{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T07:20:55Z","timestamp":1790666455672,"version":"4.1.0"},"reference-count":19,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014,2,1]]},"abstract":"<jats:p>Systemic lupus erythematosus (SLE) frequently has neuropsychiatric involvement including affective disorders, psychosis, and cognitive dysfunction. Evidence suggests that anorexia nervosa (AN) in adolescents with SLE may be triggered by steroid-induced changes in weight and body shape. We propose that AN may be another manifestation of neuropsychiatric SLE and should be considered in this patient population. A retrospective chart review identified 7 children\/adolescents diagnosed with SLE and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnostic criteria for AN, restrictive subtype, at the Hospital for Sick Children in Toronto between January 1989 and January 2011. One patient developed AN 15 months after being diagnosed with SLE that was attributed to prednisone-induced weight gain and cushingoid appearance. Of the remaining 6 patients, the median age at onset of AN symptoms was 12.2 years and diagnosis of AN was 13.6 years. The median age at SLE diagnosis was 14.2 years with median time after onset of AN symptoms of 20 months (7.5\u201332 months). All patients had evidence of joint symptoms and a positive antinuclear antibody, and 50% had lymphopenia at the time of SLE diagnosis. Treatment of SLE resulted in improvement of AN in all patients. The timing of the clinical presentation of AN in relation to the diagnosis of SLE and response to SLE treatment suggests that AN may be a novel presentation of neuropsychiatric SLE. Patients with AN who present with or develop joint symptoms, a positive antinuclear antibody, or lymphopenia should be investigated and followed for possible SLE.<\/jats:p>","DOI":"10.1542\/peds.2012-3048","type":"journal-article","created":{"date-parts":[[2014,1,6]],"date-time":"2014-01-06T21:57:06Z","timestamp":1389045426000},"page":"e447-e450","source":"Crossref","is-referenced-by-count":29,"title":["Chicken or the Egg: Anorexia Nervosa and Systemic Lupus Erythematosus in Children and Adolescents"],"prefix":"10.1542","volume":"133","author":[{"given":"Alene","family":"Toulany","sequence":"first","affiliation":[{"name":"Division of Adolescent Medicine,"},{"name":"Department of Paediatrics, and"},{"name":"University of Toronto, Toronto, Ontario, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debra K.","family":"Katzman","sequence":"additional","affiliation":[{"name":"Division of Adolescent Medicine,"},{"name":"Department of Paediatrics, and"},{"name":"University of Toronto, Toronto, Ontario, Canada;"},{"name":"Hospital for Sick Children Research Institute, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Kaufman","sequence":"additional","affiliation":[{"name":"Division of Adolescent Medicine,"},{"name":"Department of Paediatrics, and"},{"name":"University of Toronto, Toronto, Ontario, Canada;"},{"name":"Hospital for Sick Children Research Institute, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda T.","family":"Hiraki","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, and"},{"name":"University of Toronto, Toronto, Ontario, Canada;"},{"name":"Division of Rheumatology, The Hospital for Sick Children (Sickkids), Toronto, Ontario, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Earl D.","family":"Silverman","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, and"},{"name":"University of Toronto, Toronto, Ontario, Canada;"},{"name":"Hospital for Sick Children Research Institute, Toronto, Ontario, Canada"},{"name":"Division of Rheumatology, The Hospital for Sick Children (Sickkids), Toronto, Ontario, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2014,2,1]]},"reference":[{"issue":"7249","key":"2021120823492924200_B1","doi-asserted-by":"crossref","first-page":"1563","DOI":"10.1136\/bmj.320.7249.1563","article-title":"Eating disorders in adolescent females with and without type 1 diabetes: cross sectional study.","volume":"320","author":"Jones","year":"2000","journal-title":"BMJ"},{"issue":"3","key":"2021120823492924200_B2","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1097\/MEG.0b013e328012db37","article-title":"The interaction between eating disorders and celiac disease: an exploration of 10 cases.","volume":"19","author":"Leffler","year":"2007","journal-title":"Eur J Gastroenterol Hepatol"},{"issue":"2","key":"2021120823492924200_B3","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/S0002-7138(09)60237-5","article-title":"Eating disorders in adolescents with cystic fibrosis.","volume":"25","author":"Pumariega","year":"1986","journal-title":"J Am Acad Child Psychiatry"},{"issue":"1","key":"2021120823492924200_B4","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/S0033-3182(89)72328-8","article-title":"Anorexia nervosa and reflex sympathetic dystrophy syndrome.","volume":"30","author":"Silber","year":"1989","journal-title":"Psychosomatics"},{"issue":"7","key":"2021120823492924200_B5","doi-asserted-by":"crossref","first-page":"1654","DOI":"10.2337\/diacare.27.7.1654","article-title":"Disturbed eating behavior and eating disorders in preteen and early teenage girls with type 1 diabetes: a case-controlled study.","volume":"27","author":"Colton","year":"2004","journal-title":"Diabetes Care"},{"key":"2021120823492924200_B6","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1192\/bjp.149.6.756","article-title":"Physical illness. 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