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Gender and Ethnic Origin Have No Effect on Longterm Outcome of Childhood-Onset Systemic Lupus Erythematosus
PAIVI M. MIETTUNEN, OLIVA ORTIZ-ALVAREZ, ROSS E. PETTY, ROLANDO CIMAZ, PETER N. MALLESON, DAVID A. CABRAL, STEPHANIE ENSWORTH, and LORI B. TUCKER
ABSTRACT. Methods. The study cohort consisted of 51 patients (13 males and 38 females) with childhood-onset SLE followed for ≥ 5 years at the British Columbia Children's Hospital in Vancouver. Fifteen patients were Caucasian, 14 Chinese, 9 East Indian, and 13 patients were of other ethnic backgrounds: none was African-American or Hispanic. Outcome measures assessed retrospectively included Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index score (SDI), SLE-related death, need for dialysis or renal transplantation, and use of intensive immunosuppressive therapy. A SDI ≥ 2 was assigned as poor outcome. Results. The median age at diagnosis was 10.8 years and the median duration of followup was 7.2 years. Five-year survival was 100%; 10-year survival was 85.7% (12/14 patients). The median SDI score at last followup was 2.0 (range 0–9); 2.0 for male, 1.5 for female; 2.0 for Caucasian and 2.03 for non-Caucasian patients. Twenty-six out of 51 patients (51%) had poor outcome (SDI score > 2). Three female patients required dialysis: 2 had subsequent renal transplants. Thirty patients received intensive immunosuppressive therapy. The SDI scores, mortality, and need for intensive immunosuppressive therapy were not influenced by either gender or ethnic origin. Conclusion. The median SDI score was high for this cohort with childhood-onset SLE. In contrast to other published data, no association of male gender and/or non-Caucasian ethnicity with poor outcome was found in our study cohort. (J Rheumatol 2004;31:1650-4) Key Indexing Terms:
SYSTEMIC LUPUS ERYTHEMATOSUS
From the Division of Rheumatology, Department of Pediatrics, University of Calgary, Calgary; the Division of Rheumatology, Department of Pediatrics, the Department of Medicine, and the Center for Community Child Health Research, British Columbia Children's Hospital and University of British Columbia, Vancouver, BC, Canada; and the Division of Pediatric Rheumatology, University of Milan, Milan, Italy. P.M. Miettunen, MD, Division of Rheumatology, Department of Pediatrics, University of Calgary; O. Ortiz-Alvarez, MD; R.E. Petty, MD; P.N. Malleson, MBBS; D.A. Cabral, MBBS, Division of Rheumatology, Department of Pediatrics, BC's Children's Hospital and University of British Columbia; R. Cimaz, MD, Division of Pediatric Rheumatology, University of Milan; S. Ensworth, MD, Division of Rheumatology, Department of Medicine; L.B. Tucker. MD, Division of Rheumatology, Department of Pediatrics, Center for Community Child Health Research, BC's Children's Hospital and University of British Columbia. Dr. Miettunen was supported by a fellowship from The Arthritis Society, Canada. Address reprint requests to Dr. L.B. Tucker, Division of Rheumatology, BC Children's Hospital, 4480 Oak Street, Rm K4-120, Vancouver, BC, Canada, V6H 3V4. E-mail: ltucker@cw.bc.ca Submitted July 30, 2003; revision accepted February 12, 2004. |