Lupus in Children and Adolescents

A fact sheet from the Lupus Research Institute

Of the 1.5 million Americans with systemic lupus, 20 percent are children or adolescents.

Onset of lupus in children and adolescents tends to be severe and follow a more serious course than in adults.

Long-term and often permanent damage to organs from lupus or treatment for the disease occurs in almost 90 percent of people who develop lupus as children or adolescents.

Pediatric patients with lupus are two to three times more likely than adults to develop kidney disease, neurologic complications, and hematologic (blood) disease.

Kidney disease:
Approximately two-thirds of children and adolescents with lupus develop renal complications at some point. In 9 out of 10 cases, the complication presents within the first year of diagnosis.

Neurologic involvement:
Approximately 20 to 30 percent of children and adolescents with lupus experience overt neurologic involvement with symptoms such as psychosis, movement problems, depression, and cognitive dysfunction.

Arthritis:
Approximately 90 percent of children and adolescents have inflammation-typically painful-in both large and small joints when they are first diagnosed with lupus. The arthritis usually lessens with treatment.

Other common long-term complications in children and adolescents from the disease as well as currently available medicines-especially corticosteroids (prednisone) which is frequently needed at moderate to high doses to control disease-include:

  • serious infections
  • high blood pressure
  • altered appearance
  • delayed growth or short stature
  • eye and vision problems
  • chronic lung impairment
  • fertility problems
  • malignancy

Multiple needs must be attended to.

The development of a chronic immunologic disease such as lupus early in life—in the middle of physical, psychosocial, and intellectual development—can have a devastating effect on all levels of development, altering the ability of the young person to become a fully functioning adult.

Research in children and adolescents with lupus is crucial for preventing and curing lupus in this vulnerable population. Investigators also point out:

  • Because most children and adolescents do not have multiple medical problems, research in this population simplifies and magnifies the ability of researchers to understand the disease and its outcomes, as well as monitor the effects of medications.
  • Genetic risks or abnormalities in pediatric patients are likely greater since the disease is starting earlier and is typically more severe-which means that identifying the genetic differences in this population is particularly productive.

It's important to establish data—as soon as possible so that clinicians can implement changes—as to whether:

  • early and aggressive therapy improves long-term outcomes for children and adolescents with lupus.
  • lifestyle changes such as exercise and a special diet truly improve long-term outcomes for children and adolescents with lupus

Sources:
Systemic lupus erythematosus in childhood. M. Klein-Gitelman, A Reiff, E. Silverman. Rheum Dis Clin N Am 28 (2002) 561-577.
Marisa S. Klein-Gitelman, MD, Head, Division of Rheumatology; Associate Professor of Pediatrics, Northwestern University's Feinberg School of Medicine