Clinical and laboratory features of childhood systemic lupus erythematosus and its course in Department of Child Health, Cipto Mangunkusumo Hospital, Jakarta

  • Zakiudin Munasir Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
  • Tuty Mariana Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
  • Rulina Suradi Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
Keywords: systemic lupous erythematosus, clinical course, children, antinuclear antibody

Abstract

A descriptive, retrospective study has been performed among 33 children with SLE during the period of January 1986 to December 1999 in Department of Child Health, Cipto Mangunkusumo Hospital. The results of the present study show that SLE in childhood was more commonly found in girls than in boys, with a ratio of 4.5: 1. The mean age of onset was 10.5 years and the mean age of diagnosis was 10.9 years, most frequently observed in the age of > 10 years and rarely found in the age of < 5 years. The time interval between the time of onset and time of diagnosis ranged from 1 to 24 months and the most frequent interval was 1-3 months. The most common initial symptoms were prolonged fever, rash on the skin and face, and athralgia. In its natural history of the disease, kidneys, skin/mucous membrane and joints are the most frequent organs involved. Most of the SLE patients develop anemia. Positive anti ds-DNA, ANA and decreased levels of C3 and C4 respectively in 28 (28/31), in 29 (29/30), in 25 (25/33), and in 19 (19/27) cases. LE cells were encountered only in four (4/17) cases.  Out of 11 cases upon which renal biopsies were done, the most common histological features were mesangeal glomerulonephritis (class II) and diffuse proliferative glomerulonephritis (class IV). The mean time interval between the onset and renal complication manifestations was 6.96 months, cardiac complication was 16.77 months, central nerve system was 22.71 months and lungs were 25.0 months. Duration of illness of patients with SLE ranged from 2 to 175 with the mean of 31.3 months. The causes of death were mostly due to gastrointestinal bleeding and renal failure.

