Differences in longterm disease activity and treatment of adult patients with childhood and adultonset systemic lupus erythematosus

ObjectiveTo compare differences in longterm outcome between adults with childhoodonset age at diagnosis <18 years systemic lupus erythematosus SLE and with adultonset SLE.MethodsData were derived from the University of California Lupus Outcomes Study, a longitudinal cohort of 885 adult subjects with SLE 90 childhoodonset cSLE, 795 adultonset aSLE. Baseline and 1year followup data were obtained via structured 1hour telephone interviews conducted between 2002 and 2006. Using selfreport data, differences in organ involvement and disease morbidity, current disease status and activity, past and current medication use, and number of physician visits were compared, based on age at diagnosis of SLE.ResultsAverage disease duration for the cSLE and aSLE subgroups was 16.5 and 13.4 years, respectively, and mean age at followup was 30.5 and 49.9 years, respectively. When compared with aSLE subjects, cSLE subjects had a higher frequency of SLErelated renal disease, whereas aSLE subjects were more likely to report a history of pulmonary disease. Rates of clotting disorders, seizures, and myocardial infarction were similar between the 2 groups. At followup, cSLE subjects had lower overall disease activity, but were more likely to be taking steroids and other immunosuppressive therapies. The total number of yearly physician visits was similar between the 2 groups, although cSLE subjects had a higher number of nephrology visits.ConclusionThis study demonstrates important differences in the outcomes of patients with cSLE and aSLE, and provides important prognostic information about longterm SLE disease activity and treatment.