Twenty-two years' experience with childhood-onset SLE in a developing country: are outcomes similar to developed countries?

Abstract

Introduction: The outcome of systemic lupus erythematosus (SLE) has dramatically improved since the introduction of corticosteroids; however, although many regimens of treatment have been supplemented, the mortality has not improved further.

Objective: To describe the severity and outcome in patients diagnosed with SLE aged ≤18 years in a group of Thai children, compare gender and age differences, and our outcomes with those from developed countries.

Methods: The authors retrospectively reviewed the files of patients aged ≤18 years diagnosed with SLE admitted to Songklanagarind University Hospital in southern Thailand, for the period 1985-2007. Patient survival rates were calculated.

Results: There were 213 SLE patients, 41 males and 172 females, average age 11.6±2.6 years, with a median follow-up of 3.6 years. Outcomes were alive (109), lost to follow-up (22), referred (31) or deceased (51). Of the patients who were alive, 23 were not on any treatment, 59 were on prednisolone alone while 27 were on prednisolone plus some other immunosuppressive drug. Total survival rates were 88%, 76% and 64% at 2, 5 and 10 years, respectively. Males had significantly worse survival than females at 2 and 5 years (78% vs 91% and 58% vs 80%, respectively, p=0.018). There were no differences in mortality between age groups. The 5-year survival rates in the periods 1985-1993, 1994-2000 and 2001-2007 were not significantly different.

Conclusion: This retrospective study of patients with SLE in southern Thailand showed different outcomes compared to some studies and similar survival rates and treatment status to other studies, with one-fourth of surviving patients being free of medication.