A study recently published in Arthritis Care & Research concluded that there are differences in the outcomes of patients with childhood-onset systemic lupus erythematosus (SLE) and adult-onset SLE, which provides important prognostic information about long-term SLE disease activity and treatment.1
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SLE affects 10 times as many women as men and typically develops in people in their twenties and thirties. In 2005, the prevalence of SLE was estimated at between 161,000 and 322,000, with 15% to 20% of SLE patients diagnosed during childhood, age 18 years and under. Although short-term survival rates for childhood-onset SLE have improved dramatically over the last several decades, for unknown reasons, a significant percentage of childhood-onset SLE patients still die prematurely.
The researchers used data derived from the University of California’s Lupus Outcomes Study—an observational study of 885 adult subjects with SLE, 90 of whom had childhood-onset SLE. They gathered baseline and one-year follow-up data through telephone interviews conducted between 2002 and 2006. Using self-report data on differences in organ involvement and disease morbidity, current disease status and activity, past and current medication use, and number of physician visits, they then compared the data based on age at diagnosis with SLE.
Among the researchers on the project was Aimee O. Hersh, MD, a recent recipient of the ACR Research and Education Foundation (REF) Physician Scientist Development Award. When Dr. Hersh and her colleagues set out to compare the differences in long-term outcomes between adults with childhood-onset SLE and adults with adult-onset SLE, the hope was that their findings would eventually help clinicians design interventions to improve outcomes for patients with childhood-onset SLE.
“We found that patients with childhood-onset SLE were more likely to have renal disease, which was expected. But we also found that there were similar outcomes with other co-morbidities, like clotting disorders, seizures, and myocardial infarction,” explains Dr. Hersh.
The researchers also found that at follow-up, patients with childhood-onset SLE were more likely to be taking steroids and other immunosuppressive therapies and reported a higher number of nephrology visits than the patients with adult-onset SLE. “This study provides prognostic information on co-morbidities that had not been studied before,” says Dr. Hersh. “As a pediatric rheumatologist taking care of these patients, I’m asked ‘Will I have to take these medications forever?’ so studies like these are important so that we can educate our patients about future outcomes and so we can discuss the practical interventions to prevent these other co-morbidities.”
The REF is the second-largest funder of rheumatology research and training programs in the U.S., funding $11 million of research in 2008. Awards like the Physician Scientist Development Award provide salary support for young physician-scientists and are an integral part of the REF efforts to ensure the future of rheumatology.