Differences Between Pediatric and Adult Lupus

Of all cases of systemic lupus erythematosus (SLE; lupus), 15 percent to 20 percent are diagnosed during childhood. Some studies have indicated that pediatric lupus is more active and results in more permanent damage than adult-onset lupus.

What Problem Was Studied?

Past studies have shown differences in the severity of lupus between children and adults, but those studies did not necessarily compare apples to apples, so to speak. Lupus can be influenced by environmental, racial and ethnic factors, but those past studies did not include a cohesive cohort of participants with similar backgrounds. So, Arthritis Foundation-funded scientist Hermine I. Brunner, MD, MSc, of Cincinnati Children’s Hospital Medical Center in Ohio – in collaboration with the University of Toronto – set up a study to compare people with adult-onset lupus and childhood-onset lupus who had similar social and environmental backgrounds.

What Was Done in the Study?

Sixty-seven children and 132 adults with newly diagnosed lupus were enrolled in the study from hospitals in Toronto, Ontario, Canada. Information on medication use, overall disease activity, kidney disease activity and organ damage was collected at regular intervals over the course of approximately 3.5 years.

What Were the Study Results?

The research team found that 78 percent of children with lupus had some form of kidney involvement, whereas only 52 percent of adults had kidney involvement. They also found that nearly all of the children received oral corticosteroids but only about 70 percent of adults took that medication. Likewise, a greater percentage of children required treatment with immunosuppressive agents – such as azathioprine and cyclophosphamide – than did adults.

Regarding overall disease activity, children with lupus had higher mean disease activity scores at diagnosis than did the adults. The adults achieved better disease control during the study than did the children, although children received much more intensive drug therapy for lupus. Compared with the adults, the children had more steroid-associated damage, including cataracts and avascular necrosis (loss of blood supply to the bone).

What Does this Mean for People with Lupus?

The authors conclude in the article, “These results suggest that current medications and therapeutic regimens tested mostly in adults may not be sufficient to achieve comparable control of overall disease activity and renal disease activity in patients with childhood-onset SLE.” The study showed that children with lupus have more active disease at diagnosis and develop significantly more damage than people with adult-onset lupus. The authors believe this increased damage is related to increased disease activity and the higher levels of corticosteroid and immunosuppressive agents that are required to control lupus in children. They also found that most of the difference in damage was related to steroid side effects.

Brunner HI, Gladman DD, Ibanez D, Urowitz MD, Silverman ED. Difference in disease features between childhood-onset and adult-onset systemic lupus erythematosus. Arthritis Rheum 2008;58:556-62.

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