DESTIN, FLA. — Ethnicity appears to play an important role in the incidence and clinical manifestations of pediatric systemic lupus erythematosus, data from a recent study suggest.
Findings from the study of 87 white and 154 nonwhite children showed that whites accounted for more than 60% of age-matched controls without pediatric systemic lupus erythematosus (SLE) but fewer than 40% of the children with pediatric SLE. Specifically, Black, Asian, and South Asian patients are overrepresented in the pediatric SLE population, Dr. Earl Silverman reported at a rheumatology conference sponsored by Virginia Commonwealth University, Richmond.
Mucocutaneous manifestations—usually malar rash and photosensitivity—were more common in white children and organ involvement—usually renal—was more common in nonwhite children, reported Dr. Silverman, professor of pediatrics and immunology at the University of Toronto.
Although anti-DNA, anticardiolipin, lupus anticoagulant, and anti-La antibodies were similar in white and nonwhite children, anti-Sm, anti-RNP, and anti-Ro were expressed more in the nonwhite patients (34% vs. 56%; 30% vs. 42%; and 28% vs. 45%, respectively). The differences in course and incidence of SLE, based on ethnicity, are likely a result of interactions between genes and environment, he said.
Rates of arthritis, serositis, renal disease, central nervous system disease, and hematologic complications have been shown by other researchers not to differ between groups, nor did median SLE disease activity index, he noted.
However, findings from one study show intensive care unit admissions and deaths occurred more often in those younger than age 11 years, compared with those 11 years and older (32% vs. 21% and 11% vs. 0%, respectively), which suggests that SLE may be more severe in younger patients, Dr. Silverman said. Neuropsychiatric manifestations also can occur in pediatric SLE. Studies suggest that, among patients with neurologic involvement (about 25% of SLE patients), headache occurs in 68%, psychosis occurs in 36%, cognitive dysfunction occurs in 27%, cardiovascular disease occurs in 24%, seizures occur in 18%, mood disorders occur in 15%, and chorea occurs in 11%, noted Dr. Silverman.