Dilara ÜNAL, Veysel ÇAM, Hülya ERCAN EMREOL, Özge BAŞARAN
Trends in Pediatrics - 2026;7(1):18-25
Background: Pediatric autoimmune diseases (ADs) are more and more known as complicated conditions influenced by overlapping genetic and environmental factors; however, the coexistence of secondary ADs and their familial accumulation has not yet been explored thoroughly in pediatric populations. In this study we aimed to evaluate the occurrence and characteristics of secondary ADs among pediatric patients with autoimmune diseases followed in our pediatric rheumatology department and to examine the impact of a family history of autoimmunity on the development of secondary ADs. Methods: We retrospectively reviewed the records of 488 pediatric patients followed in our pediatric rheumatology department who were diagnosed with autoimmune diseases. We have collected clinical, serological, and familial data. Secondary ADs were defined as newly diagnosed autoimmune diseases evolving after the initial diagnosis. Kaplan-Meier analysis and logistic regression were used to determine predictive factors. Results: Secondary ADs were detected in 7% of patients. Systemic lupus erythematosus (SLE) (3.1%) was the most frequent, followed by autoimmune thyroid disease (0.8%), psoriasis (0.6%), and inflammatory bowel disease (0.6%). Among patients who developed SLE as a secondary diagnosis, the most frequent primary conditions were autoimmune hepatitis and immune thrombocytopenic purpura. Autoimmune hepatitis showed the strongest link with secondary AD development (OR=95.15, 95% CI: 19.07-474.70, p < 0.001). Patients with a positive family history of autoimmune diseases (FHADs) had a significantly higher likelihood of developing secondary autoimmune diseases (OR=5.11, 95% CI: 1.55-16.86, p=0.007). Meanwhile, we have seen that the probability of developing secondary ADs increased over time, reaching 26.6% over 15 years. Conclusion: In this cohort, systemic lupus erythematosus was the most frequent secondary autoimmune disease, while secondary autoimmunity overall was more strongly associated with autoimmune hepatitis and a positive family history.
