title: A comparison of the outcome of adolescent and adult-onset systemic lupus erythematosus.
abstract: OBJECTIVE
  Previous reports have suggested that juvenile-onset SLE is associated with a worse prognosis than adult-onset disease. There have been limited studies in adolescents. We sought to assess the effect of adolescent-onset SLE on the clinical course of a large multi-ethnic cohort.
  
  
  METHODS
  Patients consisted of individuals diagnosed with SLE between 11 and 18 years of age in a tertiary referral centre. All patients with adult-onset disease were used as controls. Data were analysed by univariable and multivariable analysis for demographic, clinical and serological data.
  
  
  RESULTS
  One hundred and twenty-four patients with adolescent-onset and 484 patients with adult-onset disease were identified. There was a higher percentage of males (12.9% vs 7.2%; P = 0.036) and patients of Asian ethnicity within the adolescent group (P < 0.01). By univariable analysis, adolescent-onset SLE was associated with more frequent LN and haemolytic anaemia and less serositis and SS. Ischaemic vascular events occurred in 32 adult-onset patients (6.6%) and 3 adolescent-onset patients (2.4%; P = 0.08). Thirty-five adult-onset patients developed cancer (6.8%) compared with five of the adolescent-onset group (4.8%; P = 0.54). The standardized mortality rate was significantly increased in females with adolescent-onset SLE (14.4; 95% CI 4.44, 24.4) compared with patients with adult-onset SLE. By multivariable analysis, adolescent-onset SLE retained a significant association with LN.
  
  
  CONCLUSIONS
  Adolescent-onset SLE is associated with a significantly increased risk of LN and, importantly, with a marked increase in mortality. These data suggest a more aggressive phenotype of disease in patients with onset of SLE in adolescence and supports the need for intensive follow-up and intensive therapy in this population.
authors: Department of Medicine, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal, Department of Rheumatology, University College Hospital, Arthritis Research UK Centre for Adolescent Rheumatology, University College London and Department of Rheumatology, University College Hospital, London, UK grainne.murphy@uclh.nhs.uk.
authors: Beatriz
authors: B
authors: Amaral
authors: Department of Medicine, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal, Department of Rheumatology, University College Hospital, Arthritis Research UK Centre for Adolescent Rheumatology, University College London and Department of Rheumatology, University College Hospital, London, UK grainne.murphy@uclh.nhs.uk.
authors: Grainne
authors: G
authors: Murphy
authors: Department of Medicine, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal, Department of Rheumatology, University College Hospital, Arthritis Research UK Centre for Adolescent Rheumatology, University College London and Department of Rheumatology, University College Hospital, London, UK.
authors: Yiannis
authors: Y
authors: Ioannou
authors: Department of Medicine, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal, Department of Rheumatology, University College Hospital, Arthritis Research UK Centre for Adolescent Rheumatology, University College London and Department of Rheumatology, University College Hospital, London, UK.
authors: David A
authors: DA
authors: Isenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D044466:Asian People / Q000706:statistics & numerical data; D002648:Child; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D008181:Lupus Nephritis / Q000175:diagnosis / Q000401:mortality; D008297:Male; D009369:Neoplasms / Q000209:etiology / Q000401:mortality; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: adolescent rheumatology; outcome measures; paediatric/juvenile rheumatology; systemic lupus erythematosus