A comparative study between the disease characteristics in adult-onset and childhood-onset systemic lupus erythematosus in Egyptian patients attending a large university hospital

Abstract

Introduction Disease features and laboratory abnormalities differ among adult-onset and childhood-onset systemic lupus erythematosus (aSLE and cSLE). Socioeconomic status both independent of, and in combination with, ethnicity influences the disease phenotype and outcome. Objective To compare the various disease features among patients with cSLE and aSLE in a limited monetary income Egyptian cohort attending a large free-of-charge university hospital. Patients and methods: Retrospective analysis of the medical records of 714 SLE patients attending Cairo University Hospitals from January 2000 to December 2019. Of them 602 (400 with aSLE and 202 with cSLE) were enrolled in the study. Results The mean age of disease onset was 28.27 ± 10.55 among aSLE patients compared to 12.88 ± 4.26 years among cSLE patients. Disease duration was 12.03 ± 5.05 and 4.14 ± 3.18 years in aSLE and cSLE, respectively. Female to male ratio was 15:1 among patients with aSLE, as compared to 2.67:1 among cSLE (<0.001). Arthritis (69%), oral ulcers (48.5%), neuropsychiatric (18.3%) and thrombotic manifestations of antiphospholipid syndrome (12%) were significantly more frequent in aSLE. On the other hand, renal (67.8%), serositis (49.6%), fever (49%), lymphopenia (40.6%), hemolytic anemia (38.6%), and discoid lupus (13.4%) were significantly more frequent in cSLE. Weight loss, malar rash, photosensitivity, thrombocytopenia, leucopenia and lymphadenopathy were not significantly different between the two groups. Hypocomplementemia, proteinuria, urinary sediments, hematuria were significantly more frequent in cSLE. For those patients with renal involvement, who underwent renal biopsy (58.3% in aSLE and 63.5% in cSLE), there was no significant difference with regard to the different histopathological classes. Anti-Smith, anti-cardiolipin antibodies and rheumatoid factor were significantly more frequent among aSLE patients, while anti-La antibodies were more frequent among cSLE patients. Conclusion Arthritis was the most common clinical manifestation over time in aSLE compared to renal involvement in cSLE. Renal disease tends to be more active in cSLE. The differences in disease manifestations between this cohort and other studies can be attributed to the ethnic and socioeconomic disparities.

Systemic lupus erythematosus children in Egypt: Homeland spectrum amid the global situation

“…The geographic differences in age of onset, disease manifestations, and disease activity between different cities in Egypt were noted. In a single-center study on 202 Egyptian JSLE cases, 36 the F:M ratio was lower (2.6:1). A potential explanation could be related to the difference in the number of studied patients; however, the environmental factors cannot be excluded.…”

“…The manifestations and investigations were comparable and differences in disease manifestations compared to cohorts of children from various countries can be attributed to the ethnic and socioeconomic disparities. 19,36,42,43 Data from a national cohort of juvenile SLE patients in the United Kingdom revealed that ethnicity affects both the clinical course and outcome. At diagnosis, Black African/Caribbean patients showed more "classical" laboratory and clinical features when compared to White Caucasian or Asian patients.…”

Using a Multi-Institutional Pediatric Learning Health System to Identify Systemic Lupus Erythematosus and Lupus Nephritis

“…Most patients with nephritis were diagnosed between 10 and 19 years of age. Patients with lupus nephritis were followed for a median of 6 years (IQR, [3][4][5][6][7][8][9][10][11], with a median of two (IQR, 1-5) nephrology and four (IQR, 1-7) rheumatology in-person visits per person-year.…”

“…Data are limited on the comparative effectiveness of most diagnostic and management approaches in childhood SLE. Up to 20% of all SLE cases are diagnosed before age 18 years (1)(2)(3)(4)(5)(6), and 35%-70% develop kidney involvement (2,3,7,8). Lupus nephritis develops earlier and behaves more aggressively in childhood SLE compared with adult-onset SLE (9).…”

Childhood-onset systemic lupus erythematosus: characteristics and the prospect of glucocorticoid pulse therapy

“…Approximately 15% to 20% of all SLE patients are diagnosed during childhood ( 3 ). Although childhood-onset SLE (cSLE) has similar pathogenesis, clinical manifestations, and immunologic disorders to adult-onset SLE (aSLE), there are some differences between them ( 4 ). There is evidence that cSLE has stronger genetic background and Interferon (IFN) signature ( 5 ).…”