Skip to main content

Advertisement

SpringerLink
Log in

Rheumatic diseases in Syrian refugee children: a retrospective multicentric study in Turkey

  • Observational Research
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

Since the Syrian civil war in 2011, an estimated number of 3.6 million Syrian refugees crossed into Turkey, and almost half of them were children. The distribution of rheumatic diseases in Syrian refugee children is not known. The aim of this study was to describe the profile of rheumatic diseases in Syrian refugee children living in Turkey. The demographic data, clinical and laboratory findings, medications, complications and outcome results of Syrian refugee children who had visited Pediatric Rheumatology Departments of University of Health Science Kanuni Sultan Süleyman Research and Training Hospital, Ümraniye Research and Training Hospital, Şanlıurfa Research and Training Hospital, and Cengiz Gökçek Maternity and Gynecology Hospital between April 1, 2011, and September 1, 2019, were evaluated retrospectively. A total of 151 patients were included in the study. Among them, 51 patients had juvenile idiopathic arthritis (JIA), 49 had familial Mediterranean fever (FMF), 43 had vasculitis, and 8 had connective tissue diseases. Homozygous M694V mutation was the most common mutation among FMF patients. Oligoarticular JIA (41.2%) was the most frequent type of JIA, and enthesitis-related arthritis (ERA) (27.5%) was the second one. The frequency of systemic JIA was 11.8%. One patient with SLE died due to complicated meningitis. This is the first study evaluating the distribution of rheumatic diseases in Syrian refugee children. Clinical follow-up of rheumatologic diseases is difficult in Syrian refugees due to language barriers, social and cultural differences. Health care systems should be well organized to provide appropriate care to asylum seekers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. United Nations Refugee Agency (2019) Inter-agency Information Sharing Portal https://data.unhcr.org/syrianrefugees/country. Accessed 5 Sep 2019

  2. TC Başbakanlık Afet ve Acil Durum Yönetimi Başkanlığı. https://www.afad.gov.tr/upload/Node/25337/xfiles/17aTurkiye_deki_Suriyelilerin_Demografik_Gorunumu_Yasam_Kosullari_ve_Gelecek_Beklentilerine_Yonelik_Saha_Arastirmasi_2017.pdf

  3. Karadag M, Gokcen C, Dandil F, Calisgan B (2018) Our experience with Syrian refugee patients at the child and adolescent psychiatry clinic in Gaziantep, Turkey. Int J Psychiatry Clin Pract 22(2):157–159

    Article  PubMed  Google Scholar 

  4. Akbalik Kara M, Demircioglu Kilic B, Col N, Ozcelik AA, Buyukcelik M, Balat A (2017) Kidney disease profile of Syrian refugee children. Iran J Kidney Dis 11(2):109–114

    PubMed  Google Scholar 

  5. Al-Ammouri I, Ayoub F (2016) Heart disease in Syrian refugee children: experience at Jordan University Hospital. Ann Glob Health 82(2):300–306

    Article  PubMed  Google Scholar 

  6. Ozcan PY (2019) Retinopathy of prematurity among Syrian refugees: incidence and severity. Middle East Afr J Ophthalmol 26(1):7–10

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kandemir H, Karatas H, Ceri V, Solmaz F, Kandemir SB, Solmaz A (2018) Prevalence of war-related adverse events, depression and anxiety among Syrian refugee children settled in Turkey. Eur Child Adolesc Psychiatry 27(11):1513–1517

    Article  PubMed  Google Scholar 

  8. Gungor A, Catak AI, Cuhaci Cakir B, Oden Akman A, Karagol C, Koksal T et al (2018) Evaluation of Syrian refugees who received inpatient treatment in a tertiary pediatric hospital in Turkey between January 2016 and August 2017. Int Health 10(5):371–375

    Article  PubMed  Google Scholar 

  9. Warrington P, Tyrrell G, Choy K, Eisenbeis L, Long R, Cooper R (2018) Prevalence of latent tuberculosis infection in Syrian refugees to Canada. Can J Public Health 109(1):8–14

