Systemic Lupus Erythematosus (Lupus)
in Children and Adolescents

What happens in lupus?
For an unknown reason, the immune system in a person with lupus does not work properly. 

B cells make antibodies which react with antigens.  These antigens, however, turn out not to be foreign invaders but rather parts of the person's own cells and body tissues. In other words, the person with lupus makes auto-antibodies that react with self-antigens. The auto-antibodies combine with self-antigens to make immune complexes.

At first, the immune complexes, which circulate in the blood stream, are cleaned up by the "clean-up" cells of the immune system, but after a while, the "garbage collectors" become overwhelmed with the job and the complexes travel throughout the body through blood vessels. 

Because blood vessels deliver blood everywhere, the immune complexes can deposit anywhere that blood stream takes them. As a result, different parts of the body, some visible like the skin, hair or joints, and others internal like the kidney, heart or brain, can become sick with lupus or inflamed. 

Inflamed (Latin again!) means "in flames". In other words, affected body parts become hot, red, swollen and sometimes tender. For patients with lupus, this may mean painful and swollen joints (arthritis), red skin (rash), hair loss (alopecia), hands changing colors in the cold (Raynaud's phenomenon) or mouth sores. These symptoms, although painful and unpleasant, do not seriously harm the body's functions and may be treated with relatively safe medications. However, if the internal organs become involved as can happen with children and adolescents, the problem is much more serious. 

Children with inflammation of the kidneys develop nephritis; those with brain involvement may have seizures, serious mood changes or hallucinations; others may have fluid around the heart or lungs. Prevention of internal organ involvement is very important in lupus and possible only through regular visits to the doctor for evaluations that include blood and urine tests. 

It is much easier to treat lupus when the blood tests are the only abnormality than it is later when one or more organs become inflamed. We know that if we do not help early in the flare, things will simply get worse and more medicine will be required. Fortunately, many children and adolescents develop these warning signs in their blood tests and can be treated early. The important thing to remember is that treatment is available for everyone and works very well.