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LUPUS IN CHILDREN

Dr. Rae Osborn 13 May 2022
LUPUS IN CHILDREN

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An autoimmune disease, Lupus is known among medical professionals as Systemic Lupus Erythematosus (SLE). Autoimmune illnesses are usually chronic and difficult to treat, requiring constant monitoring and careful management. Besides lupus, there are other autoimmune disorders, such as scleroderma and rheumatoid arthritis.

Lupus is found in both adults and children. In children, the disease is most commonly diagnosed in the teenage years, from the age of 12, and is more common in females. 1 in 5 cases of lupus is diagnosed in children; known as juvenile-onset Systemic Lupus Erythematosus (iSLE). The illness, in very rare cases, begins before age 5, wherein the prognosis is poor.

Symptoms of Lupus in Children

The symptoms of lupus in children are similar to those in adults. A sick child may not have all these symptoms at the same time, depending on the severity of their illness and the bodily organs affected at a particular time.

Below is a list of the symptoms of lupus.

  • A red rash on the face and over the nose, in the shape of a butterfly.
  • A rash that occurs on the arms, head, and chest.
  • Sore and stiff joints.
  • Ulcers in the mouth.
  • Fatigue and difficulty finding energy for usual daily activities.
  • Swelling of lymph nodes.
  • A drop in the number of blood platelets (thrombocytopenia).
  • A drop in the number of white blood cells (leukopenia).
  • Fever.
  • Sensitivity to the sun aggravates any rashes that develop and causes a burning and itching feeling.
  • An unusual accumulation of fluid around the heart or lungs or other organs of the body, such as the kidneys.
  • Inflammation of the lung membranes (pleurisy).
  • Issues with the kidneys, including an inflammatory response and the formation of lesions in the organ.
  • Raynaud's phenomenon, in which there is a reduced flow of blood to the fingers and toes.

Joint pain occurs in about 90% of people who have lupus, and a rash on the face is also a common symptom. The facial rash of lupus can be confused with rosacea. However, it does not show the small bumps of rosacea and is most often in the shape of a butterfly. A person with lupus will also display additional symptoms, such as fatigue and joint pain.

Diagnosis of Lupus

Lupus can be confused with other illnesses, and because of the dangerous organ damage that can result, it is important to correctly diagnose the condition. Symptoms may point to lupus, but confirmation through molecular testing is needed.

Clinical diagnosis involves testing for the presence of particular proteins called antinuclear antibodies and other autoantibodies. One antibody in particular, anti-Smith, is specifically found in SLE. This will provide definitive evidence of the condition.

Causes of Lupus

There are genetic factors at play in the development of juvenile-onset lupus. In fact, gene changes related to B and T cell activation and also those related to the functioning of immune system components, such as monocytes, neutrophils, and interferon production, are associated with lupus.

Besides genes, environmental factors that disrupt the body, including altering hormone levels, such as estrogen, can contribute to the development of lupus. The link to hormone fluctuations may also explain why juvenile-onset lupus occurs in teenagers coinciding with a spike in hormone levels.

Risk factors for Lupus

Women and girls are at a higher risk for developing lupus, with symptoms appearing sometime between the teenage years and mid-40s. The illness is also more common in non-Caucasian people. There is up to a 13% increased risk of a person developing lupus if they currently have or have had a relative with SLE.

Treatment Options for Lupus

Treatment in the case of lupus in children needs to be more aggressive than in adults.

Different medications can help manage lupus in children. In general, the medications help regulate the immune system better or even suppress the immune system. The commonly used medications are listed below, with a brief description of how they help.

  • Non-steroidal anti-inflammatories: These medications help to reduce the inflammatory response, which is a big problem with lupus. In the process of decreasing inflammation, pain is also reduced because tissues are less inflamed and irritated.
  • Corticosteroids: The preferred choices here are methotrexate or hydroxychloroquine. The dose prescribed will be lower than for adults. Methylprednisolone is another corticosteroid that can also be used to help manage the illness.
  • Intravenous gamma-globulin: This has helped kids with inflamed kidneys due to lupus.

Lupus Complications and Survival Rates

Lupus is often a chronic condition that cannot be cured but only managed. While the illness can lead to death, survival has increased in recent years, with many SLE patients (85% to 90%) living at least a further 10 years after diagnosis.

Juvenile-onset lupus can be more deadly, particularly when nephritis occurs. This is when the kidneys are inflamed and lesions develop in the tissue. Kidney damage and any damage to the heart or blood vessels do decrease survival regardless of the age of the patient. 

Lupus can also result in lung clots and damage to multiple organs, including the heart. Children who are diagnosed at an earlier age fail to grow well and may suffer more damage in the future because SLE tends to be a more aggressive form of lupus than adult-onset illness. A further complication is that medication can have side effects and impact the growing child, eventually leading to cataracts in the case of steroid therapy.

Conclusion

Lupus in children can be more severe than in adults. Therefore early diagnosis and treatment are important in helping manage the illness to avoid future complications. Accurate diagnosis is important because this disease resembles other illnesses, such as rheumatoid arthritis but often with more severe and dangerous complications.

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About the Author:

Dr. Rae Osborn has a Ph.D. in Biology from the University of Texas at Arlington. She was a tenured Associate Professor of Biology at Northwestern State University where she taught many courses for Pre-nursing and Pre-medical students. She has written extensively on medical conditions and healthy lifestyle topics, including nutrition. She is from South Africa but lived and taught in the United States for 18 years.

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