Date: Monday, October 22, 2018
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Approximately 20% of patients with Systemic Lupus Erythematosus (SLE) begin their illness in childhood or adolescence. These patients are described with a phenotype of greater severity. The aim of this study was to evaluate the prevalence of early onset SLE and the clinical and laboratory manifestations of these patients.
Methods: A total of 659 consecutive patients were included in one year. All met at least four diagnostic criteria from the American College of Rheumatology (ACR 82/97). Early-onset SLE was defined as disease diagnosed before 18 years of age and late onset or adult when age at diagnosis was ≥ 18 years. Criteria for diagnosis and damage were measured by cumulative Systemic Lupus Collaborating Clinical Damage Index (SLICC-SDI). Disease activity was measured by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) at the time of entry into the study. SLEDAI ≥12 was considered as severe activity. Manifestations were compared between early and late-onset SLE patients. Statistical analysis for categorical variables was performed with chi-square test or Fisher exact test as appropriate and for continuous variables with Student t-test. Strength of association were obtained by odds ratio and 95% confidence interval (CI). Multivariate analysis was performed using early-onset Lupus as outcome variable.
Results: 82/659 (12,44 %) met criteria for early-onset SLE, 90% of these patients were women vs. 87% late onset (p = 0.408, OR: 1.38, 95% CI: 0.63-3.45). Mean age at diagnosis was 15 ± 2 (7-17) vs. 32 ± 11 years (18-76), with a median time of 134 ± 86 vs. 96 ± 92 months (p = 0.00034) at diagnosis. Mean number of classification criteria was 7 vs. 6 (p = 0.016), and for SLEDAI score was 2 (0-36) vs. 2 (0-73), p = 0.955. At the time of their inclusion in the study, they had severe activity: 18% vs. 8.5% (p = 0.005, OR: 2.41, 95% CI: 1-19-4.6). Mean SLICC score was 1.14 (0-8) vs. 1.02 (0-9), p = 0.57. Univariate analysis also showed that Malar erythema (p: 0,014), nephritis (p: 0.010), glomerulonephriris Class IV (p: 0,0001), CNS (p: 0,019), cataracts (p: 0,019) were statistically significant. In the multivariate analysis, there was a significant association with early onset-SLE mestizo ethnicity: OR: 1.65, 95% CI: 1.01-2.69, p = 0.041; Malar erythema: OR: 1.81, 95% CI: 1.009- 3.25, p = 0.046 and renal disease: OR: 1.86, 95% CI: 1.15-3.006, p = 0.01.
Conclusion: In this cohort of SLE patients, 12.4% were classified as early onset, with a mean age at diagnosis of 15 years (7-17). Multivariate analysis persisted as independent variables associated with early-onset Lupus, mestizo ethnicity, cutaneous involvement with malar erythema and nephropathy. Association with damage index was not significant.
To cite this abstract in AMA style:Aguila Maldonado R, Pereira D, Pendon G, Spindler A, Pisoni CN, Hofman J, Collado MV, Sarano J, Graf C, Gómez GN, Alba P, Pena CE, Costi AC, Salas A, Curti A, Rillo O, Papasidero SB, Bellomio V, Roverano S, Schmid M, Allievi A, Muñoz S, Spindler WJ, Gonzalez A, Beron AM, Quintana R, Damico A, Gómez A, Tolosa S, Soriano E, Eimon A, Espósito MS, Ferreyra Mufarregue LR, Ruffino JP, Saurit V, Chiganer EH, Risueño F, Caputo F, Velozo E, Soldano J, Diaz M, Garcia M. Differences between Early and Adult-Onset Systemic Lupus Erythematosus in Cohort of Argentinian Patients [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/differences-between-early-and-adult-onset-systemic-lupus-erythematosus-in-cohort-of-argentinian-patients/. Accessed June 15, 2021.
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