A single-center study of clinical characteristics of 171 hospitalized children with systemic lupus erythematosus

Abstract

Objective To investigate the clinical characteristics at childhood-onset systemic lupus erythematosus (cSLE) in our hospital over the past decade, and to analyze the relationship with sex and anti-extractable nuclear antigen (ENA) antibodies. Methods We included 171 children with cSLE admitted to our hospital from January 2012 to December 2021, collecting their data on age, sex, onset symptoms, and system involvement, as well as serum complements C3 and C4, immunoglobulin, and ENA antibodies. We analyzed the clinical features at disease onset, compared the above indicators between sexes, and determined the relationship between anti-ENA antibodies and organ/system involvement. Results The misdiagnosis rate before the definitive diagnosis of the children was 43.27%. The initial symptoms were mainly rashes and fever (28.31% each). Hematological involvement occurred in 73.68% of the children. The proportion of anemia was significantly higher in females than in males (χ2=3.863,P<0.05). Renal involvement occurred in 61.54% of the children. The proportion of hematuria with proteinuria in males was significantly higher than that in females (χ2=10.373,P<0.05). Isolated proteinuria was significantly more frequent in females than in males (χ2=5.718,P<0.05). Across the anti-ENA antibody spectrum, the presence of anti-double stranded DNA, anti-histone, or anti-nucleosome antibodies was significantly associated with a higher proportion of kidney involvement (χ2=5.306-12.667,P<0.05); and the presence of anti-Smith or anti-ribonucleoprotein antibodies was significantly associated with a higher proportion of skin and mucosal system involvement (χ2=4.495,4.210,P<0.05) and a lower proportion of hematological involvement (χ2=5.618,6.719,P<0.05). Conclusion cSLE is easily misdiagnosed, which typically begins with fever and rashes and frequently affects the kidney and hematological system, with sex-related differences in system involvement. Certain anti-ENA antibodies are associated with renal, skin and mucosa, and hematological involvement in cSLE.

Keywords

• lupus erythematosus, systemic|child|prodromal symptoms|antigens, nuclear|sex factors