Adolescent onset of lupus results in more aggressive disease and worse outcomes: results of a nested matched case–control study within LUMINA,a multiethnic US cohort (LUMINA LVII)

Abstract

The objective of this study is to examine the clinical features and outcomes of patients with systemic lupus erythematosus (SLE) whose disease began in adolescence [juvenile-onset SLE (jSLE)] compared with adult-onset patients [adult-onset SLE (aSLE)] from a large multiethnic cohort. Systemic lupus erythematosus patients of African-American, Caucasian, or Hispanic ethnicity and ≥1 year follow-up were studied in two groups: jSLE (diagnosed at ≤18 years); aSLE (diagnosed at 19–50 years; matched for gender and disease duration at enrolment). Sociodemographic data, SLE manifestations, disease activity, damage accrual, SLE-related hospitalizations or emergency room visits, drug utilization, mortality and psychosocial characteristics and quality of life were compared. Data were analysed by univariable and multivariable analyses. Seventy-nine patients were studied (31 jSLE, 48 aSLE); 90% were women. Mean (SD) total disease duration was 6.8 (2.7) years in jSLE and 5.6 (3.3) years in aSLE (p = 0.077). Mean age at cohort entry was 18.4 (1.8) and 33.9 (9.2) years in jSLE and aSLE respectively. By univariable analysis, jSLE patients were more commonly of African-American descent, were more likely to have renal and neurological involvements, and to accrue renal damage; jSLE patients had lower levels of helplessness and scored higher in the physical component measure of the SF-36 than aSLE patients. Renal involvement [OR = 1.549, 95% CI (1.397–15.856)] and neurological involvement [OR = 1.642, 95% CI (1.689–15.786)] were independently associated with jSLE by multivariable analysis. There was a larger proportion of African-Americans within the jSLE group. After adjusting for ethnicity and follow-up time, jSLE patients experienced more renal and neurological manifestations, with more renal damage. There was a two-fold higher mortality rate in the jSLE group.

Keywords

juvenile-onset SLE outcome

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References

1 Petty RE Laxer RM . Systemic lupus erythematosus. In: JT Cassidy RE Petty RM Laxer CB Lindsley , (eds), Textbook of Pediatric Rheumatology. Philadelphia, PA : Elsiever Saunders ; 2005. p. 342–391.

2 Tucker LB Menon S Schaller JG Isenberg DA . Adult- and childhood-onset systemic lupus erythematosus: a comparison of onset, clinical features, serology, and outcome. Br J Rheumatol 1995; 34: 866 – 872 .

3 Miettunen PM Ortiz-Alvarez O Petty RE . Gender and ethnic origin have no effect on longterm outcome of childhood onset systemic lupus erythematosus. J Rheumatol 2004; 31: 1650 – 1654 .

4 Brunner HI Silverman ED To T . Risk factors for damage in childhood-onset systemic lupus erythematosus: cumulative disease activity and medication use predict disease damage. Arthritis Rheum 2002; 46: 436 – 444 .

5 Lacks S White P . Morbidity associated with childhood systemic lupus erythematosus. J Rheumatol 1990; 17: 941 – 945 .

6 Candell Chalom E Periera B Cole R . Educational, vocational, and socioeconomic status and quality of life in adults with childhood-onset systemic lupus erythematosus. Pediatr Rheumatol Online J 2004; 2: 207 – 226 .

7 Alarcon GS Roseman J Bartolucci AA . Systemic lupus erythematosus in three ethnic groups: II. Features predictive of activity early in its course. LUMINA Study Group. Lupus in minority populations, nature versus nurture. Arthritis Rheum 1998; 41: 1173 – 1180 .

8 Uribe AG McGwin G Reveille JD Alarcon GS . What have we learned from a 10-year experience with the LUMINA (Lupus in Minorities; Nature vs. nurture) cohort? Where are we heading? Autoimmun Rev 2004; 3: 321 – 329 .

9 Tan EM Cohen AS Fries JF . The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982; 25: 1271 – 1277 .

10.

10 Bertoli AM Alarcón GS Calvo-Alén J . Systemic lupus erythematosus in a multiethnic us cohort. Clinical features, course, and outcome in patients with late-onset disease. Arthritis Rheum 2006; 54: 1580 – 1587 .

11.

