Lupus and Children
SLE in Young People
Systemic Lupus Erythematosus (SLE) is a rare condition which can affect young people and children. There is no information about how common this condition is in Australia, but in USA 5-6 in every 100,000 children are diagnosed each year. Most of these children are over 10 years of age and female (4 times higher than males), although very rarely younger children can also be affected. The risk of SLE is 3 times higher in orientals and 6 times higher in Afro-Caribbeans, when compared with white population. The cause for this condition is not known. Many factors may be involved; infections, genetic susceptibility, or drugs, like some antibiotics. Regardless of what that trigger might be, it is agreed that SLE is an autoimmune condition. This means that by mistake, body’s immune system attacks self and unless such inappropriate activity is suppressed with medications, will result in multisystem disease and possible death.
SLE can affect the body in multiple ways. It can start with symptoms such as weight loss or persistent fevers. Almost all patients will have fatigue and feel they are lacking energy. There may be excessive hair loss, or sores on the scalp or inside the mouth. Commonly people can have a typical “butterfly” rash on their face, which is very sensitive and gets worse on exposure to sunlight. The joints may be painful or actually swell up. People may feel breathless and look pale because of anaemia. There may be a cough present as well, and they may rarely cough up blood. Perhaps two of the most serious problems with SLE are involvement of kidneys and brain. There may be blood in the urine, or worse, reduced urination with high blood pressure. Depression, hallucination (seeing or hearing things which are not real), as well as stroke symptoms (such as weakness, loss of vision, etc.), may be the symptoms with brain involvement.
It is very important to see a paediatric rheumatologist as soon as possible to help achieve the best possible outcome for the young person affected. Research shows that by treating SLE as early as possible, more severe complications are less likely and the need for stronger medications will be reduced. To find out how severe the condition is blood tests, as well as other investigations such as chest X-ray/CT scan or ECG from heart, may be needed. Treatment usually includes a course of steroids, as well as starting hydroxychloroquine (plaquenil) and another medication such as methotrexate or azathioprine. The paediatric rheumatologist will usually try and reduce the dose of the steroids as soon as the disease permits, although, these medications are life-saving and if needed for any length of time must be adhered to. As SLE is a chronic condition (that is, there is currently no cure available), it should be expected that treatment is required for several years. Unfortunately, any treatment has the risk of undesirable side effects and for this routine monitoring will be necessary to ensure the patient is not harmed. In addition to the above mentioned tests, yearly bone density scans may be necessary to ensure osteoporosis is detected and appropriately treated.
DR Navid Adib MBBS (Qld), FRAP (Paed Rheum), PhD (Manchester)
Paediatric Rheumatologist
Suite 13, Level 10
Evan Thomson Building
24 Chasely Street
Auchenflower Qld 4066
Ph (+61) 738701029
Fax (+61) 738710700
