Abstract
BackgroundGrowth impairment is the most common complication in patients with childhood-onset systemic lupus erythematosus (cSLE). There are limited data on risk factors affecting growth development in Asian patients with cSLE. This study aimed to determine the predictors of growth impairment in such patients.MethodsAll SLE patients aged < 15 years diagnosed in Ramathibodi Hospital between 2006 and 2016 were enrolled in a retrospective cohort study. Baseline characteristics, including height, weight, clinical manifestations, disease activity score, and medications, were reviewed from medical records from the time at diagnosis to achievement of final adult height (FAH). Age at menarche in girls, adult voice appearance in boys, and parental height were collected by interview. Parent-adjusted FAH (PaFAH) Z-score was calculated as the difference between FAH Z-score for chronological age of the patients and their mid parental height-Z score. The patients were classified into two groups: (1) normal growth (PaFAH Z-score ≥ − 1.5, 2) growth impairment (PaFAH Z-score < − 1.5). Descriptive statistics and logistic regression analysis were used to analyze the data.ResultsOf 106 cSLE patients, 19 (18%) were male and 87 (82%) were female. The mean age at study enrollment was 20.6 ± 3.0 years, mean age at diagnosis 12.1 ± 2.3 years, and mean age at achievement of FAH 17.5 ± 1.9 years. Growth impairment was found in 23.6% of patients (52.6% in boys and 17.2% in girls). Predictors of growth impairment were male sex, duration of disease before menarche in girls and adult voice appearance in boys, and cumulative corticosteroid dose (prednisolone equivalent) ≥230 mg/kg received before the late phase of puberty, with odds ratios of 7.07 (95%CI 2.11–23.74), 1.26 (95% CI 1.02–1.56), and 6.99 (95%CI 1.63–30.02), respectively.ConclusionsOne-fourth of cSLE patients developed growth impairment, which mostly affected male patients. Longer duration of disease before the late phase of puberty and corticosteroid dose ≥230 mg/kg received before the late phase of puberty were factors predictive of growth impairment.
Highlights
Growth impairment is the most common complication in patients with childhood-onset systemic lupus erythematosus
106 Thai patients with childhood-onset systemic lupus erythematosus (cSLE) were enrolled in this study, of whom 39 (37%) had bone age assessment
When we analyzed data from time at diagnosis to the late phase of puberty by multivariate analysis, we found that male sex and cumulative dose of corticosteroids of 230 mg/kg or greater were predictors of growth impairment (Table 2)
Summary
Growth impairment is the most common complication in patients with childhood-onset systemic lupus erythematosus (cSLE). Factors that contribute to growth impairment in these patients include prolonged duration of the disease, disease severity, age at disease onset, suboptimal nutrition, and use of medications, especially corticosteroids [3], which constitute the mainstay of SLE therapy. Data on growth trajectory in Asians during treatment while growing to FAH and their association with the cumulative dose of corticosteroids, which has been reported to affect growth, remain limited. Against this background, we performed this study to determine the FAH outcome and the predictors that affect growth trajectory and FAH in cSLE patients
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