Adolescent-Onset SLE More Aggressive, Has Worse Prognosis

February 11, 2014

Adolescents diagnosed with lupus are at significantly greater risk for nephritis and hemolytic anemia than people diagnosed as adults. More intensive care may be required.

Amaral B, Murphy G, Ioannou Y, Isenberg DA. A comparison of the outcome of adolescent and adult-onset systemic lupus erythematosus. Rheumatology (2014) doi: 10.1093/rheumatology/ket488 [e-pub February 6, 2014]  

A lengthy study of more than 600 systemic lupus erythematosus (SLE) patients finds that SLE diagnosed in adolescence appears to be more aggressive, with an increased risk of serious organ damage and a worse prognosis than for adults.

The retrospective study compared 124 patients diagnosed with SLE between ages 11 to 18 with a control group of 484 people diagnosed as adults (median age at onset 31), all of whom received care at University Hospital London between January 1979 and April 2012.

The male-female ratio was lower among the adolescents than in the adults (6.75% vs 12.89%), with over half of patients being Caucasian and a quarter Afro-Caribbean or Asian, slightly more of the latter group among the younger patients.

Adolescent-onset SLE was associated with a significantly increased prevalence of serious complications -- lupus nephritis (42.7% vs 27.1%) and hemolytic anaemia (7.3% vs 2.9%) – with a greater risk of dying among female patients.

In contrast, adults had a higher incidence of cancer, serositis, and Sjögren’s syndrome, as well as heart attacks and stroke.

The researchers conclude that patients diagnosed in adolescence may need intensive follow-up and therapy.