References

1. Cassidy JT, Petty RE. Systemic lupus erythematosus. In: Cassidy JT, Petty RE, editor. Textbook of Pediatric Rheumatology; 2nd edition. New York: Churchill Livingstone. 1990: 261-328.
2. Kalunian KC. Defionition, classification, and activity indices. In: Wallace DJ, Hahn BH, editor. Dubois’ Lupus Erythematosus, 4th edition. Philadelphia: Lea & Febiger, 1993; 58-63.
3. Talal N, Ahmed SA. The importance of sex hormones in lupus. In: Wallace DJ, Hahn BH, editor. Dubois’ Lupus Erythematosus, 4th edition. Philadelphia: Lea & Febiger, 1993; 148-56.
4. Norris DG, Colon AR, Stickler GB. Systemic lupuserythematosus in children. The complex problems of diagnosis and treatment encountered in 101 such patients at the Mayo Clinic. Clin Pediatr 1977; 16: 774-8.
5. Arnett FC. The genetic basis of lupus erythematosus. In: Wallace DJ, Hahn BH, editor. Dubois’ Lupus Erythematosus, 4th edition. Philadelphia: Lea & Febiger, 1993; 13-36.
6. Lehman TJA, Hanson V, Singsen BH, et al. The role of antibodies directed againts double-stranded DNA in the manifestation of systemic lupus erythematosus in children.
Munasir et al.: Clinical and laboratory features of childhood systemic lupus erythematosus 223 J Pediatr 1980; 96: 657-61.
7. Celermejer DS, Thorner PS, Baumal R, Arbus GS. Sex Differences in childhood lupus nephritis. Am J Dis Child 1984; 138: 586-8.
8. Lehman TJA, McCurdy DK, Bernstein BH, King KK, Hanson V. Systemic lupus erythematosus in the first decade of life. Pediatrics 1989; 83: 235-9.
9. Font J, Cervera R, Espinosa G, et al. Systemic lupus erythematosus (SLE) in childhood: analysis of clinical and immunological findings in 34 patients and comparison with SLE characteristics in adults. Ann Rheum Dis 1998; 57: 456-9.
10. Dubois EL, Tuffanelli DL. Clinical manifestations of systemic lupus erythematosus. Computer analysis of 520 cases. JAMA 1964; 190: 104-19.
11. McAlindon T, Giannotta L, Taub N, D’Cruz D, Hughes G. Environmental factors predicting nephritis in systemic lupus erythematosus. Ann Rheum Dis 1993; 52: 720-4.
12. Quismorio FP. Cardiac abnormalities in systemic lupus erythematosus. In: Wallace DJ, Hahn BH, editor. Dubois’ Lupus Erythematosus, 4th edition. Philadelphia: Lea &
Febiger, 1993; 332-42.
13. De Jongste JC, Neijens HJ, Duiverman EJ, et al. Respiratory tract disease in systemic lupus erythematosus. Arch Dis child 1986; 61: 478-83.
14. Miller RW, Salcedo JR, Murphy TM, Magilavy DB. Pulmonary hemorrhage in pediatric patients with systemic lupus erythematosus. J Pediatr 1986; 108: 576-9.
15. Quismorio FP. Pulmonary manifestations. In: Wallace DJ, Hahn BH, editor. Dubois’ Lupus Erythematosus, 4th edition. Philadelphia: Lea & Febiger, 1993; 343-55.
16. Cameron JS. Nephritis of systemic lupus erythematosus. In: Edelman CM Jr, editor. Pediatric Kidney disease: 2nd edition. Boston: Little Brown Co, 1992; 1407-65.
17. Fish AJ, Blau EB, Westberg NG, et al. Systemic lupus erythematosus with in the first two decades of life. Am J Med 1977; 62: 99-117.
18. Caeiro F, Michieson FMC, Bernstein R, Hughes GRV, Ansell BM. Systemic lupus erythematosus in childhood. Ann Rheum Dis 1981; 40: 325-331.
19. Siregar SP, Matondang CS. Pengalaman penatalaksanaan SLE pada anak di Bagian IKA-FKUI/RSUPN DR. Cipto Mangunkusumo. In: Matondang CS, Akib AA, editor. Strategi pendekatan klinis berbagai penyakit alergi dan reumatik pada anak. Naskah lengkap Pendidikan Kedokteran Berkelanjutan Ilmu Kesehatan Anak FKUI
XXXVI. FKUI; 1995 10-11 November; Jakarta: Penerbit Bina Rupa Aksara, 1995.
20. Alatas H. Review of lupus nephritis among children in Indonesia. Presented at sixth Asian Congress of Pediatric Nephrology. Manila 21-24 April 1996.
21. Cassidy JT. Sullivan DB, Petty RE, Ragsdale C. Lupus nephritis and encephalopathy. Prognosis in 58 children.
22. Phadke K, Trachtman H, Nicastri A, Chen CK, Tejani A. Acut renal failure as the initial manifestation of systemic lupus erythematosus in children. J Pediatr 1984; 105:
38-41.
23. Leng. Systemic lupus erythematosus in Southeast Asia. Medical Progress 1995; Jan: 5-8.
24. Barron KS, Silverman ED, Gonzales J, Reveille D. Clinical, serologic, and immunogenetic studies in chilhood onset systemic lupus erythematosus. Arthritis Rheum 1993; 36: 348-54.
25. Schur PH, Sandson J. Immunologic factors and clinical activity in systemic lupus erythematosus. N Engl J Med 1968; 278: 533-5.
26. Hughes GRV, Cohen AS, Christian CL. Anti-dsDNA in systemic lupus erythematosus. Ann Rheum Dis 1971; 30: 259-62.
27. Dumas R. Lupus nephritis. Collaborrative study by the French society of paediatric nephrology. Arch Dis Child 1985; 60: 126-8.
28. Wallace DJ. The Musculoskeletal System. In: Wallace DJ, Hahn BH, editor. Dubois’ Lupus Erythematosus, 4th edition. Philadelphia: Lea & Febiger, 1993; 322-31.
29. Montes de Oca MA, Babron MC, Bletry O, et al. Thrombosis in systemic lupus erythematosus: a French collaborative study. Arch Dis Child 1991; 66: 713-7.
30. Kelley RE, Berger JR. Ischemic strokes in a girl with lupus anticoagulant. Pediatr Neurology 1987; 3: 58-61.
31. Appan S, Boey ML, Lim KW. Multiple thromboses in systemic lupus erythematosus Arch Dis Child 1987; 62: 739-41.
32. Quismorio FP. Cardiac abnormalities in systemic lupus erythematosus. In: Wallace DJ, Hahn BH, editor. Dubois’ Lupus Erythematosus, 4th edition. Philadelphia: Lea & Febiger, 1993; 332-42.
33. Tsukara M, Matsuo K, Kojima H. Protein loosing enteropathy in a boy with systemic lupus erythematosus. J Pediatr 1980; 97: 778-80.
34. Wallace DJ. Head and neck findings in SLE: Sjogren’s syndrome and the eye, ear, and larynx. In: Wallace DJ, Hahn BH, editor. Dubois’ Lupus Erythematosus, 4th edition.
Philadelphia: Lea & Febiger, 1993; 405-9.
35. McCarty GA. Up date on laboratory studies and relation to rheumatic and allergic disease. Ann Allergy 1985; 55: 421-33.
36. Alatas H. Nephritis lupus. In: Alatas H, Tambunan T, Trihono PP, editor. Buku ajar nefrologi anak, jilid-2. Jakarta: IDAI, 1996.
37. Tan EM. Antinuclear antibodies: diagnostic markers and clues to the basis of systemic autoimmunity. Pediatr Infect Dis 1988; 7: 53.
38. Cassidy JT. Clinical assesment of immune-complex desease in children with systemic lupus erythematosus. JPediatr 1976; 89: 523-6.
Published
2006-08-30
How to Cite
1.
Munasir Z, Mariana T, Suradi R. Clinical and laboratory features of childhood systemic lupus erythematosus and its course in Department of Child Health, Cipto Mangunkusumo Hospital, Jakarta. PI [Internet]. 30Aug.2006 [cited 20Apr.2024];41(7-8):214-4. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/1079
Section
Articles
Received 2016-11-23
Accepted 2016-11-23
Published 2006-08-30