Differences in long‐term disease activity and treatment of adult patients with childhood‐ and adult‐onset systemic lupus erythematosus

Abstract

Objective. To compare differences in long-term outcome between adults with childhood-onset (age at diagnosis <18 years) systemic lupus erythematosus (SLE) and with adult-onset SLE. Using self-report data, differences in organ involvement and disease morbidity, current disease status and activity, past and current medication use, and number of physician visits were compared, based on age at diagnosis of SLE. Results. Average disease duration for the cSLE and aSLE subgroups was 16.5 and 13.4 years, respectively, and mean age at followup was 30.5 and 49.9 years, respectively. When compared with aSLE subjects, cSLE subjects had a higher frequency of SLE-related renal disease, whereas aSLE subjects were more likely to report a history of pulmonary disease. Rates of clotting disorders, seizures, and myocardial infarction were similar between the 2 groups. At followup, cSLE subjects had lower overall disease activity, but were more likely to be taking steroids and other immunosuppressive therapies. The total number of yearly physician visits was similar between the 2 groups, although cSLE subjects had a higher number of nephrology visits. Conclusion. This study demonstrates important differences in the outcomes of patients with cSLE and aSLE, and provides important prognostic information about long-term SLE disease activity and treatment.

Transition of Care and Health‐Related Outcomes in Pediatric‐Onset Systemic Lupus Erythematosus

“…Renal and neuropsychiatric involvement is significantly more common in patients with pediatric-than adult-onset SLE (19,35), reported to affect 50% and 25% of pediatriconset SLE patients, respectively, after a mean disease duration of 16 years (18). Consistent with these reports, more than one-third of patients in this cohort accrued significant additional renal and neuropsychiatric damage with involvement of either organ system after a mean disease duration of 12 years following transition.…”

“…Thus, transition of care has become an increasingly relevant issue for both patients and health care providers. Transition may present a particular challenge in multisystem medical conditions (16,17), such as pediatric-onset SLE, which is frequently complicated by renal and neuropsychiatric manifestations (16,18,19).…”

“…Continued damage accrual through adulthood results in chronic medical problems (18,22), inferior academic outcomes (23), and disease-related absence from work (24) and may contribute to the comparatively higher unemployment rates among adult patients with pediatric-onset SLE (25).…”

Growing Up and Moving On — Transition of Care for Patients with Childhood-onset Rheumatic Disease

“…Recent longterm outcome studies have demonstrated that the majority of children with JIA continue to have active disease into adulthood, dispelling the notion that children can "outgrow" JIA 2,3 . Similarly, newer literature suggests that patients with childhood-onset SLE are likely to require treatment into adulthood, and are at significant risk for early morbidity and mortality in young adulthood 4,5,6 . These findings highlight the importance of ensuring that our patients transition successfully from pediatric to adult care, and that this transition is seamless without disruptions in treatment or planned followup.…”

Psychiatric Illness of Systemic Lupus Erythematosus in Childhood: Spectrum of Clinically Important Manifestations

“…Для детей характерно более агрес-сивное течение заболевания, чаще отмеча-ются поражение почек, нейропсихические нарушения и гемолитическая анемия, более разнообразны кожные проявления и шире спектр выявляемых аутоантител [2][3][4][5][6][7][8][9]. При ежегодной за-болеваемости 0,3-0,9 на 100 тыс.…”