Background/Purpose: Previous studies suggest differences between childhood-onset SLE (cSLE) and adult onset SLE (aSLE). Whereas the prevalence of nephritis, neuropsychiatric, dermatologic, and hematologic manifestations are higher in cSLE, Raynaud’s phenomenon, pleuritis, and sicca symptoms are more common in aSLE. cSLE tends to have more severe organ involvement at presentation and higher scores on damage indices. The purpose of our study is to determine whether such differences exist among an urban, poor, uninsured, ethnic minority SLE patient population in Southern California.

Methods: This is a single center, cross sectional, retrospective study of 250 consecutive SLE patients. All patients met ACR criteria for the classification of SLE and were diagnosed at < 40 years of age. cSLE and aSLE patients were defined as age at diagnosis < 18 years and ≥18 years, respectively. Gender, ethnicity, age at diagnosis, and duration of follow up were noted. Outcome measures included prevalence of nephritis, other disease manifestations, cyclophosphamide use and SLICC scores. Group characteristics were summarized by descriptive statistics and differences between groups were analyzed by the chi square test and the student’s t test.

Results: There were 76 patients in the cSLE group and 174 patients in the aSLE group. Overall 76% of patients were Hispanic, 8% Black, 14% Asian, 1% Caucasian, and 1% other.  Ethnic breakdown was similar between cSLE and aSLE groups as was gender (84% women, 16% men). The average age at entry into study in the cSLE group was 25.5 years (range 17-37 years) and 31.0 years (range 19-39 years) in the aSLE group.  The average duration of follow up was 12.4 years and 6.8 years for cSLE and aSLE, respectively. The frequency of nephritis (54% vs 53%), neuropsychiatric lupus (9.5% vs 8.6%), cytopenias (46% vs 47%) and anti-phospholipid syndrome (6.6% vs 8.6%) were not significantly different between cSLE and aSLE, respectively, within the first two years of diagnosis. Use of cyclophosphamide was significantly higher in the cSLE group than the aSLE group (46% vs 24%, p < 0.01). At the time of entry into the study, cSLE patients showed a trend towards higher SLICC scores than aSLE. However, when the duration of follow up was accounted for, there were no significant differences between the two groups at 5, 10, 15, and 20 years of follow up.

Conclusion: In an underserved Hispanic and other ethnic minority SLE population, there is no difference in the frequency of nephritis, neuropsychiatric lupus, and other clinical manifestations between childhood-onset and adult-onset SLE at presentation. This study differs from previous studies in the large proportion of Hispanic patients included and that the studied population was all adults at the time of inclusion. As these findings differ from previous, more studies are necessary within this population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/childhood-onset-and-adult-onset-systemic-lupus-erythematosus-distinctions-in-an-underserved-ethnic-minority-cohort/