Systemic lupus erythematosus in Indian children

Area of Science:

• Pediatric Rheumatology
• Immunology
• Nephrology

Background:

• Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse clinical manifestations.
• Pediatric SLE often presents differently than adult-onset SLE, necessitating specific diagnostic and management approaches.
• Understanding the unique characteristics of SLE in prepubertal children is vital for effective treatment.

Purpose of the Study:

• To analyze the clinical and immunological features of systemic lupus erythematosus (SLE) in prepubertal children.
• To identify common presenting symptoms and organ involvement in this pediatric cohort.
• To evaluate the incidence of specific immunological markers and their correlation with disease activity.

Main Methods:

• Retrospective review of 20 prepubertal children diagnosed with SLE over 14 years.
• Analysis of clinical presentations, including fever, joint involvement, and nephrotic syndrome.
• Assessment of organ system involvement (renal, cardiovascular, respiratory, neuropsychiatric, mucocutaneous) and laboratory findings (autoantibodies, complement levels).

Main Results:

• The male:female ratio was 1:2.3, with a mean age of onset at 9.37 years.
• Fever and joint involvement (60%) and nephrotic syndrome (25%) were the most common initial symptoms.
• High rates of renal involvement (75%), hypertension (45%), and anemia (75%) were observed; leucopenia was absent.
• 100% positivity for antinuclear antibodies and high positivity for anti-dsDNA (87.5%) and anti-ssDNA (75%) antibodies were noted.

Conclusions:

• Pediatric SLE in this cohort commonly presents with constitutional symptoms and significant renal involvement.
• The immunological profile is characterized by high autoantibody titers, consistent with active autoimmunity.
• Prompt recognition and comprehensive management are essential for addressing the multi-systemic nature of childhood SLE.