title: Adolescent onset of lupus results in more aggressive disease and worse outcomes: results of a nested matched case-control study within LUMINA, a multiethnic US cohort (LUMINA LVII).
abstract: The objective of this study is to examine the clinical features and outcomes of patients with systemic lupus erythematosus (SLE) whose disease began in adolescence [juvenile-onset SLE (jSLE)] compared with adult-onset patients [adult-onset SLE (aSLE)] from a large multiethnic cohort. Systemic lupus erythematosus patients of African-American, Caucasian, or Hispanic ethnicity and >or=1 year follow-up were studied in two groups: jSLE (diagnosed at <or=18 years); aSLE (diagnosed at 19-50 years; matched for gender and disease duration at enrolment). Sociodemographic data, SLE manifestations, disease activity, damage accrual, SLE-related hospitalizations or emergency room visits, drug utilization, mortality and psychosocial characteristics and quality of life were compared. Data were analysed by univariable and multivariable analyses. Seventy-nine patients were studied (31 jSLE, 48 aSLE); 90% were women. Mean (SD) total disease duration was 6.8 (2.7) years in jSLE and 5.6 (3.3) years in aSLE (p = 0.077). Mean age at cohort entry was 18.4 (1.8) and 33.9 (9.2) years in jSLE and aSLE respectively. By univariable analysis, jSLE patients were more commonly of African-American descent, were more likely to have renal and neurological involvements, and to accrue renal damage; jSLE patients had lower levels of helplessness and scored higher in the physical component measure of the SF-36 than aSLE patients. Renal involvement [OR = 1.549, 95% CI (1.397-15.856)] and neurological involvement [OR = 1.642, 95% CI (1.689-15.786)] were independently associated with jSLE by multivariable analysis. There was a larger proportion of African-Americans within the jSLE group. After adjusting for ethnicity and follow-up time, jSLE patients experienced more renal and neurological manifestations, with more renal damage. There was a two-fold higher mortality rate in the jSLE group.
authors.affiliation: Division of Pediatric Rheumatology, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada. graciela.alarcon@ccc.uab.edu
authors.forename: L B
authors.initials: LB
authors.lastname: Tucker
authors.forename: A G
authors.initials: AG
authors.lastname: Uribe
authors.forename: M
authors.initials: M
authors.lastname: Fernández
authors.forename: L M
authors.initials: LM
authors.lastname: Vilá
authors.forename: G
authors.initials: G
authors.lastname: McGwin
authors.forename: M
authors.initials: M
authors.lastname: Apte
authors.forename: B J
authors.initials: BJ
authors.lastname: Fessler
authors.forename: H M
authors.initials: HM
authors.lastname: Bastian
authors.forename: J D
authors.initials: JD
authors.lastname: Reveille
authors.forename: G S
authors.initials: GS
authors.lastname: Alarcón
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D016022:Case-Control Studies; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000208:ethnology* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011788:Quality of Life; D012959:Socioeconomic Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology