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Retrospective Analysis of the Factors Affecting Growth Parameters in Turkish Children With Systemic Lupus
Sibel Balci1, Rabia Miray KiŞla Ekİncİ1, Engin Melek2
1Department of Pediatrics, Division of Pediatric Rheumatology, Çukurova University School of Medicine, Adana, Turkey.
Insights
Juvenile systemic lupus erythematosus (jSLE) patients show reduced height z-scores, particularly those treated with high cumulative corticosteroid doses. This highlights the impact of treatment on growth in pediatric lupus patients.
Area of Science:
- Pediatric Rheumatology
- Endocrinology
- Growth and Development
Background:
- Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect multiple organ systems.
- Growth impairment is a significant concern in children diagnosed with juvenile SLE (jSLE).
- Understanding factors influencing growth is crucial for optimizing management strategies.
Purpose of the Study:
- To investigate growth parameters in Turkish children with jSLE.
- To compare growth parameters based on treatment modalities and disease characteristics.
- To identify potential predictors of impaired growth in jSLE.
Main Methods:
- Retrospective evaluation of anthropometric data (weight, height, BMI z-scores) from 45 jSLE patients.
- Calculation of growth parameters using Turkish pediatric anthropometric references.
- Assessment of disease activity (SLEDAI-2K) and damage (SDI).
Main Results:
- Mean height z-score was significantly lower at the last visit compared to diagnosis.
- Growth parameters did not significantly differ based on treatment with cyclophosphamide or rituximab, or presence of proliferative nephritis.
- Patients receiving ≥10g cumulative corticosteroid dose exhibited a significantly lower mean height z-score at the last visit.
Conclusions:
- jSLE patients experience significantly reduced height and parent-adjusted height z-scores.
- High cumulative corticosteroid doses (≥10g) are associated with diminished height z-scores in jSLE.
- Monitoring growth and optimizing corticosteroid therapy are essential in managing jSLE.
Objectives:
This study aims to investigate the growth parameters in Turkish children with systemic lupus erythematosus (SLE) and to compare these growth parameters according to the presence or absence of cyclophosphamide, rituximab treatment, cumulative corticosteroid dose, proliferative nephritis, and the last visit disease activity and damage index.
Patients And Methods:
Medical data, growth parameters including z-scores for weight, height, and body mass index and parent-adjusted height z-scores of 45 juvenile SLE (jSLE) patients (5 males, 40 females; mean age 12.3±3.2 years; range 7.1 to 18 years) were retrospectively evaluated. Growth parameters were calculated by anthropometric references in Turkish children. The disease activity was assessed by the SLE Disease Activity Index 2000 (SLEDAI-2K). The disease outcome was measured by the Pediatric version of Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index.
Results:
The median diagnostic delay was two months (range, 0-36 months). The median follow-up duration was 3.21 years (range, 0.63-9.48 years). Mean height z-score was significantly lower at last visit than at the time of diagnosis. The growth parameters did not differ according to age at disease onset, diagnostic delay, presence of proliferative nephritis, having cyclophosphamide and rituximab treatment and the last visit (SLEDAI-2K) scores. The median duration of corticosteroid treatment was 3.2 years (range, 0.6-9.4 years) and the median cumulative corticosteroid dosage was 13.9 g (range, 1.9-58 g) of methylprednisolone. The mean height z-score at last visit was significantly lower in those who received at least 10 g of cumulative dose of corticosteroid. The last visit mean parent-adjusted height z-scores did not differ significantly regarding the cumulative corticosteroid dose.
Conclusion:
The last visit height and parent-adjusted height z-scores of jSLE patients were significantly lower. The patients treated with at least 10 g of cumulative dose of corticosteroids had lower mean height z-score.
