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Spectrum of systemic lupus erythematosus in Oman: from childhood to adulthood

  • Observational Research
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Abstract

SLE is a disease that mainly affects women of childbearing age, however, a total of 15–20% of cases present in children. Although adult onset SLE (aSLE) and childhood onset SLE (cSLE) share the same diagnostic criteria, differences have been identified. The aim of this study is to compare the similarities and differences in between cSLE and aSLE in an Arab population from Oman. We evaluated 225 SLE patients, 139 adults and 86 children, who fulfilled the criteria for diagnosis. At disease onset, 99% of SLE cohort fulfilled the SLICC criteria; however the ACR 1997 criteria were fulfilled in 66% aSLE and 80% cSLE. The clinical features of SLE in cSLE showed higher frequency of renal (50 vs 19%; p < 0.001), musculoskeletal (67 vs 53%; p = 0.036) and pulmonary involvement (13 vs 2.9%, p = 0.005); while aSLE showed higher frequency of hematological (64 vs 49%; p = 0.25) and mucocutaneous (24 vs 10%; p = 0.13) involvement. The mean disease activity score at disease onset and during disease course was also higher in cSLE (13 vs 8.5; p < 0.0005) (16 vs 11.8; p < 0.0005), respectively. Differences in autoantibody profile were also noted in cSLE with higher positivity of anti-dsDNA and antiphospholipid antibody (94 vs 84%; p = 0.027) (53 vs 37%; p = 0.25), respectively. cSLE patients were more likely than aSLE to be treated with immunosuppressant such as cyclophosphamide (51 vs 22%; p < 0.001) and MMF (70 vs 54%; p = 0.019). Similarities and differences between aSLE and cSLE in a cohort from Oman of Arab ethnicity were identified. It appears that individual races and ethnicities may exhibit differences in disease susceptibility and manifestations.

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References

  1. Lewis MJ, Jawad A (2017) The effect of ethnicity and genetic ancestry on the epidemiology, clinical features and outcome of systemic lupus erythematous. Rheumatology 56:67–77

    Article  Google Scholar 

  2. González LA, Toloza SMA, McGwin GJ, Alarcón GS (2013) Ethnicity in systemic lupus erythematous (SLE): its influence on susceptibility and outcomes. Lupus 22:1214–1224

    Article  PubMed  Google Scholar 

  3. Schwartzman-Morris J, Putterman C (2012) Gender differences in the pathogenesis and outcome of lupus and of lupus nephritis. Clin Dev Immunol 2012:604892. https://doi.org/10.1155/2012/604892

    Article  PubMed  PubMed Central  Google Scholar 

  4. Grainne Murphy G, David Isenberg D (2013) Effect of gender on clinical presentation in systemic lupus erythematosus. Rheumatology 52:2108–2115

    Article  PubMed  Google Scholar 

  5. Brunner HI, Gladman DD, Ibañez DD, Urowitz MD, Silverman ED (2008) Difference in disease features between childhood-onset and adult-onset systemic lupus erythematosus. Arthritis Rheum 58:556–562

    Article  PubMed  Google Scholar 

  6. Brunner HI, Mina R (2013) Update of differences between childhood onset systemic lupus erythematosus and adult onset systemic lupus erythematosus. Arthritis Res Ther 15:218. https://doi.org/10.1186/ar4256

    Article  PubMed  PubMed Central  Google Scholar 

  7. Abdel-Nabi HH, Abdel-Noor RA (2018). Comparison between disease onset patterns of Egyptian juvenile and adult systemic lupus erythematosus (single centre experience). Lupus https://doi.org/10.1177/0961203318760208

    Article  PubMed  Google Scholar 

  8. Torrente-Segarra V, Salman Monte TC, Rúa-Figueroa I et al (2017) Juvenile- and adult-onset systemic lupus erythematosus: a comparative study in a large cohort from the Spanish Society of Rheumatology Lupus Registry (RELESSER). RELESSER Study Group of the Spanish Society of Rheumatology (SER) and the Study Group of Systemic Autoimmune Diseases of the SER (EAS-SER). Clin Exp Rheumatol 35:1047–1055

