Tsung-Chieh Yao

Associations of Age, Gender, and BMI with Prevalence of Allergic Diseases in Children: PATCH Study

Background. Little is known about the prevalence of allergic diseases in children of different ages. This study aimed to investigate the prevalence of allergic diseases and allergic sensitization in children over a wide age range, with emphasis on the influence of age, gender, and body mass index (BMI). Methods. In a cross-sectional study, we assessed 5351 Taiwanese children aged 4–18 years using an International Study of Asthma and Allergies in Childhood questionnaire, BMI, and total and specific serum immunoglobulin E. Results. Forty-eight percent were currently symptomatic for at least one of three allergic diseases. Prevalence of wheeze ever, current wheeze, and diagnosed asthma were 17.0%, 7.5%, and 9.8%, respectively; analogous features for rhinitis were 47.8%, 44.2%, and 39.8%. Allergic sensitization was very common (57.3%). Half of the children (50.6%) with current wheeze had not been diagnosed with asthma by physicians, whereas undiagnosed rates were 32.3% for rhinitis and 25.3% for eczema. The male-to-female prevalence ratios of current wheeze increased with age from <1 at 4–5 years, peaked at 10–11 years (2.24), then reversed to 0.57 at 16–18 years. Childhood wheezing tended to remit with age, but rhinitis and eczema were more persistent. Total immunoglobulin E levels increased with age until 14–15 years, and declined thereafter. Elevated BMI was associated with greater prevalence of wheezing and eczema, with no evidence of significant effect modification by either gender or age. Multivariate analyses revealed that younger age, boys, and obesity were significantly and independently associated with current wheezing in children (all p < .01). Conclusions. The burden and co-morbidity of childhood allergies are substantial. There are striking age-dependent gender differences in asthma prevalence, exhibiting an inverted U-shaped curve for male-to-female prevalence ratios by age. Obesity is associated with a greater prevalence of asthma in children with no evidence of a significant modulation by either gender or age.

Pediatric lupus in Asia

Of all patients with systemic lupus erythematosus (SLE), 15—20% are diagnosed during childhood, with disease onset prior to the age of 16 years. Because disease expression in SLE is influenced by environment factors and differs between racial and ethnic groups. The aims of this review were to describe prevalence, clinical manifestations, common infectious complications, and outcome of pediatric-onset SLE in Asia. The prevalence of pediatric-onset SLE was 6.3—19.3 per 100,000 in Asia. The ratio of female to male was 4.7—6.2. The mean age at diagnosis of pediatric-onset SLE was 8.6—13.5 years. The most common clinical features of pediatric-onset SLE in Asia were cutaneous rashes, arthritis, hematological involvement and nephritis. The occurrence of nephritis varies from 29% to 81%. The most common histopathology of lupus nephritis was diffuse proliferative glomerulonephritis (WHO Class-IV) which occurred in 39.4—54% of case of lupus nephritis. Pediatric-onset SLE patients with infections have poor outcomes than uninfected patients. Gram-negative bacilli are the most common microorganisms responsible for bacteremia in Asian patients with SLE. Recurrent major infections predict poorer disease outcome and associated organ damage in pediatric-onset SLE. Improving the survival of SLE patients was reported in Asia in recent decades. The survival was 92% at the age of 5 years, 86% at 10 years and 79% at 15 years in children with SLE in Taiwan in 2008.

Acute pancreatitis in pediatric and adult-onset systemic lupus erythematosus: A comparison and review of the literature

