A comparison of the outcome of adolescent and adult-onset systemic lupus erythematosus

Rheumatology (Oxford). 2014 Jun;53(6):1130-5. doi: 10.1093/rheumatology/ket488. Epub 2014 Feb 6.

Abstract

Objective: Previous reports have suggested that juvenile-onset SLE is associated with a worse prognosis than adult-onset disease. There have been limited studies in adolescents. We sought to assess the effect of adolescent-onset SLE on the clinical course of a large multi-ethnic cohort.

Methods: Patients consisted of individuals diagnosed with SLE between 11 and 18 years of age in a tertiary referral centre. All patients with adult-onset disease were used as controls. Data were analysed by univariable and multivariable analysis for demographic, clinical and serological data.

Results: One hundred and twenty-four patients with adolescent-onset and 484 patients with adult-onset disease were identified. There was a higher percentage of males (12.9% vs 7.2%; P = 0.036) and patients of Asian ethnicity within the adolescent group (P < 0.01). By univariable analysis, adolescent-onset SLE was associated with more frequent LN and haemolytic anaemia and less serositis and SS. Ischaemic vascular events occurred in 32 adult-onset patients (6.6%) and 3 adolescent-onset patients (2.4%; P = 0.08). Thirty-five adult-onset patients developed cancer (6.8%) compared with five of the adolescent-onset group (4.8%; P = 0.54). The standardized mortality rate was significantly increased in females with adolescent-onset SLE (14.4; 95% CI 4.44, 24.4) compared with patients with adult-onset SLE. By multivariable analysis, adolescent-onset SLE retained a significant association with LN.

Conclusion: Adolescent-onset SLE is associated with a significantly increased risk of LN and, importantly, with a marked increase in mortality. These data suggest a more aggressive phenotype of disease in patients with onset of SLE in adolescence and supports the need for intensive follow-up and intensive therapy in this population.

Keywords: adolescent rheumatology; outcome measures; paediatric/juvenile rheumatology; systemic lupus erythematosus.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Age of Onset
  • Asian Continental Ancestry Group / statistics & numerical data
  • Child
  • Female
  • Humans
  • London / epidemiology
  • Lupus Erythematosus, Systemic / complications
  • Lupus Erythematosus, Systemic / diagnosis*
  • Lupus Erythematosus, Systemic / mortality
  • Lupus Nephritis / diagnosis
  • Lupus Nephritis / mortality
  • Male
  • Neoplasms / etiology
  • Neoplasms / mortality
  • Outcome Assessment, Health Care
  • Prognosis
  • Retrospective Studies
  • Severity of Illness Index