Juvenile onset systemic lupus erythematosus thyroid dysfunction: A subgroup with mild disease? Luciana Parente Costa a , Eloisa Bonfa ´ a , Ciro D. Martinago b , Ricardo M. de Oliveira b , Joze ´ lio Freire Carvalho a , Rosa M.R. Pereira a, * a Rheumatology Division, e Faculdade de Medicina da Universidade de Sa ˜o Paulo, Sa ˜o Paulo, SP, Brazil b RDO Diagnosticos Medicos, Sa ˜o Paulo, SP, Brazil article info Article history: Received 17 November 2008 Received in revised form 31 March 2009 Accepted 12 April 2009 Keywords: Juvenile systemic lupus erythematosus Childhood systemic lupus erythematosus Thyroid Hypothyroidism Autoimmunity abstract The aim of this study was to evaluate the frequency of thyroid dysfunction and thyroid antibodies in patients with juvenile onset Systemic Lupus Erythematosus (JOSLE) and its association with clinical and immunological features. Seventy-seven patients with JOSLE, 64 females, median age 19 years, were consecutively enrolled from March to December 2007. Clinical data related to thyroid dysfunction and lupus were obtained by chart review and patient interview. Serum levels of TSH, free T4, anti-thyro- globulin (TgAb), anti-thyroperoxidase (TPOAb), TRAb and lupus related autoantibodies were analyzed by standard techniques. Nine patients were diagnosed as hypothyroidism and 4 hyperthyroidism. 28% JOSLE patients had moderate/high titer of thyroid antibodies: 23% TgAb, 2.6% TPOAb and 3.9% TRAb. JOSLE patients with positive thyroid autoantibodies had higher frequency of anti-U1RNP antibodies than patients without these antibodies (40.9 vs. 14.5%, OR:0.25, CI:0.08–0.76, p ¼ 0.017). Furthermore, renal/ neurological/hematological involvement was less frequently observed in patients with hypothyroidism (55.6 vs. 87.5%, OR:0.18, CI:0.04–0.81, p ¼ 0.035) and with thyroid antibodies (68.4 vs. 90.9%, OR:0.22, CI:0.06–0.82, p ¼ 0.027) than in patients without these alterations. No association with PTPN22 poly- morphism was found. In conclusion, JOSLE patients have high prevalence of subclinical hypothyroidism. The novel association of anti-thyroid antibodies with anti-U1RNP antibodies in JOSLE seems to identify a subgroup of patients with less life-threatening organ involvement. Ó 2009 Elsevier Ltd. All rights reserved. 1. Introduction Systemic lupus erythematosus is a chronic autoimmune disease characterized by involvement of virtually any system and organ specific autoimmune disorders have also been described [1–11]. In fact, thyroid dysfunction is more prevalent in adult lupus with a described prevalence of hypothyroidism and hyperthyroidism varying from 3.9 to 39% and 0 to 10.9%, respectively [1–11]. More- over, several studies have demonstrated a higher prevalence of positive anti-thyroglobulin and thyroid peroxidase antibodies in patients with adult lupus than in the general population, even in those who do not have clinical thyroid disease [9,12,13]. Few studies have focused in thyroid involvement in juvenile onset systemic lupus erythematosus and results are still contro- versial [14–16]. We therefore have evaluated the frequency of thyroid dysfunction and the presence of thyroid antibodies in patients with juvenile onset systemic lupus erythematosus (JOSLE) and its possible association with clinical and immunological features. 2. Patients and methods Seventy-seven patients who fulfilled American College of Rheumatology (ACR) criteria [17] for the diagnosis of SLE were consecutively enrolled at the Juvenile Rheumatology Outpatient, University of Sa ˜o Paulo, Clinics Hospital, from March to December 2007. Only patients with disease onset before 16-year-old were included. All patients were interviewed and additional data were obtained by an extensive chart review. Information about age at diagnosis, disease duration, personal and family history of autoimmune * Corresponding author at: Faculdade de Medicina da Universidade de Sa ˜o Paulo, Av. Dr. Arnaldo, 455, 3 andar, Reumatologia, sala 3107, Sa ˜o Paulo, SP 01246-903, Brazil. Tel.: þ55 11 30617213, þ55 11 30617490; fax: þ55 11 30617490. E-mail addresses: lucianapc@gmail.com (L. Parente Costa), rosamariarp@ yahoo.com (R.M.R. Pereira). Contents lists available at ScienceDirect Journal of Autoimmunity journal homepage: www.elsevier.com/locate/jautimm 0896-8411/$ – see front matter Ó 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.jaut.2009.04.001 Journal of Autoimmunity 33 (2009) 121–124