Paediatric systemic lupus erythematosus: prognostic impact of antiphospholipid antibodies.
OBJECTIVE
The aim of our study was to investigate the prognostic impact of aPL in paediatric onset systemic lupus erythematosus (p-SLE).


METHODS
This retrospective study included 56 patients with p-SLE. Chi2-test, Fisher's exact test, incidence rate ratio and Kaplan-Meier survival curves were used to compare aPL-positive and aPL-negative patients considering the value of SDI (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index for SLE) at the end of follow-up, the occurrence of thromboses, organ system involvements and need for immunosuppressive treatment in addition to corticosteroids.


RESULTS
Anti-cardiolipin antibodies and lupus anticoagulants were detected in 27 (49%) and 19 (35%) patients, respectively. These aPL were frequently transient or intermittent (10 and 15 cases, respectively), and only rarely persistent over time (five cases). The risk of thrombosis was significantly higher (odds ratio = 6.42) and occurred earlier in the presence of aPL, especially if aPL were persistent (P < 0.05). The association between aPL and neurological, renal, haematological manifestations or need for immunosuppressive treatment was not statistically significant. After a mean follow-up of 7.2 yrs, 30 patients (54.5%) had an SDI score > or = 1. The risk of damage (SDI > or = 1) in aPL-positive patients was three times higher than in aPL-negative patients (P < 0.05). Four of the six fatal cases occurred in the aPL-positive group.


CONCLUSIONS
The presence of aPL in p-SLE could represent not only a risk factor for thrombosis but also a poor prognostic factor overall.
Descloux
E
E
Service de Médecine Interne, Centre Hospitalier Lyon Sud 69 495, Pierre Bénite cedex, France. elodiedescloux@hotmail.com
Durieu
I
I
Cochat
P
P
Vital Durand
D
D
Ninet
J
J
Fabien
N
N
Cimaz
R
R
D000293:Adolescent; D000328:Adult; D017152:Antibodies, Antiphospholipid / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D007075:Immunoglobulin M / Q000276:immunology; D007223:Infant; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000276:immunology* / Q000401:mortality; D008297:Male; D018579:Patient Selection; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D017152:Antibodies, Antiphospholipid; D007075:Immunoglobulin M