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NEW YORK (Reuters Health) Mar 09 - Juvenile-onset systemic lupus erythematosus (SLE) is generally more severe than adult-onset SLE, according to a report in the March Annals of the Rheumatic Diseases.
"We were especially surprised by the magnitude of the difference, which appears to imply a variety of disease manifestations ranging from lupus nephritis to encephalopathy," Dr. Dirk Elewaut from Ghent University Hospital, Ghent, Belgium, told Reuters Health.
Dr. Elewaut and colleagues investigated the prevalence of different signs, symptoms, and antibodies in juvenile-onset SLE, compared with those in adult-onset SLE.
Patients with juvenile-onset SLE were more likely than patients with adult-onset SLE to have generalized erythema, subacute cutaneous lupus, and fever, but less likely to have sicca symptoms and arthralgia, the authors report.
Juvenile-onset SLE patients were also more likely to have renal signs, including proteinuria, glomerulonephritis, and urinary cellular casts, and to have encephalopathy and hemolytic anemia.
Anti-ribosomal P, anti-dsDNA (double-stranded DNA), and antihistone antibodies were significantly more common in juvenile-onset patients than in adult-onset patients, the researchers note.
Among patients with juvenile-onset SLE, there was a striking association of anti-dsDNA antibodies with renal signs and an inverse association of anti-ribosomal P antibodies with renal signs.
"The diagnostic value of autoantibodies in autoimmunity in general varies in relation to age," Dr. Elewaut commented. "The current study confirms this in another pathology, such that in general, the frequency of autoantibodies in juvenile onset SLE is more prevalent than in adult onset SLE."
"We intend to conduct a prospective multicenter follow-up study in juvenile SLE," Dr. Elewaut said. "In this way, we will be able to assess the evolution of autoantibodies and disease manifestations in juvenile SLE over time, which would provide additional prospective data to the cross-sectional data presented in the paper in Annals."
 
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