Background/Purpose: The diagnosis of systemic lupus erythematosus (SLE) in childhood affects growth due to disease and therapy. To date, there are few studies of final adult height achieved in children diagnosed with SLE and no study examining the relationship of pubertal status at diagnosis and final height. Our aim was to examine the relationship between age at menarche and final adult height, accounting for ethnicity.

Methods: We completed a retrospective cohort study, reviewing 564 female patients < 18 years of age at diagnosis, and followed at a tertiary care, pediatric center from July 1982 to March 2016. All patients met American College of Rheumatology and/or Systemic Lupus International Collaborating Clinics classification criteria for SLE. Patients with documented vertebral collapse (15 patients) or growth hormone therapy (4 patients) were excluded. We reviewed prospectively collected demographic and clinical data including self-reported ethnicity, height, age at menarche, age at diagnosis, disease activity, disease damage and medication use. Final height was the height achieved after <1 cm growth per year for 2 years following menarche or height at 18 years of age. We compared age at diagnosis and menarche as well as final height between patients diagnosed with SLE pre- and post-menarche using a t-test. We divided patients diagnosed post-menarche into females who grew >1 cm post-menarche and females who had achieved final height at diagnosis (no growth). We examined SLE diagnosis post-menarche, compared with pre-menarche in association with final height, adjusting for ethnicity, in linear regression models.

Results: Our cohort included 401 female SLE patients with final height and menarche data. Of those, 115 patients (29%) were diagnosed pre-menarche (mean age of diagnosis 10.7 years [SD 2.2 years]) and 286 patients (71%) were diagnosed post-menarche (mean age of diagnosis 15.1 years [SD 1.6 years]). Age of menarche was 13.5 years (SD 1.4 years) in the pre-menarche group, compared to 12.5 years (SD 1.4 years) in the post-menarche group (P <0.001). The mean final height for females diagnosed post-menarche was greater than those diagnosed pre-menarche (Table 1). In subgroup analysis of the post-menarche group, the mean final height of girls with no growth (161.9 cm [SD 6.8 cm]) was greater than girls diagnosed pre-menarche (p=0.001). In regression analysis, those diagnosed post-menarche were significantly taller than those diagnosed pre-menarche, adjusted for ethnicity (Beta = 2.6cm, SD 0.7cm, P <0.001).

Conclusion: In this large cohort study of females with childhood-onset SLE, patients diagnosed post-menarche achieved a taller final height than those diagnosed pre-menarche even after accounting for ethnicity. Future analyses will explore the relationship of disease activity, damage and medication use with growth velocity and final adult height.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/menarchal-status-at-diagnosis-and-final-height-in-females-with-childhood-onset-systemic-lupus-erythematosus/