This study aimed to compare differences of acute pancreatitis between adult- and pediatric-onset systemic lupus erythematosus (SLE) patients and to clarify the risk factors for mortality. Medical records that carried the dual diagnosis of SLE and acute pancreatitis between 1991 and 2005 were reviewed. Forty-eight episodes of acute pancreatitis were identified in 13 pediatric-onset SLE (pSLE) and 27 adult-onset SLE (aSLE) patients. The prevalence was 1.34% overall, with higher prevalence in pSLE (5.22%) compared with aSLE (0.99%) (p < 0.001). The SLEDAI score on presentation of acute pancreatitis was higher in pSLE (mean ± SD: 21.77 ± 13.09) than in aSLE patients (13.37 ± 8.32) (p = 0.05). Eleven patients died during episodes of acute pancreatitis and mortality rate was significantly higher in pSLE than in the aSLE group (53.8% and 14.8%, respectively, p = 0.015). Mortality was associated with concurrent SLE symptoms (p = 0.049), higher SLEDAI score at presentation of acute pancreatitis (p = 0.011), severe acute pancreatitis (p < 0.001), and the presence of complications (p < 0.001). The multivariate logistic regression analysis showed that severity of acute pancreatitis was the most powerful risk factor for mortality in SLE patients with this disease. In summary, our results indicate that acute pancreatitis occurs more frequently, tends to be more severe, and is associated with higher mortality in pSLE patients when compared with aSLE patient.

Clinical features of children with juvenile idiopathic arthritis using the ILAR classification criteria: A community-based cohort study in Taiwan

BACKGROUND/PURPOSE The aim of the study was to describe the clinical features of children affected by juvenile idiopathic arthritis (JIA) under the International League of Associations for Rheumatology-derived classification criteria in a community-based setting. METHODS Consecutive cases of JIA from defined geographic areas of Taiwan were diagnosed and followed in an observational cohort from 1995 to 2010. In addition to the clinical and laboratory data required for the International League of Associations for Rheumatology system, information about the medication and disease activity during the study period was also recorded. RESULTS Out of 292 children with chronic joint pain, 195 were diagnosed as JIA: systemic arthritis (19%), oligoarthritis (persistent 16.4%; extended 6.7%), polyarthritis rheumatoid factor-negative (11.8%), polyarthritis rheumatoid factor-positive (4.6%), psoriatic arthritis (1.5%), enthesitis-related arthritis (ERA; 37.4%), and undifferentiated arthritis (2.6%). Human leukocyte antigen-B27 was positive in 82.2% of patients with ERA. Uveitis was observed in 6.7% of patients. Disease-modifying anti-rheumatic drugs, including biologic medications, were used in 73.3% of children during the observational period. At the last follow-up, 40% of patients experienced a continuously active or relapsing course. CONCLUSION Compared with previous reports on Western populations, a remarkably high prevalence was found in the ERA of the Chinese cohort, but a relatively low rate of uveitis. Ongoing disease activity was evident in a substantial number of children. These results provided a good starting point in understanding the epidemiology of this serious disease in the Chinese population.

Association of RANTES Promoter Polymorphism With Juvenile Rheumatoid Arthritis

OBJECTIVE We recently reported that RANTES was a key molecule in the pathogenesis of juvenile rheumatoid arthritis (JRA) in a longitudinal cohort. This study was undertaken to investigate genetic associations between the RANTES -28 C/G and -403 G/A polymorphisms and JRA in a well-documented cohort of patients who were followed up prospectively. METHODS Patients with JRA (n = 107) and healthy children (n = 139) were genotyped through use of a polymerase chain reaction-based assay. Association of the RANTES promoter polymorphisms with results of laboratory tests, clinical variables, outcome after clinical remission, and response to intraarticular triamcinolone injection was evaluated in patients who were followed up for >1 year. RESULTS JRA patients had a significantly higher frequency of the RANTES -28 G/G genotype, as compared with ethnically matched healthy controls. The RANTES -28 C/G polymorphism was associated with the duration of clinical remission, with patients carrying the RANTES -28G allele experiencing only 49% of the duration of remission experienced by patients who were RANTES -28 C/C homozygous. The RANTES -28 C/G polymorphism was associated with the duration of clinical response to intraarticular triamcinolone injection, with patients carrying the RANTES -28G allele showing shorter duration of clinical response. No significant association between the RANTES -403 G/A polymorphism and JRA was found in this Chinese population. CONCLUSION Our findings indicate that the RANTES -28 C/G polymorphism represents a genetic risk factor for JRA. It is noteworthy that this RANTES promoter polymorphism was also associated with an early relapse of disease after clinical remission and a shorter duration of clinical response to intraarticular administration of corticosteroids.

