Lupus Eritematoso Diseminado en la Infancia Estudio Clinico y de Sobrevida en 31 Casos

Abstract

Thirty one patients, aged 4 to 15 years old with Systemic Lupus Eiythematosus (SLE) were evaluated retrospectively in order to analyse the clinical course of the disease. Twenty six patients were female and 5 males. All of them fulffled the criterions stated by the American Rheum atolo gist Academy for the diagnosis of S.L.E. Clinical and laboratory diagnostic parameters were similar to those of adult type. Our patients had mainly articular and cutaneous lessions. Whole survival rates were 68 and 40 per cent at five and ten years respectively. In children with renal lupus lesions the survival rates diminished to 57 and 28 per cent Patients without renal involvement had 90 per cent survival rates along the whole 10 years period. The authors rise the possibility to lower mortality rates, in those patients presenting initially with renal S.L.E. damage, by adding to their treatment other inmunosuppressors to the usually prescribed adrenal steroid derivates, because among 19 patients with such an evidence, only 5/12 (42^ receiving steroids alone survived at 5 years follow up in contrast with 7/7 of those receiving combined schedules.La sobrevida del paciente con Lupus Eritematoso Diseminado (LED) infantil ha sido materia de controversia debido a los diferentes resultados que se ban publicado en los ultimos afios. En efecto, los primeros trabajos 1 -demostraban sobrevidas a 5 afios de 72% y 42% en nifios sin y con compromise renal respectivamente, en cambio publicaciones mas recientes dan sobrevidas de 100% en pacientes con Iesi6n renal 2 .Estos resultados pueden explicarse, en gran medida, por los avances alcanzados en el diagnos-tic© mediante la introduction de nuevas te"cnicas inmunologicas que permiten hacerlo mas precozmente, un mejor manejo de la actividad lupica y por otra parte, el uso de corticosteroides y andbioticos que ha significado controlar en mejor forma la enfermedad y evitar las complicaciones infecciosas que constituyen una de las principles causas de mortalidad en estos pacientes 3 .No obstante estos adelantos, queda aun por resolver el papel que tienen los nuevos tratamientos, especialmente las drogas inmunosupresoras

Changes in the survival of patients with systemic lupus erythematosus in childhood: 30 years experience in Chile

“…For children with kidney involvement this percentage was lower, it decreased significantly to 28%. 6 We must note that during this period our therapeutical approach to the patient with SLE with or without nephropathy was mainly the use of oral steroids, hydroxychloroquine and in isolated cases certain types of immunosuppressor treatment. This data reflects the poor prognosis of the patients as well as the elevated number of unwanted side effects associated to the use of steroids.…”

Nefropatía lúpica en pacientes pediátricos

“…El motivo de consulta fue muy variable e inespecífico, predominando las manifestaciones musculoesqueléticas y síntomas constitucionales, que no siempre habían sido objeto de estudio, similar a lo descrito en la cohorte chilena de 31 pacientes de González et. al 22 . Cuatro pacientes tuvieron lesiones cutáneas intermitentes.…”