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Systemic lupus erythematosus in Saudi children: long-term outcomes
1Section of Rheumatology, Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. mayouf@kfshrc.edu.sa
Insights
Systemic lupus erythematosus (SLE) in Saudi children often leads to long-term damage, particularly in growth, renal, and neuropsychiatric domains. Early-onset disease significantly impacts outcomes, and infection remains a primary cause of mortality in pediatric SLE patients.
Area of Science:
- Pediatric Rheumatology
- Autoimmune Diseases
- Longitudinal Studies
Background:
- Systemic lupus erythematosus (SLE) is a chronic autoimmune disease affecting children.
- Understanding long-term outcomes in pediatric SLE is crucial for effective management.
- Saudi Arabian data on pediatric SLE outcomes are limited.
Purpose of the Study:
- To evaluate the long-term outcomes of Saudi children diagnosed with SLE.
- To identify factors influencing disease damage and mortality in this cohort.
- To compare findings with international reports on pediatric SLE.
Main Methods:
- Retrospective chart review of 152 Saudi children with SLE (1990-2010).
- Assessment of long-term outcomes using the pediatric adaptation of the Systemic Lupus International Collaborating Clinics American College of Rheumatology Damage Index (pSDI).
- Analysis of clinical features, treatment, age at onset, disease duration, and mortality causes.
Main Results:
- 52.6% of patients experienced disease damage (mean pSDI: 1.3), predominantly affecting growth, renal, and neuropsychiatric systems.
- 14 patients required dialysis, and five underwent renal transplant.
- Nine SLE-related deaths occurred, with infection being the leading cause (8/9).
- Younger age at onset and longer disease duration were significantly associated with increased damage and mortality.
Conclusions:
- Pediatric SLE outcomes in Saudi Arabia are comparable to international data.
- Early-onset SLE is a significant predictor of poorer long-term outcomes.
- Infection control is critical for reducing mortality in children with SLE.
Objective:
To report the long-term outcome of Saudi children with systemic lupus erythematosus (SLE).
Methods:
Charts of all children with SLE treated between 1990 and 2010 at King Faisal Specialist Hospital and Research Center Riyadh, were reviewed. The long-term outcome measured by pediatric adaptation of the Systemic Lupus International Collaborating Clinics American College of Rheumatology Damage Index (pSDI) and death related to SLE were determined. The data included: gender, age at disease onset, clinical features and treatment at last follow-up visit.
Results:
One hundred and fifty-two patients (129 girls and 23 boys) were included. The mean age at onset of SLE was 8.8 ± 2.6 years, while the mean age at diagnosis was 9.5 ± 2.6 years and the mean disease duration was 7.5 ± 4.6 years. All patients were treated with corticosteroid and immunosuppressive drugs. Eighty (52.6%) patients had damage with a mean SDI score of 1.3 ± 1.7. Damage accrual was mostly in the growth (26.8%), renal (17.1%) and neuropsychiatric (15.8%) domains. Due to progressive renal disease, 14 patients required dialysis; five of them underwent renal transplant. There were nine deaths related to SLE, eight of them due to infection. Based on logistic regression, patient disease damage was significantly associated with young age at disease onset and long disease duration. Similarly, death related to SLE was influenced by early-onset disease. In contrast, gender, disease duration and therapy did not affect the suggested outcome measures.
Conclusion:
Our results are comparable to reports from other tertiary centers. Early-onset disease probably influences the long-term outcome of SLE in children. Infection remains an important cause of death in children with SLE.
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