JUVENILE-ONSET VERSUS ADULT-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS: DIFFERENT CLINICAL AND SEROLOGICAL PATTERN

Abstract

Systemic lupus erythematosus (SLE) is a worldwide multisystem autoimmune disease of unknown etiology. It usually affects adults as well as adolescences and affects ten times as many women as men. It is characterized by production of autoantibodies, which result in widespread immunological abnormalities and immune complex formation (Postal et al., 2012). Our study aimed to evaluate the differences in organ involvement, serological pattern, disease activity and damage indices between juvenile-onset and adult-onset SLE patients at diagnosis and follow-up. Our study was cross section study, which included 160 SLE patients according to SLICC classification criteria for SLE (Petri et al., 2012). They were divided to two groups: Group 1: 80 Patients with adult-onset, physician diagnosed SLE who enrolled from adult rheumatology unit, clinic and Internal Medicine department of Ain Shams University Hospital. Adult onset SLE was defined as age of onset above 16 years. Group 2: 80 Patients with juvenile-onset, physician diagnosed SLE who enrolled from pediatric Immunology and rheumatology unit and Pediatrics’ Hospital of Ain Shams University. Juvenile onset SLE was defined as age of onset below 16 years. All the patients were subjected to: Full history taking with special emphasis on: drugs intake and musculoskeletal affection, thorough clinical examination, the disease activity was assessed by (SLEDAI), (SLICC/ACR) Damage Index, renal BILAG score, different laboratory Investigations including Complete blood count and differential leucocytes, ESR in first hour, CRP level, Kidney function tests, Liver enzymes (ALT, AST), Complete urine analysis, 24 hours urinary proteins, corrected creatinine clearance,Antinuclear antibody (ANA), Anti ds DNA antibody and Serum complement level. Fundus examination and echocardiography were done when necessary. In our study, the most common clinical presentation among adult SLE was malar rash (75%) followed by articular manifestations (62.5%), while in juvenile SLE we found that the most common clinical presentation among juvenile SLE was articular manifestations (71.2%) followed by nephritis (67.2%). Major organ involvement like kidney and brain were higher in juvenile SLE. Different hematological abnormalities were higher in juvenile SLE than adult SLE patients including (leucopenia, anemia, lymphopenia, neutropenia and thrombocytopenia). We found also frequency of hemolytic anemia; anemia of chronic illness and microcytic anemia were higher in juvenile than adult SLE patients were. In our study, frequency of hematuria, proteinuria, urinary cast, pyuria and 24-hour urinary protein (proteinuria) were higher and more frequent in juvenile than adult SLE patients were. Studying different histopathological types of lupus nephritis according to WHO classification, we found that the most common class of lupus nephritis in juvenile SLE was class II (53.2% vs 20.6%) in adult, but the most common class of lupus nephritis in adult was class IV (37.9% vs 8.5%) in juvenile. We found that more C3 and C4 consumptions and anti DNA antibodies were higher in juvenile than adult was. Positive anti cardiolipin antibodies and lupus anticoagulant antibodies were higher in juvenile SLE than adult (28% vs 14%- 24% vs 11%) and antiphospholipid syndrome was more frequent in juvenile.