Background In earlier studies, we found that the juvenile onset of systemic lupus erythematosus (SLE) did not significantly modify the clinical expression of the disease.1 Although juvenile-onset SLE may have a more sombre prognosis than adult-onset SLE, there have been few comparative studies of these types of SLE.
Objectives To compare the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR) of a cohort of patients with juvenile-onset SLE and patients with adult-onset SLE.
Methods We calculated the SLICC/ACR scores of 236 patients diagnosed as SLE between 1988 and 2000. The SLE disease activity index (SLEDAI) of the first hospital study was calculated retrospectively.
Results In 61 patients (25.8%), SLE had begun before the age of 19 years. This group included 52 women (85.2%). The mean age at onset of SLE was 13.4 years (SD 3.2) and mean duration of the disease was 9.9 years (SD 6.5). The comparison of patients with juvenile-onset SLE and a group of 175 patients with adult-onset SLE did not reveal significant differences in sex, duration of the disease, and SLEDAI score at the onset of the disease (mean 16.31; SD 8.26 vs 14.08; SD 8.08). There were no differences in the SLICC/ACR scores obtained at the last follow-up visit (mean 1.6; SD 1.7 vs 1.45; SD 1.94) (p > 0.05), although kidney disease (proteinuria over 3.5 g/day, treatment by dialysis or transplantation) (24 of 25; 39.3% vs 42 of 211; 24%) (p: 0.03; OR: 2; 95% CI: 1.1–3.8) and avascular necrosis (4 of 25; 6.6% vs 2 of 211; 1.1%) (p: 0.04; OR: 6; 95% CI: 1.08–3.4) were more frequent in patients with juvenile-onset disease. Both groups had a similar mortality (1 of 61; 1.6% vs 7 of 175; 4%) (p > 0.05).
Conclusion Although kidney disease and avascular necrosis were more frequent in patients with juvenile-onset SLE, the SLICC tissue damage score was similar in patients with juvenile-onset SLE and adult-onset SLE.