11 Alarcon GS Friedman AW Straaton KV . Systemic lupus erythematosus in three ethnic groups: III. A comparison of characteristics early in the natural history of the LUMINA cohort. LUpus in MInority populations: NAture vs. Nurture. Lupus 1999; 8: 197 – 209 .

12.

12 US Department of Commerce Bureau of the Census. . Current population reports, series P-23, no. 28 and series P-60, no. 68 and subsequent years. Washington, DC : Housing and Household Economic Statistics Division ; 1995.

13.

13 Cohen S Mermelstein R Kamarck T Hoberman HN . Measuring the functional components of social support. In: IG Sarason BR Sarason , (eds), Social Support: Theory, Research and Applications. Boston : Martinus Nijhoff ; 1985. p. 73–94.

14.

14 Engle EW Callahan LF Pincus T Hochberg MC . Learned helplessness in systemic lupus erythematosus: analysis using the Rheumatology Attitudes Index. Arthritis Rheum 1990; 33: 281 – 286 .

15.

15 Pilowsky I . Dimensions of illness behaviour as measured by the Illness Behaviour Questionnaire: a replication study. J Psychosom Res 1993; 37: 53 – 62 .

16.

16 Ware JE Kosinski M Keller SD . SF-36 physical and mental health summary scales: a user’s manual. Boston : The Health Institute, New England Medical Center ; 1994.

17.

17 Liang MH Socher SA Larson MG Schur PH . Reliability and validity of six systems for the clinical assessment of disease activity in systemic lupus erythematosus. Arthritis Rheum 1989; 32: 1107 – 1118 .

18.

18 Gladman DD Urowitz MB Goldsmith CH . The reliability of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index in patients with systemic lupus erythematosus. Arthritis Rheum 1997; 40: 809 – 813 .

19.

19 Font J Cervera R Espinosa G . Systemic lupus erythematosus (SLE) in childhood: analysis of clinical and immunological findings in 34 patients and comparison with SLE characteristics in adults. Ann Rheum Dis 1998; 57: 456 – 459 .

20.

20 Ruperto N Buratti S Duarte-Salazar C . Health-related quality of life in juvenile-onset systemic lupus erythematosus and its relationship to disease activity and damage. Arthritis Rheum 2004: 51: 458 – 464 .

21.

21 Ravelli A Duarte-Salazar C Buratti S . Assessment of damage in juvenile-onset systemic lupus erythematosus: a multicenter cohort study. Arthritis Rheum 2003; 49: 501 – 507 .

22.

22 Gutiérrez-Suárez R Ruperto N Gastaldi R . A proposal for a pediatric version of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index based on the analysis of 1,015 patients with juvenile-onset systemic lupus erythematosus. Arthritis Rheum 2006; 54: 2989 – 2996 .

23.

23 Lilleby V Flato B Forre O . Disease duration, hypertension and medication requirements are associated with organ damage in childhood-onset systemic lupus erythematosus. Clin Exp Rheumatol 2005; 23: 261 – 269 .

24.

24 Tucker LB Cabral DA . Transition of the adolescent patient with rheumatic disease: Issues to consider. Ped Clin North Am 2005; 52: 641 – 652 .

25.

25 Alarcon GS McGwin G Sanchez ML . Systemic lupus in three ethnic groups: XIV. Poverty, wealth, and their influence on disease activity. Arthritis Rheum 2004; 51: 73 – 77 .

26.

26 Meller S Homey B Ruzicka T . Socioeconomic factors in lupus erythematosus. Autoimmun Rev 2005; 4: 242 – 246 .

27.

27 King KK Kornreich HK Bernstein BH . The clinical spectrum of systemic lupus erythematosus in childhood. Arthritis Rheum 1977; 20(2 Suppl.): 287 – 294 .

28.

28 Meislin AG Rothfield NF . Systemic lupus erythematosus in childhood: analysis of 42 cases with comparative data in 200 adult cases followed concurrently. Pediatrics 1968; 42: 37 – 49 .

29.

29 Levy M Montes de Oca M Claude-Babron M . Unfavorable outcomes (end-stage renal failure/death) in childhood onset systemic lupus erythematosus. A multicenter study in Paris and its environs. Clin Exp Rheumatol 1994; 12: S63 – S68 .

30.

30 Singh S Kumar L Joshi K . Mortality patterns in childhood lupus – 10 years experience in a developing country. Clin Rheumatol 2002; 21: 462 – 465 .