Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2017 Sep;96(37):e8086.
doi: 10.1097/MD.0000000000008086.

Differences in clinical features observed between childhood-onset versus adult-onset systemic lupus erythematosus: A systematic review and meta-analysis

Pravesh Kumar Bundhun  1 , Alka Kumari, Feng Huang
Affiliations
Meta-Analysis

Differences in clinical features observed between childhood-onset versus adult-onset systemic lupus erythematosus: A systematic review and meta-analysis

Pravesh Kumar Bundhun et al. Medicine (Baltimore). 2017 Sep.

Abstract

Background: Systemic lupus erythematosus (SLE) affects people in childhood (childhood onset) or in adulthood (adult onset). Observational studies that have previously compared childhood-onset versus adult-onset SLE were often restricted to 1 ethnic group, or to a particular area, with a small sample size of patients. We aimed to systematically compare childhood-onset versus adult-onset SLE through a meta-analysis.

Methods: Electronic databases were searched for relevant publications comparing childhood-onset with adult-onset SLE. Adverse clinical features were considered as the endpoints. The Newcastle Ottawa Scale (NOS) was used to assess the methodological quality of the studies and RevMan software (version 5.3) was used to carry out this analysis whereby risk ratios (RRs) and 95% confidence intervals (95% CIs) were used as the statistical parameters.

Results: A total number of 10,261 participants (1560 participants with childhood-onset SLE and 8701 participants with adult-onset SLE) were enrolled. Results of this analysis showed that compared with childhood-onset SLE, pulmonary involvement was significantly higher with adult-onset SLE (RR: 1.51, 95% CI: 1.18-1.93; P = .001), whereas renal involvement was significantly higher with childhood-onset SLE (RR: 0.65, 95% CI: 0.55-0.77; P = .00001). Raynaud phenomenon and photosensitivity were significantly higher in adult-onset SLE (RR: 1.29, 95% CI: 1.04-1.60; P = .02) and (RR: 1.08, 95% CI: 1.01-1.17; P = .03), respectively. Malar rash significantly favored adult-onset SLE (RR: 0.84, 95% CI: 0.75-0.94; P = .002). Childhood-onset SLE was associated with significantly higher hemolytic anemia, thrombocytopenia, leukocytopenia, and lymphopenia. Seizure and ocular manifestations were significantly higher with childhood-onset SLE (RR: 0.57, 95% CI: 0.47-0.70; P = .00001) and (RR: 0.34, 95% CI: 0.21-0.55; P = .00001), respectively, whereas pleuritis was significantly higher with adult-onset SLE (RR: 1.45, 95% CI: 1.17-1.79; P = .0008). Vasculitis and fever were significantly higher with childhood-onset SLE (RR: 0.51, 95% CI: 0.36-0.74; P = .0004) and (RR: 0.78, 95% CI: 0.68-0.89; P = .0002) respectively.

Conclusion: Significant differences were observed between childhood-onset versus adult-onset SLE, showing the former to be more aggressive.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they do not have any competing interests.

Figures

Figure 1
Figure 1
Flow diagram representing the study selection.
Figure 2
Figure 2
System involvement between childhood-onset versus adult-onset SLE (part 1).
Figure 3
Figure 3
System involvement between childhood-onset versus adult-onset SLE (part 2).
Figure 4
Figure 4
Rheumatological and connective tissue manifestations (part 1).
Figure 5
Figure 5
Rheumatological and connective tissue manifestations (part 2).
Figure 6
Figure 6
Hematological manifestations.
Figure 7
Figure 7
Nervous system manifestations.
Figure 8
Figure 8
Funnel plot showing publication bias.
Figure 9
Figure 9
Funnel plot showing publication bias.
Figure 10
Figure 10
Funnel plot showing publication bias.
See this image and copyright information in PMC

References

    1. Brinks R, Hoyer A, Weber S, et al. Age-specific and sex-specific incidence of systemic lupus erythematosus: an estimate from cross-sectional claims data of 2.3 million people in the German statutory health insurance 2002. Lupus Sci Med 2016;3:e000181. - PMC - PubMed
    1. Tiao J, Feng R, Carr K, et al. Using the American College of Rheumatology (ACR) and Systemic Lupus International Collaborating Clinics (SLICC) criteria to determine the diagnosis of systemic lupus erythematosus (SLE) in patients with subacute cutaneous lupus erythematosus (SCLE). J Am Acad Dermatol 2016;74:862–9. - PMC - PubMed
    1. Petri M, Orbai AM, Alarcón GS, et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum 2012;64:2677–86. - PMC - PubMed
    1. Budhoo A, Mody GM, Dubula T, et al. Comparison of ethnicity, gender, age of onset and outcome in South Africans with systemic lupus erythematosus. Lupus 2017;26:438–46. - PubMed
    1. Nikpour M, Bridge JA, Richter S. A systematic review of prevalence, disease characteristics and management of systemic lupus erythematosus in Australia: identifying areas of unmet need. Intern Med J 2014;44:1170–9. - PubMed

MeSH terms