Puja Srivastava

Childhood onset systemic lupus erythematosus: how is it different from adult SLE?

About 20% of systemic lupus erythematosus (SLE) starts in childhood and children have less gender bias in favor of females as compared to adults. Systemic manifestations, nephritis, neuro‐psychiatric disease and cytopenias are more common in children at presentation than adults. Since most children develop lupus in their early adolescence, dealing with the diagnosis of an unpredictable lifelong disease during this phase of life is challenging. Physicians must recognise specific medical and social needs of this age group, for optimal long‐term outcome. Steroids and immunosuppressive drugs are the cornerstone for treatment in children as with adults with lupus. The outcome has improved considerably with these drugs and 10‐year survival is nearly 90%. Due to longer life spans more damage accrues in children as compared to adults. Most of the drugs are associated with significant toxicity and the goal of having a drug which reduces disease activity and damage without hampering normal growth, development and fertility is still an elusive one. The current review focuses on clinical and immunological aspects of childhood SLE and how it differs from adulthood SLE.

Assesment of efficacy of local steroid injection for heel enthesitis in patients with seronegative spondyloarthropathy: A serial ultrasound study

Introduction: Corticosteroid injection for heel enthesitis in SpA is controversial. We studied soft tissue changes at symptomatic heel enthesitis, by ultrasound examination and compared VAS pain score and USG findings, at baseline and 6 weeks after local corticosteroid injection. Methods: SpA patients with symptomatic heel enthesitis, refractory to 6 weeks of full dose NSAIDs, were offered local corticosteroid injection. Heel entheses were examined by USG before and 6 weeks after injection. Standard OMERACT definitions were used to define enthesitis, Achilles tendon >5.2 mm and plantar fascia >4.4 mm thick at 2 cm proximal to insertion, were considered thickened). Results: Forty two symptomatic entheses were examined by USG in 32 patients, which included 22 right and 16 left tendoachilles, 1 right and 3 left plantar fascia. Mean age of patients was 29.2 years, 29 were males. Cohort included 17 patients with Ankylosing SpA, 7 with JIA-ERA and 2 each with IBD associated Arthritis, PsA, ReA and Undifferentiated SpA. Sixweek followup (post-injection)wasavailable for 26patients.All patients reported improvement in Pain on VAS after injection (p<0.0001), which correlated with USG findings. There was significant reduction in entheseal thickness (p<0.0001), power Doppler signal (p<0.0001), peritendinous edema (p1⁄40.002), bursitis and bursal vascularity (p1⁄40.003 and <0.0001 respectively). There was no change in bone erosions and enthesophytes. None of the patients had injection related complications at 6 weeks of follow up. Conclusions: This study confirms the clinical and sonographic efficacy of local steroid injection for refractory heel enthesitis in patients with SpA