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Forty-six patients with juvenile chronic arthritis maintained on glucocorticoid therapy have been reviewed retrospectively for evidence of vertebral collapse. The 23 patients who had sustained vertebral fractures had received a daily dose 2.3 times higher than those without. No patients sustained a vertebral collapse until they had received a prednisolone cumulative dose of at least 5 g. It would appear that the ideal dose, if collapse of vertebrae is to be avoided, should be not more than 5 mgs daily, probably best given as 10 mg on alternate days; unfortunately, some children with serious systemic disease cannot be controlled on these low doses. In such cases it seems justified to investigate the possible use of the oxazoline derivative of prednisolone (deflazacort) in view of its reported bone-sparing properties in adults.

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SUMMARY The clinical and serological features have been analysed retrospectively in 42 patients with an onset of systemic lupus erythematosus (SLE) up to 16 years of age. Thirty-seven (88 -1 %) were female and 5 (11 9 %) male. The mean age of onset was 12 3 years (range 7-16); 11 patients were 10 years or under. The mean duration of disease from diagnosis was 7 1 years (range 6 months-25 years). There were 6 deaths, 3 from infection, 2 from renal failure, and 1 from heart failure. Survival was calculated both from the date of onset and from the date of diagnosis. With the latter the estimated overall survival at 5 years was 82 -6 and at 10 years 76 -1 %. The survival for patients with lupus nephritis was 59 5 % at 5 years and 47 6 % at 10 years. These data suggests that SLE in childhood is not necessarily associated with a poor prognosis, though renal involvement is still serious. There appeared to be no major differences between prepubertal, adolescent, and adult SLE with respect to clinical and serological findings.

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