 11 years of age that was maintained until 14 years of age. At 14 years of age the mean BMD values for boys and girls were 0.984 and 1.017 g/cm², respectively. A stepwise multiple regression analysis of paired variables showed that the "vertebral area-age" pair was the most significant in the determination of BMD values and the introduction of a third variable (weight or height) did not significantly increase the correlation coefficient.