    PubMed  Google Scholar 

  9. Hartman EAR, van Royen-Kerkhof A, Jacobs JWG, Welsing PMJ, Fritsch-Stork RDE (2018) Performance of the 2012 Systemic Lupus International Collaborating Clinics classification criteria versus the 1997 American College of Rheumatology classification criteria in adult and juvenile systemic lupus erythematosus. A systematic review and meta-analysis. Autoimmun Rev 17:316–322

    Article  PubMed  Google Scholar 

  10. Kang JH, Park DJ, Lee KE, Lee JS, Choi YD, Lee SS (2017) Comparison of clinical, serological, and prognostic differences among juvenile-, adult-, and late-onset lupus nephritis in Korean patients. Clin Rheumatol 36:1289–1295

    Article  PubMed  Google Scholar 

  11. Malattia C, Martini A (2013) Pediatric onset systemic lupus erythematosus. Best Pract Res Clin Rheumatol 27:351–362

    Article  PubMed  Google Scholar 

  12. Livingston B, Bonner A, Pope J (2012) Differences in autoantibody profiles and disease activity and damage scores between childhood- and adult-onset systemic lupus erythematosus: a meta-analysis. Semin Arthritis Rheum 42:271–280

    Article  PubMed  CAS  Google Scholar 

  13. Hersh AO, von Scheven E, Yazdany J et al (2009) Differences in long-term disease activity and treatment of adult patients with childhood- and adult-onset systemic lupus erythematosus. Arthritis Rheum 61:13–20

    Article  PubMed  PubMed Central  Google Scholar 

  14. Tucker LB, Uribe AG, Fernandez M et al (2008) Adolescent onset of lupus results in more aggressive disease and worse outcomes: results of a nested matched case-control study within LUMINA, a multiethnic US cohort (LUMINA LVII). Lupus 17:314–322

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Hersh AO, Trupin L, Yazdany J et al (2010) Childhood-onset disease predicts mortality in an adult cohort of patients with systemic lupus erythematosus. Arthritis Care Res (Hoboken) 62:1152–1159

    Article  Google Scholar 

  16. Tektonidou MG, Lewandowski LB, Jinxiang H, Dasgupta A, Ward MM (2017) Survival in adults and children with systemic lupus erythematosus: a systematic review and Bayesian meta-analysis of studies from 1950 to 2016. Ann Rheum Dis 76:2009–2016

    Article  PubMed  Google Scholar 

  17. Abdwani R, Rizvi SG, El-Nour I (2008) Childhood onset systemic lupus erythematosus: demographics and clinical analysis. Lupus 17:683–686

    Article  PubMed  CAS  Google Scholar 

  18. Abdwani R, Al-Abrawi S, Sharef SW, Al-Zakwani I (2013) Geogrpahical clustering of juvenile onset systemic lupus erythematosus in the Sultanate of Oman. Oman Med J 28:199–203

    Article  PubMed  PubMed Central  Google Scholar 

  19. Al-Maini MH, El-Ageb EM, Al-Wahaibi SS et al (2003) Demographic, autoimmune, and clinical profiles of patients with systemic lupus erythematosus in Oman. Rheumatol Int 23:186–191

    Article  PubMed  CAS  Google Scholar 

  20. Al-Maini M, El-ageb El-N, Al-shukaily AK, Al-wahaibi S, Richens E (2002) Tribal and geographical variations of lupus in the Sultanate of Oman: a hospital-based study. Rheum Int 21:141–145

    Article  CAS  Google Scholar 

  21. Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725

    Article  PubMed  CAS  Google Scholar 

  22. Petri M, Orbai AM, Alarcón GS, Gordon C, Merrill JT et al (2012) Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum 64:2677–2686

    Article  PubMed  PubMed Central  Google Scholar 

  23. Weening JJ, Agati VD, Schawrtz MM et al (2004) Classification of glomerulonephritis in systemic lupus erythematosus revisited. Kidney Int 65:521–530

    Article  PubMed  Google Scholar 

  24. Bombardier C, Gladman D, Urowitz M, Vhang CH; Committee on Prognosis Studies in SLE (1993) Derivation of SLEDAI. A disease activity index for lupus patients. Arthritis Rheum 35:630–640

    Article  Google Scholar 

  25. Margery-Muir A, Bundell C, Nelson D, Groth D, Wetherall J (2017) Gender balance in patients with systemic lupus erythematous. Autoimmun Rev 16:258–268

