Complex issues of early diagnosis of systemic lupus erythematosus in children

Abstract

Data on the current clinical manifestations of systemic lupus erythematosus (SLE) in children and adolescents are presented with a description of the polymorphism of individual symptoms of skin lesions, musculoskeletal system and internal organs, which are difficult for early diagnosis of the disease. The questions of classification analysis of SLE are highlighted, attention is focused on the fact that classification criteria are not always sufficient for early diagnosis of the disease in childhood, which in some cases leads to the “loss” of patients with not fully formed syndromes and/or atypical forms of the disease. The diagnostic criteria for SLE of Systemic Lupus Collaborating Clinics (2012) are quite informative, but they have not been widely adopted in the clinical practice of pediatric rheumatology. American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria (2017) are provided. The results of dynamic monitoring of 22 patients who were treated in the children’s clinic of the Institute over the past 10 years are presented. It is shown that in 28 % of patients the diagnosis was verified only with repeated hospitalizations, in 10 % — almost 6 years after the onset of the disease. The clinical cases of SLE are described: in a patient with a primary chronic course (lesions of the skin and musculoskeletal systems) and a child with a subacute severe course of the disease with kidney damage. The issues of their diagnosis in the onset of the disease are discussed using the classification criteria for SLE proposed by ACR/EULAR (2017). The use of modern clinical and immunological criteria for the diagnosis of SLE in most cases allows you to establish the diagnosis at an earlier stage of the disease and to start timely the pathogenetic therapy.

Keywords

• systemic lupus erythematosus
• diagnosis
• children