Differences in Disease Features Between Childhood-Onset and Adult-Onset Systemic Lupus Erythematosus Patients Presenting with Acute Abdominal Pain

OBJECTIVE Abdominal pain in systemic lupus erythematosus (SLE) patients has rarely been analyzed in pediatric populations. We planned to investigate the potential differences between childhood-onset and adult-onset SLE patients who were hospitalized because of acute abdominal pain. METHODS A retrospective study including 23 childhood-onset SLE patients with 38 admissions and 88 adult-onset SLE patients with 108 admissions from 1999 to 2008 were conducted in our hospital. All of them had the chief complaint of diffuse abdominal pain. RESULTS The etiologies of acute abdominal pain in adult-onset SLE patients were more diverse than childhood-onset SLE patients. The most common cause of acute abdominal pain in SLE patients was lupus mesenteric vasculitis (LMV) (18.5%), followed by acute gastroenteritis (14.4%), pancreatitis (10.3%), appendicitis (7.5%), and cholecystitis (6.2%). Compared with adults, children were admitted more often due to LMV (31.6% versus 13.9%; P = 0.016), had more frequently recurrent episodes (39.1% versus 14.8%; P = 0.009), and were more often treated with immunosuppressive agents (31.6% versus 7.4%; P < 0.001) at the time of admission. The overall case fatality rate of acute abdomen in SLE patients was 9.4%. The extra-gastrointestinal symptoms, laboratory evaluation, disease activity, and organ damage measured by the SLE Disease Activity Index and outcomes were comparable between children and adults. CONCLUSIONS Various etiologies of acute abdominal pain should be considered in SLE patients. LMV is the most common cause of acute abdomen in childhood-onset SLE patients with low mortality and morbidity provided by prompt diagnosis and timely administration of high-dose intravenous corticosteroids after excluding real surgical abdomen.

MCP‐1 gene regulatory region polymorphism in Chinese children with mild, moderate and near‐fatal asthma

Background:  A polymorphism in the monocyte chemoattractant protein 1 (MCP‐1) gene regulatory region has been associated with asthma in Caucasians. This polymorphism is possibly endemic to the Asian region, but its impact on Asian populations is unclear. In addition, the relationship of this marker with life‐threatening asthma has not been clarified. The aim of this study was to test the genetic association between the MCP‐1 –2518A/G polymorphism and asthma/atopy in a cohort of Chinese children, with particular emphasis on those patients who had experienced life‐threatening asthma attacks.

Association of disease activity and anti-rheumatic treatment in juvenile idiopathic arthritis with serum lipid profiles: a prospective study.

OBJECTIVES Patients with juvenile idiopathic arthritis (JIA) have abnormal serum lipid profiles. This study aimed to explore the association of disease activity and anti-rheumatic treatment with serum lipid profiles in a JIA cohort. METHODS Fifty-eight patients newly diagnosed with JIA who had not been treated with corticosteroids or disease-modifying anti-rheumatic drugs were enrolled. We measured their serum lipid profiles at baseline and 18 months later, and determined whether there were differences in lipid levels and atherogenic indices between patients who were in inactive disease and those who were not. For a case-control comparison at 18 months, control subjects from a population-based study cohort (NAHSIT study) were selected. RESULTS Thirty-one of the 58 patients achieved inactive disease status after 18-month treatment. In these patients, high-density lipoprotein cholesterol (HDL-C) and total cholesterol (TC) levels increased significantly (p = 0.001 and p = 0.044); whereas the ratios of low-density lipoprotein cholesterol (LDL-C) to HDL-C and TC to HDL-C decreased with borderline significance (p = 0.066 and p = 0.080). The overall changes in HDL-C levels, LDL-C/HDL-C and TC/HDL-C ratio between baseline and 18 months were correlated with those in C-reactive protein levels (p = 0.005, p = 0.001, and p = 0.002, respectively). There were also significant differences among inactive, active and control subjects in HDL-C and TC levels (p = 0.021 and p = 0.013) but not in LDL, LDL-C/HDL-C, TC/HDL-C ratio, and triglyceride levels. CONCLUSIONS Abnormal lipid levels and atherogenic indices were associated with disease activity in JIA and improved substantially following effective anti-rheumatic treatment. This improvement may reduce the risk of cardiovascular disease in JIA.

