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Predictors of arthritis in pediatric patients with lupus
S D Sule1, D G Moodalbail2, J Burnham3
1Johns Hopkins University, Baltimore, MD, USA. ssule@jhmi.edu.
Insights
Predictors of arthritis in pediatric systemic lupus erythematosus (SLE) include increased age, malar rash, RNP antibodies, anemia, and thrombocytopenia. Identifying these markers can help clinicians manage SLE arthritis and improve children's quality of life.
Area of Science:
- Pediatric Rheumatology
- Systemic Lupus Erythematosus (SLE)
- Autoimmune Diseases
Background:
- Arthritis is a common manifestation of SLE in children, often causing significant morbidity and reduced quality of life.
- Pediatric SLE arthritis is typically non-erosive and non-deforming.
- Identifying predictors of arthritis in pediatric SLE is crucial for early intervention.
Purpose of the Study:
- To identify clinical and laboratory predictors of arthritis in a cohort of pediatric patients with SLE.
- To aid clinicians in identifying at-risk patients before arthritis onset.
- To improve the quality of life for children diagnosed with SLE.
Main Methods:
- A cohort study was conducted on incident and prevalent pediatric SLE patients (age ≤ 19 years).
- Cross-sectional analysis compared demographic and clinical characteristics at presentation.
- Time-to-event analysis using Cox proportional hazards identified predictors of arthritis.
Main Results:
- Increased age, malar rash, and RNP antibodies were predictive of arthritis in longitudinal analyses.
- Anemia and thrombocytopenia were significantly associated with an increased risk of arthritis.
- Malar rash was also associated with arthritis in cross-sectional analyses.
Conclusions:
- Key clinical and laboratory markers predictive of arthritis in pediatric SLE were identified.
- Early recognition of these markers can facilitate timely management strategies.
- Proactive identification of at-risk individuals may improve outcomes and quality of life for children with SLE.
Background:
Arthritis is one of the most common manifestations of systemic lupus erythematosus (SLE). Although typically non-erosive and non-deforming, children with SLE arthritis can have significant morbidity with decreased quality of life. Our goal was to identify potential clinical and laboratory predictors of arthritis in a cohort of pediatric patients with SLE.
Methods:
We performed a cohort study of incident and prevalent patients with SLE aged ≤ 19 years. In cross sectional analysis, we compared demographic and clinical characteristics at initial clinic presentation between patients with arthritis noted at any time during follow-up and those without arthritis. We performed time to event analysis using Cox proportional hazard ratios to identify predictors of arthritis, clustering for repeated measures.
Results:
Forty seven children and adolescents with SLE were followed in the cohort, 91 % female and 68 % Black. In cross-sectional analyses, presence of malar rash was associated with arthritis. In longitudinal analyses, controlling for gender and race, increased age (HR: 1.4, 95 % CI: 1.1-1.7), malar rash (HR: 2.1, 95 % CI: 1.1-3.6), and presence of RNP antibodies (HR: 1.9, 95 % CI: 1.1-3.4) were predictive of arthritis. When controlling for gender, race, and medication use, anemia (HR: 8.5, 95 % CI: 2.9-24.2) and thrombocytopenia (HR: 6.1, 95 % CI: 2.4-15.6) were associated with increased risk of arthritis.
Conclusions:
We identified markers predictive of arthritis in a longitudinal cohort of children with SLE. The recognition of these markers may help clinicians identify patients at risk for arthritis before its onset thus improving quality of life in children with SLE.
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