Timing of Childhood‐Onset Systemic Lupus Erythematosus Diagnosis Relative to Menarche and the Impact on Final Adult Height

Abstract

Objective The aim of this study was to examine the impact of timing of a childhood‐onset systemic lupus erythematosus (SLE) diagnosis relative to menarchal status, on final height, accounting for disease‐associated factors. Methods We conducted a cohort study of female patients age <18 years at childhood‐onset SLE diagnosis, followed at a tertiary care pediatric center from July 1982 to March 2016 and restricted to patients with documented age of menarche and final height. We compared final height between patients diagnosed pre‐ and postmenarche. We tested the association of the timing of childhood‐onset SLE diagnosis with final height, adjusted for ethnicity, in linear regression models. We performed subgroup analyses of patients with growth during follow‐up, additionally adjusting for average daily corticosteroid dose and disease activity. Results Of 401 female childhood‐onset SLE patients in the study, 115 patients (29%) were diagnosed premenarche and 286 (71%) postmenarche. Patients diagnosed premenarche were older at menarche compared with patients diagnosed postmenarche (mean ± SD age 13.5 ± 1.4 versus 12.5 ± 1.3 years; P < 0.001). The mean ± SD final height for girls diagnosed postmenarche (161.4 ± 6.9 cm) was greater than for those diagnosed premenarche (158.8 ± 7.3 cm; P = 0.001). In regression analysis, those diagnosed postmenarche were significantly taller than those diagnosed premenarche, as adjusted for ethnicity and disease severity (mean ± SD β = 2.6 ± 0.7 cm; P = 0.0006). Conclusion In this large cohort study of girls with childhood‐onset SLE, patients diagnosed postmenarche achieved a taller final height than those diagnosed premenarche, even after accounting for ethnicity and disease severity.

Pattern of Physical Growth and Pubertal Changes in Adolescent Girls with Systemic Lupus Erthythematosus

“…It was also recorded that SLE girls who had a younger age at diagnosis and a longer duration of therapy were found to have a signi cant delay in breast development as well as a delay in attainment of menarche. This is in tandem with observations made among Canadian SLE patients (15) who had a younger age at onset and also had a signi cant delay in breast development and age at menarche (p < 0.05). These cumulative ndings suggest a strong correlation that disease activity directly affects the pubertal status in SLE patients.…”

“…Despite being a major manifestation, growth and pubertal development in systemic lupus erythematosus, are not well studied 13 and still remains an under-researched area. There are only a few reports from the west suggesting compromised physical growth (12)(13)(14)(15)(16)(17) as well as delayed pubertal attainments (11,15,16,18) among children and adolescents with SLE. There hasn't even been a single study so far that documents the auxological pattern in Indian SLE children.…”

Causal associations of birth body size and adult body size with systemic lupus erythematosus: a bidirectional mendelian randomization study

“…Patients who developed SLE during childhood are shorter than those who developed Frontiers in Genetics frontiersin.org it during adulthood (Heshin-Bekenstein et al, 2018). Female patients who developed SLE before menarche are shorter than those who developed SLE after menarche (Sontichai et al, 2022). Research focusing on children with SLE has also identified sex and hormone use as factors that lead to reduced final height in patients with SLE (Jongvilaikasem and Rianthavorn, 2021;Ponin et al, 2022).…”

The causal effects of age at menarche, age at first live birth, and estradiol levels on systemic lupus erythematosus: A two-sample Mendelian randomization analysis

“…Premature menarche has been considered a risk factor for the development of SLE, 5 while the development of SLE prior to menarche may delay menarche in patients. 6,7 In contrast, a later AAM has been observed to reduce the risk of SLE in black women, and SLE patients may experience a later menarche than healthy controls. 8 Furthermore, pregnancy in patients with SLE is usually associated with greater risk, as pregnancy itself often causes recurrences of SLE.…”