A comparison between childhood and adult onset systemic lupus erythematosus adjusted for ethnicity from the 1000 Canadian Faces of Lupus Cohort

Hyein Kim; Deborah M Levy; Earl D Silverman; Carol Hitchon; Sasha Bernatsky; Christian Pineau; C Doug Smith; Lori Tucker; Ross Petty; Hector Arbillaga; Michel Zummer; Marie Hudson; Paul Fortin; Adam M Huber; Gaelle Chedeville; Christine Peschken; Janet E Pope

doi:10.1093/rheumatology/kez006

A comparison between childhood and adult onset systemic lupus erythematosus adjusted for ethnicity from the 1000 Canadian Faces of Lupus Cohort

Rheumatology (Oxford). 2019 Feb 25:kez006. doi: 10.1093/rheumatology/kez006. Online ahead of print.

Authors

Hyein Kim¹, Deborah M Levy^{2

3}, Earl D Silverman^{2

3}, Carol Hitchon⁴, Sasha Bernatsky⁵, Christian Pineau⁵, C Doug Smith⁶, Lori Tucker⁷, Ross Petty⁷, Hector Arbillaga⁸, Michel Zummer⁹, Marie Hudson¹⁰, Paul Fortin¹¹, Adam M Huber¹², Gaelle Chedeville¹³, Christine Peschken⁴, Janet E Pope^{1

14}

Affiliations

¹ Department of Medicine, University of Western Ontario, London.
² Department of Pediatrics, Hospital for Sick Children, Toronto, Canada.
³ Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada.
⁴ Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
⁵ Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada.
⁶ Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁷ Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada.
⁸ Division of Rheumatology, Rheumatology Clinic, Lethbridge, Alberta, Canada.
⁹ Department of Rheumatology, Hopital Maisonneuve Rosemount, Montreal, Canada.
¹⁰ Department of Rheumatology, Jewish General Hospital, Montreal, Canada.
¹¹ Department of Medicine, Division of Rheumatology, Laval University, Quebec City, Quebec, Canada.
¹² Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada.
¹³ Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada.
¹⁴ Rheumatology Centre, Department of Medicine, Division of Rheumatology, St. Joseph's Health Care, London, Ontario, Canada.

PMID: 30805629
DOI: 10.1093/rheumatology/kez006

Abstract

Objective: Childhood-onset SLE (cSLE) manifests differently than adult-onset SLE (aSLE). This study determined whether ethnic differences contribute to the differences in clinical presentation between the two groups.

Methods: This cross-sectional study used data from a multi-centred registry from eight adult and four paediatric Canadian centres gathered at study entry. We compared the frequency of clinical manifestations and autoantibodies between aSLE and cSLE. For those with a significant difference, a multivariable logistic regression was performed, adjusting for ethnicity, SLE onset (cSLE vs aSLE), disease duration and centre. Disease activity and damage between aSLE and cSLE were compared after stratifying by disease duration.

Results: Of 552 aSLE subjects, 502 (90.9%) were female and 381 (69.0%) were Caucasian. Mean age at diagnosis was 37.0 ± 13.6 years and disease duration 10.9 ± 9.6 years. Of 276 cSLE subjects, 231 (83.7%) were female and 101 (36.6%) were Caucasian. Mean age at diagnosis was 12.7 ± 3.3 years and disease duration 5.6 ± 8.2 years. In multivariable regression analysis, aSLE was associated with decreased odds of having a neurologic disorder (odds ratio = 0.49) and increased odds of having aCL antibodies (odds ratio = 1.85). Disease activity and damage accrual scores were higher in aSLE than cSLE within the same disease duration strata, although the differences were not clinically significant. Ethnicity was not associated with any differences in clinical manifestations or autoantibody frequency between aSLE and cSLE.

Conclusions: Although a crude comparison of aSLE and cSLE yielded several differences in clinical symptoms and autoantibodies, this difference was not attributable to ethnic differences between aSLE and cSLE.

Keywords: SDI; SLAM; SLE; SLEDAI; adult-onset SLE; autoantibodies; registry; systemic lupus erythematosus (SLE).