Pediatric Rheumatology Online Journal → July 2003 → Childhood Lupus→ Clinical Presentation, course and Outcomes → Abstract #98

THE SAME OR DIFFERENT? COMPARISON OF AN INCEPTION COHORT OF CHILDHOOD-ONSET VERSUS OF ADULT SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

H. I. Brunner,¹ D. D. Gladman,³ D. Ibanez,³ M. D. Urowitz,³ E. D. Silverman.²

¹Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; ²Rheumatology, Hospital for Sick Children, Toronto, ON, Canada; ³Rheumatology, University Health Network, Toronto Western Hospital, Toronto, ON, Canada

Background: There is an ongoing controversy whether SLE in children (cSLE) is different from SLE diagnosed in adults (aSLE).
Methods: An inception cohort with cSLE (n=67) followed at the Lupus Clinic at the Hospital for Sick Children, was compared with an inception cohort of aSLE (n=132) followed at the University of Toronto Lupus Clinic, each diagnosed between 1990-98 and followed until 1999. Prospective information included data on medications, laboratory markers, disease activity [SLE Disease Activity Index (SLEDAI)> and damage [Systemic Lupus International Collaborating Clinics/ ACR Disease Damage Index (SDI)>. Cohorts were compared using 2-sample t-tests, chi-square and Fisher Exact tests. Bonferroni corrected p-values of 0.004 were deemed statistically significant.
Results: 85% of cSLE and 88% of aSLE patients were female with a mean follow-up duration of 3.3 and 3.8 years [p= not significant (NS)>. At diagnosis cSLE was more active than aSLE with mean SLEDAI scores of 16.8 versus 9.6 (p 0.0001). There was no difference in the time-adjusted mean SLEDAI during the follow-up (cSLE: 5.7; aSLE: 5.2). Treatment with steroids/ immunosuppressives was used in 97% / 66% of cSLE, but only 70% / 36% of aSLE patients (both: p0.0001). During the follow-up period SDI scores were higher in cSLE than aSLE (1.67 vs 0.85, p = 0.017). cSLE patients had significantly more cataracts and avascular necrosis than aSLE patients (both: p 0.0005).
Conclusions: Children with SLE had more active disease at presentation than adults. However, the disease activity measured over the follow-up of 3-4 years was similar in the two groups. Children with SLE received more corticosteroids and immunosuppressive drugs for disease control. Children with SLE accrued more damage at follow-up than adults, often related to steroid toxicity.