ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2504

Male Children With Higher SLE Disease Activity In An US Cohort

Lakshmi N. Moorthy1, Elizabeth Roy2, Margaret Peterson3, Afton L. Hassett4, Alexa B. Adams5, Laura V. Barinstein6, Elizabeth C. Chalom7, Karen Onel8, Linda Ray9, Jorge Lopez-Benitez10, Kathleen A. Haines11, Philip Hashkes12, Daniel J. Kingsbury13, Victoria Cartwright14, Nora G. Singer15, Ingrid Tomanova-Soltys16, Andreas Reiff17, Sandy D. Hong18 and Thomas J. A. Lehman19, 1Pediatric Rheumatology, Robert Wood Johnson Medical School-Rutgers University, New Brunswick, NJ, 2RWJMS-UMDNJ, New Brunswick, NJ, 3Hospital for Special Surgery, New York, NY, 4Anesthesiology, University of Michigan, Ann Arbor, MI, 5Pediatric Rheumatology, Hospital for Special Surgery, New York, NY, 6Pediatric Rheumatology, Mount Sinai Med Ctr, New York, NY, 7Pediatrics, St. Barnabas Medical Center, Livingston, NJ, 8Pediatric Rheumatology, University of Chicago Hospitals, Chicago, IL, 9Pediatric Rheumatology, University of Mississippi Medical Center, Jackson, MS, 10Pediatric Rheumatology Program Centro Medico La Costa, Asuncion, Paraguay, 11Department of Pediatrics, Joseph M Sanzari Children’s Hospital, Hackensack University Medical Center, Hackensack, NJ, 12Pediatric Rheumatology, Shaare Zedek Medical Center, Jerusalem, Israel, 13Randall Children's Hospital at Legacy Emanuel, Portland, OR, 14Legacy Emanuel Children's Hospital, Portland, OR, 15Medicine, Division of Rheumatology, MetroHealth Medical Center, Cleveland, OH, 16Winthrop University Hospital, Mineola, NY, 17Division of Rheumatology, Children's Hospital Los Angeles, Los Angeles, CA, 18Pediatrics-Rheumatology, U of Iowa Children's Hosp, Iowa City, IA, 19Chief Div Ped Rheum PTD, Hospital for Special Surgery, New York, NY

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords:

Session Information

Title: Systemic Lupus Erythematosus-Clinical Aspects III: Biomarkers, Quality of Life and Disease Indicators, Late Complications

Session Type: Abstract Submissions (ACR)

Background/Purpose: Although systemic lupus erythematosus (SLE) is more common in females, males tend to have more severe disease. We compared age at SLE diagnosis, duration, activity, damage, and medication use in young males to that in young females in an expanded pediatric cohort from the US.

Methods: We examined age at SLE onset, and duration of pediatric SLE patients (≤18years) from a cross-sectional multicenter cohort.   We determined use (current and past) of cyclophosphamide or rituximab, mycophenolate, and azathioprine.   Physicians completed the SLE disease activity index (SLEDAI), Physicians Global Assessment of disease activity (PGA) and the Systemic Lupus International Collaborating Clinics/ACR damage index (SDI).  We compared age at SLE diagnosis, duration, activity and damage in boys to that in girls.  Depending on the data distribution, the independent samples t-tests (t) and/or Mann-Whitney U (MWU) tests were used to compare samples.  We compared medication using the Chi-Square test.

Results: We identified 29 boys and 138 girls. Compared to girls, boys had a higher age of disease onset (p<0.01), lesser disease duration (p<0.01), and greater disease activity as assessed by SLEDAI and PGA (p<0.05) (Table 1). Differences in SDI and immunosuppressive medication use between the two groups were not statistically significant (Table 1).

Conclusion: SLE activity was higher in boys compared to girls in our cohort. Boys had a later age at diagnosis and shorter disease duration when compared to the girls in our study.  A higher index of suspicion is warranted to diagnose and detect worsening in young males with SLE, so that aggressive treatment can be instituted early.

Table 1: Comparison between young males and young females with SLE

Variables

Males (n=29 unless specified)

Females (n=138 unless specified)

 

Ethnicity (non-white, %)

23 (80%)

112 (81%)

 

Age at diagnosis in years (mean±SD)

13±3

11±4* (t)

 

Mean SLE duration in months (mean±SD)

18±20

40 ±41* (MWU)

 

PGA- none/mild SLE activity (n, %)

12 (45%)

86 (65%, n=133)

 

PGA- moderate-severe SLE activity (n, %)

17 (59%)

47 (33%, n=133)

 

PGA mean (mean±SD)

1.7±0.8

1.2±0.8* (n=133) (MWU)

 

SLEDAI mean (mean±SD)

7±6

5±6*(n=135) (MWU)

 

SDI mean (mean±SD)

0.9±1 (n=28)

0.8±1 (n=135)

 

Cyclophosphamide/ Rituximab (n, %)

 

10 (34%)

43 (31%)

Azathioprine (n, %)

5 (17%)

31 (22%)

 

Mycophenolate (n, %)

9 (31%)

44 (32%)

 

* p<0.05; Mann Whitney U test (MWU); Independent samples t test (t).

Disclosure:

L. N. Moorthy,

Arthritis Foundation InvestigatorAward,

2;

E. Roy,
None;

M. Peterson,
None;

A. L. Hassett,

Brestol-Myers Squibb and Pfizer,

2;

A. B. Adams,
None;

L. V. Barinstein,
None;

E. C. Chalom,
None;

K. Onel,
None;

L. Ray,
None;

J. Lopez-Benitez,
None;

K. A. Haines,
None;

P. Hashkes,
None;

D. J. Kingsbury,

AbbVie,

2;

V. Cartwright,
None;

N. G. Singer,
None;

I. Tomanova-Soltys,
None;

A. Reiff,
None;

S. D. Hong,
None;

T. J. A. Lehman,

Amgen, Pfizer, Abbvie,

8.

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