    Article  PubMed  PubMed Central  Google Scholar 

  10. Savas N, Barutcu G, Yeniceri A (2018) Evaluation of purified protein derivatives test at tuberculosis dispensary in Hatay, Turkey, applied to Turks and Syrian refugees (2012–2015). Cent Eur J Public Health 26(4):247–252

    Article  PubMed  Google Scholar 

  11. Yalcinkaya F, Ozen S, Ozcakar ZB, Aktay N, Cakar N, Duzova A et al (2009) A new set of criteria for the diagnosis of familial Mediterranean fever in childhood. Rheumatology (Oxford) 48(4):395–398

    Article  Google Scholar 

  12. Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J et al (2004) International league of associations for rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 31(2):390–392

    PubMed  Google Scholar 

  13. Petri M, Orbai AM, Alarcon GS, Gordon C, Merrill JT, Fortin PR et al (2012) Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum 64(8):2677–2686

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ozen S, Pistorio A, Iusan SM, Bakkaloglu A, Herlin T, Brik R, et al. EULAR/PRINTO/PRES criteria for Henoch–Schonlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: Final classification criteria. Ann Rheum Dis. 2010;69(5):798–806.

  15. TC İçişleri Bakanlığı Göç İdaresi Genel Müdürlüğü https://www.goc.gov.tr/gecici-koruma5638

  16. Jarjour RA (2010) Familial Mediterranean fever in Syrian patients: MEFV gene mutations and genotype-phenotype correlation. Mol Biol Rep 37(1):1–5

    Article  CAS  PubMed  Google Scholar 

  17. Jarjour RA, Al-Berrawi S (2015) Familial Mediterranean fever in Syrian children: phenotype-genotype correlation. Rheumatol Int 35(4):629–634

    Article  PubMed  Google Scholar 

  18. Mattit H, Joma M, Al-Cheikh S, El-Khateeb M, Medlej-Hashim M, Salem N et al (2006) Familial Mediterranean fever in the Syrian population: gene mutation frequencies, carrier rates and phenotype-genotype correlation. Eur J Med Genet 49(6):481–486

    Article  PubMed  Google Scholar 

  19. Gumus E. The Frequency of MEFV Gene Mutations and Genotypes in Sanliurfa Province, South-Eastern Region of Turkey, after the Syrian Civil War by Using Next Generation Sequencing and Report of a Novel Exon 4 Mutation (I423T). J Clin Med. 2018;7(5).

  20. Al-Alami JR, Tayeh MK, Najib DA, Abu-Rubaiha ZA, Majeed HA, Al-Khateeb MS et al (2003) Familial Mediterranean fever mutation frequencies and carrier rates among a mixed Arabic population. Saudi Med J 24(10):1055–1059

    PubMed  Google Scholar 

  21. Demirkaya E, Ozen S, Sozeri B, Ayaz NA, Kasapcopur O, Unsal E et al (2018) The Turkish version of the Juvenile Arthritis Multidimensional Assessment Report (JAMAR). Rheumatol Int 38(Suppl 1):395–402

    Article  PubMed  PubMed Central  Google Scholar 

  22. Cakan M, Aktay-Ayaz N, Keskindemirci G, Ekinci DY, Karadag SG (2017) Subtype frequencies, demographic features, and remission rates in juvenile idiopathic arthritis—265 cases from a Turkish center. Turk J Pediatr 59(5):548–554

    Article  PubMed  Google Scholar 

  23. Demirkaya E, Ozen S, Bilginer Y, Ayaz NA, Makay BB, Unsal E et al (2011) The distribution of juvenile idiopathic arthritis in the eastern Mediterranean: results from the registry of the Turkish Paediatric Rheumatology Association. Clin Exp Rheumatol 29(1):111–116

    PubMed  Google Scholar 

  24. El Miedany Y, El Mikkawy DME, Youssef SS, El Gaafary M, Nassar N, Consolaro A et al (2018) The Egyptian Arabic version of the Juvenile arthritis multidimensional assessment report (JAMAR). Rheumatol Int 38(Suppl 1):155–161

