Comparison of clinical presentation and outcome of childhood-onset and adulthood-onset of systemic lupus erythematosus among Indonesian patients.

INTRODUCTION: The clinical presentation of childhood-onset systemic lupus erythematosus (SLE) is generally perceived to differ from that of adult-onset SLE. OBJECTIVE: We aimed to compare the demographic and clinical manifestation between childhood-onset vs. adult-onset SLE in a cohort of Indonesian patients at tertiary care centers. METHODS: This retrospective study included patients in the Hasan Sadikin Lupus Registry from 2008 until December 2017. The demographics, clinical presentations, and outcomes were compared between childhood-onset SLE (<18 years old) (Group 1) and adult-onset SLE (≥18 years old) (Group 2). RESULTS: Eight hundred seventy patients were involved into this study. The proportion of childhood-onset SLE was 20% (174 patients). The mean age of group 1 versus group 2 was 13.56 ± 3.04 vs 30.41 ± 8.54 years. The following clinical manifestations at SLE diagnosis were significantly more common in childhood-onset than in adult-onset SLE patients: hematological disorder (p = 0.033) and arthritis (p = 0.006). While discoid rash (p = 0.036) and photosensitivity (p < 0.001) were significantly found higher in adult-onset SLE. Cyclophosphamide therapy was significantly more common to be used in childhood-onset (38.5% vs 21.0%, p = <0.001). However, frequency of mortality on follow-up tended to be higher in childhood-onset group (11.5% vs 7.0%, p = 0.208). CONCLUSION: Arthritis and hematologic involvements at SLE diagnosis were more prominent in childhood-onset compared to adult-onset patients, and mortality in childhood-onset SLE during follow-up relatively higher. This data may suggest the need for more aggressive management approach to childhood-onset patients with SLE.

Risk Factors for Poor Pregnancy Outcome in Systemic Lupus Erythematosus Patients.

BACKGROUND: systemic lupus erythematosus (SLE) is still a challenging autoimmune disease, especially in pregnancy setting. An early risk factors awareness of poor pregnancy outcome is important to optimize the outcome of pregnancy in SLE patients. This study was conducted to describe pregnancy outcome and determine the risk factors associated with poor pregnancy outcome in SLE patients. METHODS: a retrospective case-control study of SLE patients with poor and normal pregnancy outcome was performed. Pregnancy histories were reviewed from Dr. Hasan Sadikin General Hospital lupus registry study. The case group was pregnancy with poor outcome, defined as abortion, premature birth, stillbirth, intrauterine growth restriction (IUGR) and neonatal death. The control group was pregnancy with good outcome, defined as live birth and full term. RESULTS: a total of 84 SLE patients were enrolled in this study with 109 pregnancies after SLE diagnosis. The median age of subjects at the time of pregnancy was 28 (25-32) years old. Poor pregnancy outcome comprising 22.9% abortion, 14.7% premature birth, 5.5% stillbirth, 1.8% IUGR and 4.6% neonatal death. There was a significant difference in the number of planned pregnancy (P=0.011) between groups with poor and good outcome. Clinical variables significantly associated with poor pregnancy outcome were lupus nephritis (OR = 4.813, 95% CI 1.709 - 13.557, P = 0.003) and neuropsychiatric SLE (OR = 5.045, 95% CI 1.278 - 19.920, P = 0.021). CONCLUSION: the pregnancy in SLE patient should be planned to have better outcome. Lupus nephritis and neuropsychiatric (NP) SLE were risk factors for poor pregnancy outcome in SLE patient.