A77: Clinical and Laboratory Features and Systemic Lupus Erythematous Disease Activity Index 2000 (SLEDAI 2K) at Onset and Follow Up in a Cohort of 109 Paediatric Lupus Patients From a Tertiary Level Centre in India
Authors: Sujata Sawhney, Mehul Jariwala, Manjari Agarwal
Journal: Arthritis & Rheumatology (2014)

Background/Purpose:

Pediatric Rheumatology is a relatively new branch in India. To the best of our knowledge, this is the first paper that has studied SLEDAI 2K in 109 children with SLE at onset, 6 months and annually thereafter for a median follow up of 38 months.



Methods:

In our unit, disease activity of all children with lupus is captured on disease assessment proformas and completed every 3–6 months. This form captures demographics, clinical assessment, lab results and therapy. All paediatric lupus patients (diagnosed per the ACR criteria 1992) with disease onset <18 years seen at our unit from 2001 were included. The clinical and laboratory features at presentation and the SLEDAI 2K was captured at onset, 6 months and thereafter annually. We chose SLE 2K as an outcome measure as it captures new, recurrent and ongoing disease activity ([1]).



The aims of the study were 

To detail the presentation of cSLE from India
To study the SLEDAI 2K at onset and follow up
To compare the data from India to that available from the West.


available from the West.



Results:

Demographics: 109 patients identified, 90 were females. The median age at onset was 11.4 (3.4-18) years and median age at diagnosis 12.1 (3.5-19). The median duration of follow up was 38 months (3-152).



Clinical presentation at onset: As in table 1. Nine children had MAS at onset.


Table 1. Table 1.	Feature	% positive
Constitutional	 	
fever	83	
arthralgia	80	
Fatigue	70	
myalgia	55	
weight loss	43	
Lupus features	 	
malar rash	62	
arthritis	60	
alopecia	59	
mucositis	56	
photosensitivity	39	
vasculitis	38	
nephritis	35	
lymphadenopathy	33	
neurologic	17	
effusion	14	



Labs at onset: ANA positive in 97%, DsDNA in 80%, low complements seen in 84%. Anemia, leucopenia and thrombocytopenia present in 37, 31, and 28% respectively. APL antibodies positive in 28%.



SLEDAI 2K at onset and follow up: Table 2


Table 2. SLEDAI 2K in a Cohort of cSLE Patients at Onset and 5 Year Follow Up	disease duration months	no of patients	Median SLEDAI	% pts with SLEDAI <4	SLEDAI Range
0	109	16	2	1 to 52	
6	107	2	56	0 to 28	
12	97	2	66	0 to 16	
24	77	2	70	0 to 28	
36	58	2	71	0 to 24	
48	44	0	75	0 to 50	
60	37	2	70	0 to 12	



Median SLEDAI 2K 16 at onset and subsequently all median SLEDAIs were <4. Patients with inactive disease (SLEDAI 2K <4) ([1]) 70–75% after the 6 months. Nineteen patients had a new organ involvement 6 months after disease onset, eight nephritis. Follow up: 54 patients had no flare, 27–1 flare and 28 patients had 2–5 flares each. One patient died, no patient had renal failure/transplant. Seven patients had hypothyroidism and 1 had celiac disease.



Comparison with Western data: Of 256 patients with cSLE described from Toronto, the mean SLEDAI was 13 at onset and 2.9 at one year, very similar to our study ([2]). The cohort from Israel studied 102 patients with a higher SLEDAI of 17 at onset, 7.6 at 5 years with 5 patients in renal failure ([3]).



Conclusion:

80% of patients had fever and 33% had nephritis at onset. The disease burden at onset was high; median SLEDAI fell to <4 within 6 months and remained low through follow up. 17% had new organ involvement after 6 months. 50% had no disease flare. The disease burden is similar to that described in the West.