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The management of pediatric systemic lupus erythematosus

Nature Clinical Practice Rheumatology volume 1, pages 82–92 (2005)Cite this article

Abstract

Most children and adolescents with systemic lupus erythematosus (SLE) now survive into adulthood, leading the pediatric rheumatology community to focus on preventing long-term complications of SLE, including atherosclerosis, obesity, and osteoporosis, and their treatment. Unfortunately, because of the paucity of data in pediatric SLE, little is known about epidemiology, long-term outcome, and optimal treatment. Most research focuses on adults with SLE, but pediatric SLE differs significantly from adult SLE in many aspects, including disease expression, approaches to pharmacologic intervention, management of treatment toxicity, and psychosocial issues. Children and adolescents with SLE require specialized, multidisciplinary care. Treatment can be optimized by early recognition of disease flares and complications, minimizing medication toxicity, educating families about prevention, promoting school performance, addressing concerns about reproductive health, and negotiating the transition to adult-centered medical care. Developmentally appropriate concerns about pain, appearance, and peers often affect treatment adherence and must be addressed by the health-care team. Research in pediatric SLE is desperately needed and provides a unique opportunity to understand how developmental immunology and the hormonal changes associated with puberty affect the pathophysiology of SLE.

Key Points

  • Emphasis is now placed on treatment of systemic lupus erythematosus (SLE) and preventing long-term complications

  • Much has been inferred from adult studies because of a paucity of data on pediatric SLE

  • Age-related differences affect the pattern of disease expression and the psychosocial impact of SLE

  • A specialized, multidisciplinary health-care team improves family education, treatment, and outcome of pediatric SLE

  • Research in pediatric SLE is required to understand how the developing immune system and puberty affect the pathophysiology of SLE

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Figure 1: Typical growth chart for female adolescent with systemic lupus erythematosus receiving glucocorticoid therapy.
Figure 2: Bone mineral density versus age in Caucasian females.

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Authors and Affiliations

  1. Division of Pediatric Rheumatology,

    Stacy P Ardoin & Laura E Schanberg

  2. Department of Pediatrics at Duke University Medical Center, Durham, NC, USA

    Stacy P Ardoin & Laura E Schanberg

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  1. Stacy P Ardoin
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  2. Laura E Schanberg
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Correspondence to Laura E Schanberg.

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Ardoin, S., Schanberg, L. The management of pediatric systemic lupus erythematosus. Nat Rev Rheumatol 1, 82–92 (2005). https://doi.org/10.1038/ncprheum0046

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