Background Systemic lupus erythematosus (SLE) is a chronic, multisystemic disease affecting predominantly woman in reproductive age. Previous studies have reported childhood-onset (c)SLE to be more severe than adult-onset (a)SLE.
Objectives The aim of this study was to compare the prevalence and types of cumulative damage in SLE according to age of disease onset.
Methods We conducted a cross-sectional study including 247 adult and 63 cSLE SLE patients matched for disease duration and followed at Rheumatology and Pediatric Rheumatology Unit of the State University of Campinas. Damage was analyzed according to Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) and data were extracted from patients charts.
Results We included 247 aSLE patients (234 women; mean age 38.7 years (SD =12.4) and 63 cSLE patients (61 women; mean age 18.6 years (SD =5.6). SDI scores ≥1 were observed in 166 aSLE and 28 patients cSLE (p<0.001). The mean SDI in aSLE (mean =2; SD=1.2) was similar to cSLE (mean =1.5, DP =0.7) (p>0.05). In aSLE we observed the following frequency of damage: musculoskeletal 66/166 (37.3%), premature gonadal failure 55/166 (33.1%), cardiovascular in 44/166 (26.5%), ocular 29/166 (17.5%), neuropsychiatric 28/166 (16.7%), vascular 19/166 (11.4%), pulmonary 17/166 (10.2%), renal 15/166 (9%), diabetes with 14/166 (8.4%), gastrointestinal 12/166 (7.2%), skin 7/166 (4.2%) and malignancy in 1/166 (0.6%) patient. In cSLE we observed the following prevalence of damage: musculoskeletal 13/28 (46.4%), cardiovascular 7/28 (25%), ocular 6/28 (21.4%), neuropsychiatric 5/28 (18%), pulmonary 3/28 (11%), diabetes 2/28 (7.1%), renal 1/28 (36%), gastrointestinal 1/28 (3.6%), skin 1/28 (3,6%), malignancy 1/28 (3.6%). The prevalence of cardiovascular damage was high in our cSLE cohort and was due mainly to valvular stenosis and diastolic dysfunction. Although the types of damage was similar among groups, aSLE patients had significantly more premature gonadal failure and cSLE patients had more cardiovascular damage (p<0.05).
Conclusions aSLE have more damage than cSLE. However when present, the types of damage are similar between groups except for gonadal failure that is more frequently observed in aSLE and cardiovascular damage more frequently observed in cSLE. cSLE patients have a greater life expectancy and have therefore a greater tendency to present more damage later in life. Close follow-up for permanent damage is necessary in SLE.
Disclosure of Interest K. Peliçari Grant/Research support from: FAPESP - 2010.13636-2, M. Postal Grant/Research support from: FAPESP - 2009.10744.1, N. Sinicato Grant/Research support from: FAPESP - 2010.13637.9, L. Costallat: None Declared, R. Marini: None Declared, S. Appenzeller: None Declared
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