“I would like everyone to think three times before ordering an ANA because up to 20% of healthy children have positive ANAs,” said Dr. Szer, also a professor of pediatrics at the University of California, San Diego. “That's practically everybody.”
A common cutaneous sign of SLE is a malar rash that spares the nasolabial folds. Other cutaneous signs include discoid rash, photosensitive rash, and recurrent mouth sores.
“Lupus in children is usually insidious,” she added. “It may be acute, but it is always organ- or life-threatening. Delay in diagnosis clearly leads to lupus crisis. There is a point of no return with these patients. There's irreversible renal damage and death.”
Erythrocyte sedimentation rate tends to be very high. Corrected sedimentation rate tends to be normal unless your patient has an infection, and renal disease is found in 90% of children. “The disease is very aggressive in children, especially during the first 2 years,” she said. “We think of this as cancer medicine. We induce things into remission and then we maintain that remission.”
This rash over the extensor surface of the elbow is characteristic of DMS. Courtesy Dr. Ilona S. Szer