© 1995 British Society for Rheumatology
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ADULT- AND CHILDHOOD-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS: A COMPARISON OF ONSET, CLINICAL FEATURES, SEROLOGY, AND OUTCOME
*Division of Pediatric Rheumatology, The Floating Hospital, New England Medical Center and Tufts University School of Medicine Boston, MA, USA
The Bloomsbury Rheumatology Unit, Department of Medicine, University College London
Correspondence to:
Correspondence to: L. B. Tucker, Division of Pediatric Rheumatology, Box 286, New England Medical Center, 750 Washington Street, Boston, MA 02111, USA.
This study examines the differences which may distinguish systemic lupus erythematosus (SLE) presenting in adult life or childhood. A common database was established, with analysis of clinical, serological and outcome features of a cohert of patients with SLE, with disease diagnosed before the age of 16 (n = 39) or after the age of 16 (n = 165). Disease onset was generally more severe in the childhood-onset patients. Cardiopulmonary disease was more common in the older-onset group, but major haematological manifestations were more frequent in the childhood-onset group. Serologically, anti-DNA, anti-Sm and anti-RNP antibodies and a low C3 were all found more frequently in the younger patients. Twice as many adult-onset cases had died at the time of the last follow-up (10 vs 5%), but this group had been followed for a longer period (average 7.5 yr, S.D. 3.9 for adults vs average 4.8 yr, S.D. 3.2 for children). However, the younger patients were twice as likely (82 vs 40%) to require high-dose prednisone, although the requirement for immunosuppressive agents was similar in the two groups. Clinicians should anticipate that children with SLE have a more severe disease onset than adults in general.
KEY WORDS: Systemic lupus erythematosus, Childhood rheumatic disease, Disease severity, Disease outcome
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