Immunological and clinical differences between juvenile and adult onset of systemic lupus erythematosus.
BACKGROUND
Systemic lupus erythematosus (SLE) in children usually follows a more severe course than in adults, but sometimes in the previous studies reported there are many confounding factors.


OBJECTIVE
To analyse the immunological and clinical characteristics of SLE juvenile onset and SLE adult onset.


METHODS
We studied 179 patients with SLE, 49 patients were aged 6-18 yrs at onset of disease. Anti-dsDNA antibodies were detected by radioimmunoassay and antibodies to extractable nuclear antigens (ENA): anti-nRNP, anti-Sm, anti-Ro/SS-A and anti-La/SS-B antibodies by ELISA, counterimmuno-electrophoresis and immunoblotting.


RESULTS
Juvenile-onset SLE shows a higher frequency of cutaneous vasculitis (44.8% vs 27.6%; P < 0.05), seizures (18.3% vs 7.6%; P < 0.05) nephropathy (67.3% vs 48.4%; P < 0.025), and discoid lupus erythematosus (26.5% vs 13.8%; P < 0.05). The incidence of articular manifestations is lower than in adults (85.7% vs 96.1%; P < 0.025). No significant differences were found between the two groups in relation with the prevalence of antinuclear antibodies.


CONCLUSIONS
Juvenile-onset SLE has more frequent neurological and renal manifestations than adult-onset SLE, but immunological markers are similar in both groups. These features suggest the most severe clinical manifestations in the juvenile-onset SLE group are not related with the presence of studied antibodies by different methods.
Service of Rheumatology, Gregorio Marañón Hospital, Universidad Complutense of Madrid, Spain.
L
L
Carreño
F J
FJ
López-Longo
I
I
Monteagudo
M
M
Rodríguez-Mahou
M
M
Bascones
C M
CM
González
C
C
Saint-Cyr
N
N
Lapointe
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000818:Animals; D000974:Antibodies, Antinuclear / Q000097:blood*; D015415:Biomarkers; D002460:Cell Line; D002648:Child; D002675:Child, Preschool; D003176:Complement C3 / Q000032:analysis; D003181:Complement C4 / Q000032:analysis; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006417:Hematuria / Q000175:diagnosis; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008179:Lupus Erythematosus, Discoid / Q000175:diagnosis / Q000276:immunology; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000276:immunology*; D008297:Male; D051381:Rats
D000974:Antibodies, Antinuclear; D015415:Biomarkers; D003176:Complement C3; D003181:Complement C4; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007075:Immunoglobulin M