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Adolescent lupus represents 'aggressive phenotype'



Major finding: There was a higher rate of lupus nephritis in adolescent- vs. adult-onset lupus patients (42.7% vs. 27.1%, P = .001), even after adjustment for gender and ethnicity (OR, 1.87; P = .004).

Data source: Retrospective study of 608 patients with 124 adolescent- or 484 adult-onset lupus managed at a single U.K. center between 1978 and 2012.

Disclosures: Dr. Murphy and Dr. Beresford had no conflicts of interest.

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BIRMINGHAM, ENGLAND – Adolescent-onset lupus has a potentially worse clinical phenotype than does adult-onset disease, the results of a large, retrospective study have shown.

Individuals who developed systemic lupus erythematosus (SLE) between the ages of 11 and 18 years had a higher rate of lupus nephritis (42.7% vs. 27.1%; P = .001) and hemolytic anemia (7.3% vs. 2.9%, P =.035) than did those who developed the disease as adults (at the age of 19 years or older).

Dr. Michael Beresford


There was also a "clinically relevant increase in both vascular events and malignancy in patients who develop SLE at a young age," said Dr. Grainne Murphy, a clinical research fellow at University College London at the annual meeting of the British Society for Rheumatology.

"These data support the evidence to date that a more aggressive phenotype of disease occurs in patients with onset of SLE in the adolescent years and emphasizes the need for intensive follow-up and aggressive therapy," Dr. Murphy and associates wrote in their abstract. Approximately 15%-20% of patients with SLE develop it before the age of 18 years.

"One of the things that we are worried about is that when [an adolescent] reaches adult care, [he/she] may have had lupus for 10 years already," commented Dr. Michael Beresford, professor of pediatric rheumatology, University of Liverpool, England, in an interview.

"The fact that there is a signal in this large, single-center study that there may be increased mortality, and potentially an increased risk of cardiovascular disease long term, is an important message, emphasizing we need to look in much more detail at this risk," said Dr. Beresford, the joint interim-director of the Medicines for Children Research Network of the U.K. National Institute for Health Research and chief investigator of the U.K. JSLE Cohort Study and Repository. He was not involved with the study.

The study involved 608 patients with SLE seen at UCL between January 1978 and October 2012. A total of 124 patients had developed the autoimmune disease as adolescents and 484 as adults; the median age at diagnosis was 15 years and 31 years, respectively, and the median duration of follow-up was 14 years and 16 years.

The percentage of males was lower in the adult-onset group (7.2% male vs. 12.9% in the adolescent-onset group) and there were more individuals of Asian ethnicity in the adolescent group (28.2% vs. 13.4%, respectively); otherwise the populations were well matched in terms of their demographics.

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