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  • Open Access

Liver and spleen biometrics in childhood-onset systemic lupus erythematosus patients

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  • 1,
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Pediatric Rheumatology201412 (Suppl 1) :P327

https://doi.org/10.1186/1546-0096-12-S1-P327

  • Published:

Keywords

  • Systemic Lupus Erythematosus
  • Systemic Lupus Erythematosus Patient
  • Disease Activity Index
  • Hepatic Lobe
  • Cumulative Damage

Introduction

Involvement of the reticuloendothelial system occurs in 20-50% childhood-onset systemic lupus erythematosus (c-SLE) patients at disease onset, usually associated with disease activity. Hepatomegaly and/or splenomegaly may also be associated with abnormal liver function tests. Abdominal ultrasound can be used to assess liver and spleen measurements in children and adolescents without risk of radiation. However, a systematic evaluation of these visceral organ dimensions has not been performed in c-SLE population, particularly during the disease course.

Objectives

To evaluate liver and spleen dimensions in c-SLE patients and healthy controls and to assess possible associations between abnormalities in liver and spleen sizes with demographic data, clinical features, disease activity, cumulative damage and treatment.

Methods

30 c-SLE patients and 30 healthy control volunteers underwent abdominal ultrasound. The following two liver measurements were performed in left hepatic lobe: craniocaudal and anteroposterior and three in right hepatic lobe (RHL): posterior craniocaudal (PCC-RHL), anterior craniocaudal and anteroposterior. Three spleen dimension measurements were also evaluated: longitudinal, transverse and anteroposterior. Demographic, clinical and laboratorial data, and treatment were assessed. Disease activity was evaluated according to SLE Disease Activity Index 2000 (SLEDAI-2K), European Consensus Lupus Activity Measurement (ECLAM) and Systemic Lupus Activity Measure (SLAM) scores.

Results

Mean current age was similar in c-SLE and controls (170.31 ± 27.81 vs. 164.15 ± 39.25 months; p=0.486), likewise the frequency of female gender (77% vs. 63%, p=0.398). The mean of PCC-RHL dimension was significantly higher in c-SLE compared to controls (13.30 ± 1.85 vs. 12.52 ± 0.93, p=0.044). There were no differences between the other hepatic biometrics and splenic parameters (p>0.05). Further analysis in c-SLE patients according to PCC-RHL dimension > 13.3 cm (mean of this biometric measurement in 30 c-SLE patients) versus < 13.3 cm showed that the median of SLEDAI-2K [8 (0-18) vs. 2 (0-8), p=0.004], ECLAM [4 (0-9) vs. 2 (0-5), p=0.019] and SLAM [5 (1-13) vs. 2 (0-14), p=0.016] were significantly higher in patients with higher PCC-RHL dimension, likewise the mean of erythrocyte sedimentation rate (33.7 ± 16 vs. 22.0 ± 13 mm/1st hour, p=0.038). The frequencies of nephritis were significantly higher in patients with PCC-RHL dimension > 13.3 cm versus < 13.3 cm (77% vs. 29%, p=0.010). The median of serum liver enzymes were similar in both groups (p>0.05). Positive correlation was observed between SLEDAI-2K and PCC-RHL (p=0.001, r=+0.595). Negative correlation was evidenced between disease duration and longitudinal dimension of spleen (p=0.031, r=- 0.394).

Conclusion

Our data raises the novel possibility that disease activity could lead to a subclinical and localized hepatomegaly during the disease course. Long disease duration resulted to spleen atrophy in c-SLE patients.

Disclosure of interest

A. Guariento: None declared, M. F. Silva: None declared, P. S. F. Tassetano: None declared, S. M. Rocha: None declared, L. M. Campos: None declared, M. Valente: None declared, C. Silva Grant / Research Support from: This study was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP - grants 2008/58238-4 to CAS), by Conselho Nacional do Desenvolvimento Científico e Tecnológico (CNPQ – grant 302724/2011-7 to CAS), by Federico Foundation to CAS and by Núcleo de Apoio à Pesquisa “Saúde da Criança e do Adolescente” da USP (NAP-CriAd).

Authors’ Affiliations

(1)
Pediatric Rheumatology Division, Faculdade De Medicina Da Universidade De São Paulo, São Paulo, SP, Brazil
(2)
Pediatric Radiology Department, Faculdade De Medicina Da Universidade De São Paulo, São Paulo, SP, Brazil

Copyright

© Guariento et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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