Systemic lupus erythematosus in children
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects multiple organs and systems in the body. It can cause inflammation, damage, and pain in the skin, joints, kidneys, blood vessels, brain, heart, and lungs. SLE is more common in females than males, and it usually occurs between the ages of 15 and 45. However, SLE can also affect children, although it is rare. According to the Lupus Foundation of America, about 5,000 to 10,000 children in the United States have SLE or a related condition.
SLE in children can have similar symptoms and complications as in adults, but some aspects of the disease may differ. For example, children with SLE may have more severe kidney involvement, higher risk of infections, lower growth rate, delayed puberty, and emotional and psychological challenges. Therefore, children with SLE need special care and attention from their parents, doctors, teachers, and peers.
The diagnosis of SLE in children can be challenging because the symptoms are often nonspecific and vary from person to person. Some common signs and symptoms of SLE in children include:
– Fever
– Fatigue
– Rash
– Joint pain and swelling
– Mouth ulcers
– Hair loss
– Chest pain
– Seizures
– Headaches
– Memory problems
– Mood changes
To diagnose SLE in children, doctors use a combination of medical history, physical examination, blood tests, urine tests, and imaging tests. The American College of Rheumatology has established 11 criteria for the classification of SLE. A person must have at least four of these criteria to be diagnosed with SLE. The criteria are:
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– Malar rash (a butterfly-shaped rash on the cheeks and nose)
– Discoid rash (red, scaly patches on the skin that can cause scarring)
– Photosensitivity (skin reaction to sunlight or artificial light)
– Oral ulcers (sores in the mouth or nose)
– Arthritis (inflammation of two or more joints)
– Serositis (inflammation of the lining of the lungs or heart)
– Kidney disorder (abnormal urine protein or cellular casts)
– Neurologic disorder (seizures or psychosis)
– Blood disorder (anemia, low white blood cell count, or low platelet count)
– Immunologic disorder (positive anti-dsDNA, anti-Sm, or antiphospholipid antibodies)
– Positive antinuclear antibody (ANA) test
The treatment of SLE in children aims to control the inflammation, prevent organ damage, reduce symptoms, and improve quality of life. The treatment plan depends on the severity and type of symptoms and complications. Some common medications used to treat SLE in children include:
– Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation
– Corticosteroids to suppress the immune system and decrease inflammation
– Antimalarials to prevent flares and protect against skin and joint problems
– Immunosuppressants to modulate the immune system and prevent organ damage
– Biologics to target specific molecules involved in the disease process
In addition to medications, children with SLE may also benefit from lifestyle modifications such as:
– Avoiding sun exposure and using sunscreen and protective clothing
– Eating a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats
– Drinking plenty of water and avoiding alcohol and caffeine
– Getting enough sleep and rest
– Exercising regularly but avoiding overexertion
– Managing stress through relaxation techniques such as meditation, yoga, or breathing exercises
– Seeking emotional support from family, friends, counselors, or support groups
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SLE in children is a serious and complex condition that requires lifelong monitoring and care. However, with proper treatment and management, many children with SLE can lead normal and fulfilling lives. Recent advances in research and therapy have improved the prognosis and outcomes for children with SLE.
References:
: Lupus Foundation of America. (2020). Lupus facts and statistics. Retrieved from https://www.lupus.org/resources/lupus-facts-and-statistics
: Bhattad S., & Singh S. (2018). Systemic lupus erythematosus in children. Indian Journal of Rheumatology 13(4), 224–231. https://doi.org/10.4103/injr.injr_83_18
: Hochberg M.C. (1997). Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis & Rheumatism 40(9), 1725. https://doi.org/10.1002/art.1780400928
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