Differences in clinical features observed between childhood-onset versus adult-onset systemic lupus erythematosus

Abstract

Background:Systemic lupus erythematosus (SLE) affects people in childhood (childhood onset) or in adulthood (adult onset). Observational studies that have previously compared childhood-onset versus adult-onset SLE were often restricted to 1 ethnic group, or to a particular area, with a small sample size of patients. We aimed to systematically compare childhood-onset versus adult-onset SLE through a meta-analysis.Methods:Electronic databases were searched for relevant publications comparing childhood-onset with adult-onset SLE. Adverse clinical features were considered as the endpoints. The Newcastle Ottawa Scale (NOS) was used to assess the methodological quality of the studies and RevMan software (version 5.3) was used to carry out this analysis whereby risk ratios (RRs) and 95% confidence intervals (95% CIs) were used as the statistical parameters.Results:A total number of 10,261 participants (1560 participants with childhood-onset SLE and 8701 participants with adult-onset SLE) were enrolled. Results of this analysis showed that compared with childhood-onset SLE, pulmonary involvement was significantly higher with adult-onset SLE (RR: 1.51, 95% CI: 1.18–1.93; P = .001), whereas renal involvement was significantly higher with childhood-onset SLE (RR: 0.65, 95% CI: 0.55–0.77; P = .00001). Raynaud phenomenon and photosensitivity were significantly higher in adult-onset SLE (RR: 1.29, 95% CI: 1.04–1.60; P = .02) and (RR: 1.08, 95% CI: 1.01–1.17; P = .03), respectively. Malar rash significantly favored adult-onset SLE (RR: 0.84, 95% CI: 0.75–0.94; P = .002). Childhood-onset SLE was associated with significantly higher hemolytic anemia, thrombocytopenia, leukocytopenia, and lymphopenia. Seizure and ocular manifestations were significantly higher with childhood-onset SLE (RR: 0.57, 95% CI: 0.47–0.70; P = .00001) and (RR: 0.34, 95% CI: 0.21–0.55; P = .00001), respectively, whereas pleuritis was significantly higher with adult-onset SLE (RR: 1.45, 95% CI: 1.17–1.79; P = .0008). Vasculitis and fever were significantly higher with childhood-onset SLE (RR: 0.51, 95% CI: 0.36–0.74; P = .0004) and (RR: 0.78, 95% CI: 0.68–0.89; P = .0002) respectively.Conclusion:Significant differences were observed between childhood-onset versus adult-onset SLE, showing the former to be more aggressive.

Epidemiology and management practices for childhood-onset systemic lupus erythematosus patients: a survey in Latin America

“…The most important clinical features reported by LAPR were nephritis, skin, hematological, musculoskeletal, fever, serositis, and neuropsychiatric. Renal involvement, hematological, seizure, and ocular manifestations, vasculitis, and fever were significantly higher in cSLE compared to adult SLE patients [40].…”

Dynamic changes of lymphocyte counts in adult patients with severe pandemic H1N1 influenza A

“…Lymphopenia may occur in either non-infectious or infectious diseases. The non-infectious diseases include autoimmune diseases such as systemic lupus erythematosus [15], cardiovascular diseases [16], intracerebral hemorrhage [17], or during or after chemotherapy or chemoradiation therapy [18][19][20], or conditions of exhaustion, after excessive X-ray irradiation, with vitamin deficiency, and in the terminal phase of uremia. Since these diseases or conditions have their own clinical manifestations and do not have fever and other toxemic symptoms, the lymphopenia in these diseases or conditions cannot be defined as that in severe influenza A/H1N1 infection.…”

Clinically diagnosed urticaria and risk of systemic lupus erythematosus in children: A nationwide population‐based case‐control study

“…Approximately 10%‐20% of affected individuals have childhood‐onset SLE . Most children with SLE have a more aggressive disease activity than adults; therefore, highlighting optimal care for pediatric SLE patients is necessary …”