The outcome of patients with renal involvement in pediatric-onset systemic lupus erythematosus – a 20-year experience in Asia

Systemic lupus erythematosus (SLE) predominantly affects women of childbearing age, but 15–20% of cases are diagnosed during childhood. It is important for physicians to understand the epidemiology and clinical presentation for early detection and diagnosis of this disease in difference races. The aim of this retrospective review was to provide a 20-year experience for initial clinical and laboratory manifestations and outcomes in pediatric-onset SLE (pSLE) in a medical center in Asia. We reviewed medical records between April 1990 and June 2012 of patients with a diagnosis of International Classification of Diseases, Ninth Revision (ICD-9) code 710.0 (SLE), who admitted or received follow-up in the Department of Pediatrics at Chang Chung Memorial Hospital. Patients with a diagnosis of SLE prior to their 18th birthday and followed up at our hospital were eligible for inclusion in this study. Medical records regarding age, gender, date of birth and diagnosis, clinical manifestations at diagnosis, laboratory results, image studies and the classification criteria were reviewed. Patients received regular outpatient department follow-up and laboratory survey every 1–6 months. The study cohort consisted of 189 patients; 164 females (86.87%) and 25 males (13.23%). The overall mean age at pSLE diagnosis was 12.62 ± 2.77 years. The most common clinical symptom was malar rash, followed by arthritis and oral ulcers. There was no significant difference in clinical and laboratory manifestations between females and males. More than half of the patients presented with renal involvement initially. The most common histological finding was Class IV lupus nephritis (LN), especially in males (p = 0.034) and young age. Even with severe LN, the rate of end-stage renal disease (ESRD) was low if adequate treatment was initiated. The 5, 10 and 15-year ESRD-free survival rates were 95.4%, 94.0% and 89.9% in patients with biopsy-proven LN. However, infection was the leading cause of mortality. Therefore, aggressive treatment for major organ involvement is important, but physicians must also be aware of fatal infection. The overall survival rates were 5 years: 93.4% and 10–20 years: 89.6%.

LACK OF ASSOCIATION OF MANNOSE-BINDING LECTIN GENE POLYMORPHISMS WITH DEVELOPMENT AND CLINICAL MANIFESTATIONS OF SYSTEMIC LUPUS ERYTHEMATOSUS IN CHINESE CHILDREN

Mannose-binding lectin (MBL) gene polymorphisms may be associated with adult-onset systemic lupus erythematosus (SLE), but studies in children with SLE are rare. This study tested the genetic association between MBL polymorphisms and paediatric-onset SLE in a cohort of Chinese children in Taiwan. In all 150 children with SLE and 100 healthy controls of comparable age were genotyped for codon 52, 54 and 57 mutations of the MBL gene using a polymerase chain reaction–based assay. Clinical manifestations, organ involvement, disease activity, laboratory characteristics and outcome were recorded and compared between patients with different MBL genotypes. Codon 54 mutation was fairly common in both SLE patients and controls, whereas codon 52 and codon 57 mutations were not detected in our study subjects. No statistically significant differences were found in allele frequencies of the codon 54 mutation between SLE and control groups. Moreover, no association was found between this MBL polymorphism and clinical manifestations, organ involvement, disease activity, laboratory characteristics or outcome of SLE. These results suggest that MBL polymorphisms do not influence susceptibility to paediatric-onset SLE and do not influence clinical manifestations of SLE in Chinese children.