    Article  PubMed  Google Scholar 

  26. Hiraki L, Benseler S, Tyrrell P, Hebert D, Harevey E, Silverman E (2008) Clinical and laboratory characteristics and long term outcome of pediatric systemic lupus erythematosus: a longitudinal study. J Pediatr 152:550–556

    Article  PubMed  Google Scholar 

  27. Bader-Meunier B, Armengaud JB, Haddad E, Salomon R, Deschenes G et al (2005) Initial presentation of childhood-onset systemic lupus erythematosus: a French multicenter study. J Pediatr 146:648–653

    Article  PubMed  CAS  Google Scholar 

  28. Ines L, Silva C, Galindo M et al (2015) Classification of systemic lupus erythematosus: systemic lupus international collaborating clinics versus American college of rheumatology criteria. A comparative study of 2,055 patients from a real-life, international systemic lupus erythematosus cohort. Arthrits Care Res (Hoboken) 67:1180–1185

    Article  Google Scholar 

  29. Lythgoe H, Morgan T, Heaf E et al (2017) Evaluation of ACR and SLICC classification criteria in juvenile-onset systemic lupus erythematous; a longitudinal analysis. Lupus 26:1285–1290

    Article  PubMed  CAS  Google Scholar 

  30. Bundhund PK, Kumari A, Huang F (2017) Medicine (Baltimore) 96(37):e8086

    Article  Google Scholar 

  31. Benseler SM, Silverman ED (2007) Neuropsychiatric involvement in pediatric systemic lupus erythematosus. Lupus 16:564–571

    Article  PubMed  CAS  Google Scholar 

  32. Hanly JG, Urowitz MB, Sanchez-Guerrero J et al (2007) Neuropsychiatric events at the time of diagnosis of systemic lupus erythematosus: an international inception cohort study. Arthritis Rheum 56:265–273

    Article  PubMed  CAS  Google Scholar 

  33. Marks SD, Sebire NJ, Pilkington C, Tullus K (2007) Clinicopathological correlations of paediatric lupus nephritis. Pediatr Nephrol 22:77–83

    Article  PubMed  Google Scholar 

  34. Zappitelli M, Duffy CM, Bernard C, Gupta IR (2008) Evaluation of activity, chronicity and tubulointersitial indices for childhood lupus nephritis. Pediatr Nephrol 23:83–91

    Article  PubMed  Google Scholar 

  35. Tarr T, Derfalvi B, Gyori N et al (2015) Similarities and differences between pediatric and adult patients with systemic lupus erythematosus. Lupus 24:796–803

    Article  PubMed  CAS  Google Scholar 

  36. Merkel PA (2004) Systemic lupus erythematosus. In: Andreoli TE, Carpenter CCJ, Griggs RC, Loscalzo J (eds) Cecil essentials of medicine, 6th edn. W. B. Saunders, Philadelphia (PA, pp 745–749

    Google Scholar 

  37. Ni JD, Yao X, Pan HF, Li XP, Xu JH, Ye DQ (2009) Clinical and serological correlates of anti-Sm autoantibodies in Chinese patients with systemic lupus erythematosus: 1,584 cases. Rheumatol Int 29:1323–1326

    Article  PubMed  Google Scholar 

  38. Pons-Estel BA, Catoggio LJ, Cardiel MH et al (2004) The GLADEL multinational Latin American prospective inception cohort of 1,214 patients with systemic lupus erythematosus: ethnic and disease heterogeneity among Hispanics. Medicine (Baltimore) 83:1–17

    Article  Google Scholar 

  39. Arnett FC, Hamilton RG, Roebber MG, Harley JB, Reichlin M (1988) Increased frequencies of Sm and nRNP autoantibodies in American blacks compared to whites with systemic lupus erythematosus. J Rheumatol 15:1773–1776

    PubMed  CAS  Google Scholar 

  40. Ale’ed A, Al-Mayouf S (2014) Systemic lupus erythematosus in Arab children. Differences and similarities with different ethnicities. Saudi Med J 35:566–571

    PubMed  Google Scholar 

Download references

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Correspondence to Reem Abdwani.

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Al Rasbi, A., Abdalla, E., Sultan, R. et al. Spectrum of systemic lupus erythematosus in Oman: from childhood to adulthood. Rheumatol Int 38, 1691–1698 (2018). https://doi.org/10.1007/s00296-018-4032-2

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  • DOI: https://doi.org/10.1007/s00296-018-4032-2

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