Abstract
Systemic lupus erythematosus (SLE) is a complex autoimmune disease that can affect all organ systems due to alterations of both the innate and adaptive immune systems. Although onset during infancy is rare, the incidence of SLE rises steadily during childhood until mid-adulthood, especially among females. In this study we aimed to highlight the possible discrepancies in clinical presentations as well as serological profiles of pediatric and adult onset SLE patients, we also focused attention on the disease assessment by SLE activity index (SLE DDI) and damage index at time of presentation. Subjects were subdivided into 2 groups: Group I: A total of 92 Pediatric systemic lupus erythematosus (pSLE) that were selected from the students attending the school children hospital of medical health insurance. Group II: A total of 90 adult systemic lupus erythematosus (aSLE) patients and were recruited from those attending the Alexandria Main University Hospital and outpatient clinic. All patients were subjected to: detailed history taking and complete physical and mental examination, also activity indices as well as damage index were applied for every lupus patient of the studied groups, laboratory investigations were done for all patients. Our results demonstrated that, regarding mucocutaneous manifestations: pSLE patients have values higher than aSLE patients regarding photosensitivity (63.3% and 61.1%) and vascular lesions (23.9% and 22.2%) respectively. Regarding haematological manifestations: pSLE patients have values higher than aSLE patients regarding anemia (86.96% and 84.4), leucopenia (28.3% and 22.22) and thrombocytopenia (46.7% and 25.56%) respectively. Regarding renal abnormalities, pSLE patients have higher incidence of nephritic syndrome than aSLE patients. Regarding SLEDAI, pSLE patients have values statistically higher than aSLE patients. Regarding SLAM, pSLE patients have values statistically higher than aSLE patients, while no differences of damage index was noticed.
Highlights
Systemic lupus erythematosus (SLE) is an autoimmune disease affecting multiple organ systems triggered by the production of auto antibodies. [1]SLE presents throughout the age spectrum
There are limited studies directly comparing adult and childhood onset SLE, it has been suggested that pediatric lupus patients have a more aggressive disease course and an increased rate of more unusual clinical presentations compared with their adult counterparts. [4]
In the Lupus in Minorities: Nature vs. nurture (LUMINA) multiethnic cohort, young age was an important independent predictor of new or worsening proteinuria on routine screening, and adolescent onset of SLE resulted in more aggressive disease and worse outcomes. [7, 8] The high morbidity and mortality observed from lupus nephritis in past studies of SLE in children may be due to delays in diagnosis and treatment [1, 3, 4]
Summary
Systemic lupus erythematosus (SLE) is an autoimmune disease affecting multiple organ systems triggered by the production of auto antibodies. [1]SLE presents throughout the age spectrum. More precise estimates are difficult due to a lack of a clear age limit for diagnosis of pediatric SLE. There are limited studies directly comparing adult and childhood onset SLE, it has been suggested that pediatric lupus patients have a more aggressive disease course and an increased rate of more unusual clinical presentations compared with their adult counterparts. In the Lupus in Minorities: Nature vs nurture (LUMINA) multiethnic cohort, young age was an important independent predictor of new or worsening proteinuria on routine screening, and adolescent onset of SLE resulted in more aggressive disease and worse outcomes. [7, 8] The high morbidity and mortality observed from lupus nephritis in past studies of SLE in children may be due to delays in diagnosis and treatment [1, 3, 4] In the Lupus in Minorities: Nature vs. nurture (LUMINA) multiethnic cohort, young age was an important independent predictor of new or worsening proteinuria on routine screening, and adolescent onset of SLE resulted in more aggressive disease and worse outcomes. [7, 8] The high morbidity and mortality observed from lupus nephritis in past studies of SLE in children may be due to delays in diagnosis and treatment [1, 3, 4]
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