May Forum- Juvenile vs Adult-onset SLE
Welcome to the May edition of #chatJRheum
This week’s article is of interest to pediatric and adult rheumatologists, alike.
It adds to a growing body of literature aimed at defining differences in clinical characteristics between juvenile-onset SLE (jSLE) and adult-onset SLE (aSLE).
Along with ethnic and geographic influences, age of onset effects expression and outcomes of SLE. This has been described in a number of cohorts, including a Canadian cohort. For example, jSLE more commonly presents with fever, lymphadenopathy, malar rash, cytopenias, and nephritis.
This study included 935 patients: 719 aSLE and 216 jSLE in a longitudinal study of 2 tertiary cohorts in Turkey. Here are my takeaway points:
- Higher rates of nephritis and AIHA were noted in jSLE. Also more dsDNA, anticardiolipin IgM and IgG positivity.
- In aSLE, more anti-RO, anti-LA positivity, also MSK and CV damage was observed.
- Among presentations of lupus nephritis there was no histological difference, yet they observed increased renal damage in jSLE.
- While there was no difference in SLICC damage scores after controlling for disease duration, there was a trend toward higher damage scores in jSLE, despite their shorter duration of disease.
- There was no difference in mortality observed between the two groups.
There were a number of noteworthy limitations. The all Caucasian cohort cannot necessarily be extrapolated to cohorts common in our practices that include other minorities such as Asian and African American patients. Also, there was limited information on treatment and adherence.
I ask you to reflect back on the patients with SLE whom you have cared for, whether adult or juvenile. Does this fit your clinical observations? Does this information change your approach and management? It certainly will change mine!
Dr. Sarah Troster, Forum Editor