    Article  PubMed  PubMed Central  Google Scholar 

  25. Al-Abrawi S, Al-Mayouf SM, Abdwani R, Abdalla E, Consolaro A, Bovis F et al (2018) The Omani arabic version of the Juvenile arthritis multidimensional assessment report (JAMAR). Rheumatol Int 38(Suppl 1):299–306

    Article  PubMed  PubMed Central  Google Scholar 

  26. Aiche MF, Djoudi H, Al-Mayouf S, Consolaro A, Bovis F, Ruperto N et al (2018) The Algerian Arabic version of the Juvenile arthritis multidimensional assessment report (JAMAR). Rheumatol Int 38(Suppl 1):27–33

    Article  PubMed  PubMed Central  Google Scholar 

  27. Hashad S, Zletni MA, Al-Mayouf SM, Etayari H, Ibrahim E, Etfil M et al (2018) The Libyan Arabic version of the Juvenile arthritis multidimensional assessment report (JAMAR). Rheumatol Int 38(Suppl 1):267–274

    Article  PubMed  PubMed Central  Google Scholar 

  28. Al-Mayouf SM, AlE'ed A, Muzaffer M, Consolaro A, Bovis F, Ruperto N et al (2018) The Arabic version of the Juvenile arthritis multidimensional assessment report (JAMAR). Rheumatol Int 38(Suppl 1):43–49

    Article  PubMed  PubMed Central  Google Scholar 

  29. Karadag SG, Tanatar A, Sonmez HE, Cakmak F, Kiyak A, Yavuz S et al (2019) The clinical spectrum of Henoch-Schonlein purpura in children: a single-center study. Clin Rheumatol 38(6):1707–1714

    Article  PubMed  Google Scholar 

  30. Ekinci RMK, Balci S, Melek E, Karabay Bayazit A, Dogruel D, Altintas DU, et al. Clinical manifestations and outcomes of 420 children with Henoch Schonlein Purpura from a single referral center from Turkey: a three-year experience. Mod Rheumatol. 2019:1–19.

  31. Cakici EK, Gur G, Yazilitas F, Eroglu FK, Gungor T, Arda N et al (2019) A retrospective analysis of children with Henoch–Schonlein purpura and re-evaluation of renal pathologies using Oxford classification. Clin Exp Nephrol 23(7):939–947

    Article  CAS  PubMed  Google Scholar 

  32. Ozen S, Bakkaloglu A, Dusunsel R, Soylemezoglu O, Ozaltin F, Poyrazoglu H et al (2007) Childhood vasculitides in Turkey: a nationwide survey. Clin Rheumatol 26(2):196–200

    PubMed  Google Scholar 

  33. Wang K, Sun X, Cao Y, Dai L, Sun F, Yu P et al (2018) Risk factors for renal involvement and severe kidney disease in 2731 Chinese children with Henoch-Schonlein purpura: a retrospective study. Medicine (Baltimore) 97(38):e12520

    Article  Google Scholar 

  34. Hwang HH, Lim IS, Choi BS, Yi DY (2018) Analysis of seasonal tendencies in pediatric Henoch–Schonlein purpura and comparison with outbreak of infectious diseases. Medicine (Baltimore) 97(36):e12217

    Article  Google Scholar 

  35. Shim JO, Han K, Park S, Kim GH, Ko JS, Chung JY (2018) Ten-year Nationwide population-based survey on the characteristics of children with Henoch–Schonlein Purpura in Korea. J Korean Med Sci 33(25):e174

    Article  PubMed  PubMed Central  Google Scholar 

  36. Calvo-Rio V, Loricera J, Mata C, Martin L, Ortiz-Sanjuan F, Alvarez L et al (2014) Henoch-Schonlein purpura in northern Spain: clinical spectrum of the disease in 417 patients from a single center. Medicine (Baltimore) 93(2):106–113

    Article  Google Scholar 

  37. Trapani S, Micheli A, Grisolia F, Resti M, Chiappini E, Falcini F et al (2005) Henoch Schonlein purpura in childhood: epidemiological and clinical analysis of 150 cases over a 5-year period and review of literature. Semin Arthritis Rheum 35(3):143–153

    Article  PubMed  Google Scholar 

  38. Buscatti IM, Casella BB, Aikawa NE, Watanabe A, Farhat SCL, Campos LMA et al (2018) Henoch–Schonlein purpura nephritis: initial risk factors and outcomes in a Latin American tertiary center. Clin Rheumatol 37(5):1319–1324

    Article  PubMed  Google Scholar 

  39. Hamdan JM, Barqawi MA (2008) Henoch–Schonlein purpura in children. Influence of age on the incidence of nephritis and arthritis. Saudi Med J 29(4):549–552.

