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Delay in Referral, Diagnosis, and Treatment in Pediatric Patients With Juvenile Systemic Lupus Erythematosus: A
Marcela Beatriz Álvarez1, Adolfo G Hernandez-Garduno2, Ana Victoria Villarreal-Treviño3
1Sección de Reumatología Infantil, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina.
Insights
Managing juvenile systemic lupus erythematosus (jSLE) delays impact patient outcomes. Key barriers to timely diagnosis include sociodemographic and clinical factors, with a mean diagnosis time of 3.5 months.
Area of Science:
- Pediatric Rheumatology
- Systemic Autoimmune Diseases
- Clinical Outcomes Research
Background:
- Delayed management of juvenile systemic lupus erythematosus (jSLE) significantly impacts patient prognosis.
- Effective early intervention is crucial for improving long-term outcomes in jSLE.
Purpose of the Study:
- To systematically review the existing literature on delays in referral, diagnosis, and treatment of jSLE patients.
- To identify barriers and facilitators influencing these delays.
- To estimate the time from symptom onset to diagnosis in jSLE.
Main Methods:
- Systematic review of studies from Scopus, PubMed, and Web of Science up to March 2025.
- Adherence to PRISMA guidelines and critical appraisal using Joanna Briggs Institute (JBI) checklists.
- Meta-analysis of random effects models to quantify diagnostic delays.
Main Results:
- Included 24 studies across multiple continents; median JBI quality score was 5.
- Mean time from jSLE onset to diagnosis estimated at 3.5 months (CI=2.73-4.27).
- Barriers to timely diagnosis included male sex, low ANA titers, low income, and mild symptoms; no North-South divide in diagnosis time.
Conclusions:
- No established consensus exists for defining referral, diagnosis, or treatment delays in jSLE.
- Sociodemographic and clinical factors present significant barriers to prompt jSLE management.
Background/Objective:
The delay in managing patients with juvenile systemic lupus erythematosus (jSLE) is one of the most important determinants impacting outcomes.
Methods:
We conducted a systematic review regarding the delay in referral, diagnosis, and treatment of patients with jSLE, and the barriers and facilitators related to these processes. Electronic searches were conducted in Scopus, PubMed, and Web of Science for studies published up to March 4, 2025; additionally, reports were identified through a citation search. The project followed the PRISMA guidelines, and the critical appraisal was based on the Joanna Briggs Institute Checklist (JBI). Meta-analyses, using random effects models, were conducted to estimate the delay.
Results:
The review included 24 papers from Europe, Asia, the Americas, and Africa. The median JBI quality score was 5 (IQR=4.75 to 6). Only one study presented a definition for the delay to diagnosis of jSLE. The estimated mean time from onset to diagnosis was 3.5 months (95% CI=2.73-4.27, I2 =93.4%, p <0.0001). Only 3 studies reported a referral delay. Two studies indicated that all patients received therapy at diagnosis. There was no difference in the time to diagnosis between countries from the Global North and the Global South. The most common barriers identified for timely diagnosis were male sex, low anti-nuclear antibody titers, low family income, and patients presenting mild clinical manifestations.
Conclusions:
Currently, no consensus exists on defining the delays in referral, diagnosis, or treatment for jSLE patients. Common barriers are related to both sociodemographic and clinical factors.
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