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Managing hypertriglyceridemia in children with systemic lupus erythematosus: Two sides of the same coin

Biswanath Basu1, Binu George Babu1, Suman Bhattacharyya1

  • 1Division of Pediatric Nephrology, Department of Pediatrics, NRS Medical College & Hospital, Kolkata, India.

Reumatologia Clinica
|October 9, 2016
PubMed

Insights

Extreme hypertriglyceridemia in children with systemic lupus erythematosus (SLE) can be caused by steroid treatment or anti-lipoprotein-lipase (LPL) autoantibodies. Individualized management based on the cause is crucial for effective treatment.

Area of Science:

  • Pediatrics
  • Rheumatology
  • Endocrinology

Background:

  • Hypertriglyceridemia is a frequent comorbidity in pediatric patients diagnosed with systemic lupus erythematosus (SLE).
  • Understanding the specific etiologies of severe hypertriglyceridemia in this population is essential for effective management.
  • This study investigates two pediatric cases of SLE presenting with extreme hypertriglyceridemia.

Observation:

  • The first patient developed severe hypertriglyceridemia after one week of oral prednisolone, with no detectable anti-lipoprotein-lipase (LPL) autoantibodies.
  • The second patient presented with extreme hypertriglyceridemia and tested positive for anti-LPL autoantibodies.
  • Both patients were managed with immunosuppressants and lipid-lowering agents, with individualized therapeutic adjustments.

Findings:

  • Extreme hypertriglyceridemia in pediatric SLE can be induced by corticosteroid therapy.
  • The presence of anti-LPL autoantibodies represents another significant cause of severe hypertriglyceridemia in these patients.
  • Treatment outcomes varied, with the first patient improving after switching from prednisolone to mycophenolate mofetil (MMF), and the second patient responding to plasmapheresis and increased immunosuppression.

Implications:

  • These findings highlight the need for careful monitoring of lipid profiles in children with SLE, particularly during corticosteroid treatment.
  • Differentiating between steroid-induced hypertriglyceridemia and autoimmune-related hypertriglyceridemia is critical for tailoring treatment strategies.
  • Individualized management approaches, considering the specific etiology, are paramount for optimizing outcomes in pediatric SLE patients with hypertriglyceridemia.

Keywords:
HipertrigliceridemiaHypertriglyceridemiaLipoprotein lipaseLipoproteína lipasaLupus eritematoso sistémicoSystemic lupus erythematosus

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