Twenty-two years' experience with childhood-onset SLE in a developing country: are outcomes similar to developed countries?

Abstract

IntroductionThe outcome of systemic lupus erythematosus (SLE) has dramatically improved since the introduction of corticosteroids; however, although many regimens of treatment have been supplemented, the mortality has not improved further. Objective To describe the severity and outcome in patients diagnosed with SLE aged ≤18 years in a group of Thai children, compare gender and age differences, and our outcomes with those from developed countries. Methods The authors retrospectively reviewed the fi les of patients aged ≤18 years diagnosed with SLE admitted to Songklanagarind University Hospital in southern Thailand, for the period 1985-2007. Patient survival rates were calculated. Results There were 213 SLE patients, 41 males and 172 females, average age 11.6±2.6 years, with a median follow-up of 3.6 years. Outcomes were alive (109), lost to follow-up (22), referred (31) or deceased (51). Of the patients who were alive, 23 were not on any treatment, 59 were on prednisolone alone while 27 were on prednisolone plus some other immunosuppressive drug. Total survival rates were 88%, 76% and 64% at 2, 5 and 10 years, respectively. Males had signifi cantly worse survival than females at 2 and 5 years (78% vs 91% and 58% vs 80%, respectively, p=0.018). There were no differences in mortality between age groups. The 5-year survival rates in the periods 1985-1993, 1994-2000 and 2001-2007 were not signifi cantly different. Conclusion This retrospective study of patients with SLE in southern Thailand showed different outcomes compared to some studies and similar survival rates and treatment status to other studies, with one-fourth of surviving patients being free of medication.

Update on differences between childhood-onset and adult-onset systemic lupus erythematosus

“…However, the prognosis of SLE reported from developing countries remains less favorable. A cohort study from Thailand suggests survival rates of only 76% at 5 years and 64% at 10 years after diagnosis with cSLE [46]. …”

Chinese Systemic Lupus Erythematosus Treatment and Research Group Registry IX

“…[1413141516] Meanwhile, the data of Chinese lupus were limited due to lack of prospective multicenter studies. [7] Chinese SLE Treatment and Research group (CSTAR) developed the first nationwide online registry of Chinese lupus.…”

Influence of ethnicity on childhood‐onset systemic lupus erythematosus: Results from a multiethnic multicenter Canadian cohort

“…1-5 Although many studies of North American cSLE cohorts have focused on multi-ethnic populations, they have primarily originated from single centers, or have been small cohort studies. 1,3,4,6,7 Larger cohorts reported from Taiwan, India, and Thailand 28,9 represent more ethnically homogeneous populations than those seen in North America. In particular, descriptions of cSLE in North American Asian, South Asian and Aboriginal (Native Americans/First Nations Canadians) populations are sparse, 1,10 despite the rapid growth of these ethnic groups in Western countries.…”