Early-onset lupus and clinical connotations

Autores: Rodrigo Águila Maldonado, Adrián Salas, Rosana Quintana, Pierina Sansinanea, Carolina Costi, Walter Spindler, Alberto Spindler, Diana Dubinsky, César Graf, Dora Pereira, Gisela Pendon, María Paula Iriarte Padula, Rafael Chaparro, María Silvia Yacuzzi, Edson Chiganer, Gustavo Vijoditz, Victoria Collado, Judit Sarano, Alicia Eimon, Cecilia Pisoni, Analía Álvarez, Andrea González, Eliana Lancioni, Federico Zazzetti, Ana Curti, Verónica Bellomio, Marta Espósito, Graciela Gómez, Agustina Damico, Julia Romero, Bernardo Pons-Estel, Juan Soldano, Alberto Allievi, Sebastián Muñoz, Flavia Caputo, Mónica Díaz, Juan Pablo Ruffino, Verónica Saurit, Laura Encinas, Marcela Colazo, Eleonora Bresan, Alejandro Martínez, Mercedes García

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Introduction: patients with systemic lupus erythematosus (SLE) develop their disease in childhood or adolescence in about 15-20%, described as a more severe phenotype.

Objectives: to evaluate the prevalence of early-onset SLE, as well as its clinical and laboratory manifestations.

Materials and methods: this was a cross-sectional, retrospective, and multicenter study that included 659 consecutive patients. Based on the time of diagnosis, patients were classified as having early-onset SLE (<18 years of age) or late-onset SLE (≥18 years of age). Their characteristics and clinical manifestations were compared.

Results: ninety-three patients met criteria for early-onset SLE, with a mean age at diagnosis of 14.7 years and a mean disease duration of 300 (SD 135) months, compared with 227 (SD 142) months in late-onset patients (p<0.001). In the univariate analysis, early-onset SLE was significantly associated with malar erythema (p=0.046), nephropathy (p=0.004), proteinuria >0.5 g/day (p=0.024), neurological involvement (p=0.045), and intravenous cyclophosphamide treatment (p<0.001). Multivariate analysis showed an association between early-onset SLE and class IV lupus nephropathy (p=0.001), as well as hypocomplementemia (p=0.001).

Conclusions: predictors of greater severity were observed in early-onset SLE. Hypocomplementemia and class IV nephropathy act as surrogates of higher immunological activity and disease involvement, potentially requiring more intensive therapy.