With this information, Dr. Hedrich said subgroups of patients may exist within pediatric age groups, including those with monogenic lupus who present early in life, those with a higher genetic predisposition due to a number of risk alleles and a third group who may have some risk alleles but must accrue additional risk factors over time.
As researchers continue to identify genes that contribute to the development of lupus, Dr. Hedrich hopes clinicians will be able to stratify patients according to their molecular makeup, which may enable the prediction of treatment responses and, ultimately, pave the way for personalized medicine in pediatric lupus.
In Sum
Although options for the treatment of children with lupus have been limited historically, genetic studies have provided several advances in therapeutics and to our understanding of the pathophysiology of lupus. In the future, new genetic causes of lupus may be identified and may lead to new therapeutic targets and personalized treatment plans.
Elizabeth Sloan, MD, is a pediatric rheumatologist who recently completed her fellowship training at UT Southwestern Medical Center, Dallas, and looks forward to joining the faculty of the Division of Pediatric Rheumatology at UT Southwestern in the fall of 2021. Dr. Sloan has also served on the ACR FIT Subcommittee and the ACR Special Committee on Pediatric Rheumatology.
References
- Arazi A, Rao DA, Berthier CC, et al. The immune cell landscape in kidneys of patients with lupus nephritis. Nat Immunol. 2019 Jul;20(7):902–914.
- Rovin BH, Solomons N, Pendergraft WF 3rd, et al. A randomized, controlled double-blind study comparing the efficacy and safety of dose-ranging voclosporin with placebo in achieving remission in patients with active lupus nephritis. Kidney Int. 2019 Jan;95(1):219–231.
- Furie R, Rovin BH, Houssiau F, et al. Two-year, randomized, controlled trial of belimumab in lupus nephritis. N Engl J Med. 2020 Sep;383(12):1117–1128.
- Rovin BH, Furie R, Latinis K, et al. Efficacy and safety of rituximab in patients with active proliferative lupus nephritis: The lupus nephritis assessment with rituximab study. Arthritis Rheum. 2012 Apr;64(4):1215–1226.
- Groot N, de Graeff N, Avcin T, et al. European evidence-based recommendations for diagnosis and treatment of childhood-onset systemic lupus erythematosus: The SHARE initiative. Ann Rheum Dis. 2017 Nov;76(11):1788–1796.
- Massias JS, Smith EM, Al-Abadi E, et al. Clinical and laboratory phenotypes in juvenile-onset systemic lupus erythematosus across ethnicities in the UK. Lupus. 2021 Apr;30(4):597–607.
- Charras A, Smith E, Hedrich CM. Systemic lupus erythematosus in children and young people. Curr Rheumatol Rep. 2021 Feb;23(3):20.