  40. al Rasheed SA, Abdurrahman MB, al Mugeiren MM, al Fawaz IM (1991) Henoch–Schonlein syndrome in Saudi Arabia. J Trop Pediatr 37(3):127–130

  41. Lardhi AA (2012) Henoch–Schonlein purpura in children from the eastern province of Saudi Arabia. Saudi Med J 33(9):973–978

    PubMed  Google Scholar 

  42. al Harbi NN (1996) Henoch-Schoenlein syndrome in children: experience from southern part of Saudi Arabia. East Afr Med J 73(3):191–193

    CAS  PubMed  Google Scholar 

  43. Lei WT, Tsai PL, Chu SH, Kao YH, Lin CY, Fang LC, Shyur SD, Lin YW, Wu SI (2018) Incidence and risk factors for recurrent Henoch-Schönlein purpura in children from a 16-year nationwide database Pediatr Rheumatol Online J. 16:25.

  44. Christou EAA, Banos A, Kosmara D, Bertsias GK, Boumpas DT (2019) Sexual dimorphism in SLE: above and beyond sex hormones. Lupus 28:3–10

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

No specific funding was received from any funding bodies in the public, commercial, or not-for-profit sectors to carry out the work described in this manuscript.

Author information

Authors and Affiliations

  1. Department of Pediatric Rheumatology, Kanuni Sultan Süleyman Research and Training Hospital, University of Health Science, Istanbul, Turkey

    Şerife Gül Karadağ, Hafize Emine Sönmez & Figen Çakmak

  2. Department of Pediatric Rheumatology, Ümraniye Research and Training Hospital, University of Health Science, Istanbul, Turkey

    Ferhat Demir & Betül Sözeri

  3. Department of Pediatric Rheumatology, Şanlıurfa Research and Training Hospital, Şanlıurfa, Turkey

    Mustafa Çakan

  4. Department of Pediatric Rheumatology, Cengiz Gökçek Maternity and Gynecology Hospital, Gaziantep, Turkey

    Kübra Öztürk

  5. Department of Pediatric Rheumatology, Faculty of Medicine, Istanbul University, 34093, Çapa-Fatih, Istanbul, Turkey

    Ayşe Tanatar & Nuray Aktay Ayaz

Authors
  1. Şerife Gül Karadağ
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hafize Emine Sönmez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ferhat Demir
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mustafa Çakan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kübra Öztürk
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ayşe Tanatar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Figen Çakmak
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Betül Sözeri
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Nuray Aktay Ayaz
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SGK conceptualized and designed the study, drafted the initial manuscript, and had full access to all the data in the study; HES designed the study, conducted the data analyses, drafted the initial manuscript, and had full access to all the data in the study; FD, MÇ, KÖ, AT, and FÇ drafted the initial manuscript; BS and NAA conceptualized and designed the study, drafted the final manuscript, and had full access to all the data in the study and all authors reviewed and revised the manuscript and approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Nuray Aktay Ayaz.

Ethics declarations

Conflict of interest

The authors have declared no conflicts of interest.

Ethical approval

The study was reviewed and approved by the local ethical review committee (Ethics approval number: B.10.1. TKH.4.34.H.GP.0.01/224, 2019/12/18).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Karadağ, Ş.G., Sönmez, H.E., Demir, F. et al. Rheumatic diseases in Syrian refugee children: a retrospective multicentric study in Turkey. Rheumatol Int 40, 583–589 (2020). https://doi.org/10.1007/s00296-020-04534-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-020-04534-3

Keywords

Search

Navigation