title: Clinical phenotype and outcome in lupus according to age: a comparison between juvenile and adult onset.
abstract: OBJECTIVE
  To study differences in demographic, clinical and immunologic characteristics, activity and cumulative organ damage according to age of onset in systemic lupus erythematosus (SLE).
  
  
  METHODS
  Cross-sectional study was performed including 204 SLE patients. Characteristics were compared between juvenile and adult-onset SLE patients using parametric and nonparametric tests (SPSS 23.0).
  
  
  RESULTS
  Juvenile-SLE patients had malar rash more often (78.9% vs 53%; p=0.001), oral ulcers (45.5% vs 17.5%; p=0.001), neurological involvement (13.1% vs 3.6%; p=0.02) nephritis (50% vs 33.9%), p=0.04) and haematological manifestations such as hemolytic anaemia (23.6% vs 5.4%; p=0.002) and leukopenia (46.1% vs 4.2%; p<0.001). Arthritis was more prevalent in adult-onset patients (70.9% vs 90%; p<0.04). Overall, 20% of juvenile patients had chronic damage (Systemic Lupus International Collaborating Clinics/Damage Index [SLICC/DI]≥1), However, the percentage of patients with irreversible damage was higher in the adult SLE patient group (24%, p=0.04). No statistically significant differences were found in other characteristics studied.
  
  
  CONCLUSIONS
  In summary, our study confirms the existence of differences in clinical manifestations, according to age at diagnosis of SLE. Juvenile-SLE patients showed a more aggressive clinical presentation.
authors.affiliation: Rheumatology Department of São João Hospital Centre, Oporto, Portugal. Electronic address: anaritapfonseca@gmail.com.
authors.forename: Rita
authors.initials: R
authors.lastname: Fonseca
authors.affiliation: Rheumatology Department of São João Hospital Centre, Oporto, Portugal.
authors.forename: Francisca
authors.initials: F
authors.lastname: Aguiar
authors.affiliation: Pediatric Department of São João Hospital Centre, Oporto, Portugal.
authors.forename: Mariana
authors.initials: M
authors.lastname: Rodrigues
authors.affiliation: Rheumatology Department of São João Hospital Centre, Oporto, Portugal.
authors.forename: Iva
authors.initials: I
authors.lastname: Brito
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000743:Anemia, Hemolytic / Q000209:etiology; D001168:Arthritis / Q000209:etiology; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007970:Leukopenia / Q000209:etiology; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000453:epidemiology* / Q000473:pathology; D008181:Lupus Nephritis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D018709:Statistics, Nonparametric; D063189:Symptom Assessment; D016896:Treatment Outcome; D055815:Young Adult
keywords: Adult-onset lupus; Epidemiology; Epidemiología; Juvenile-onset lupus; Lupus del adulto; Lupus juvenil