Systemic lupus erythematosus
Differences in Autoantibody Profiles and Disease Activity and Damage Scores Between Childhood- and Adult-Onset Systemic Lupus Erythematosus: A Meta-Analysis

https://doi.org/10.1016/j.semarthrit.2012.05.001Get rights and content

Background

Age at systemic lupus erythematosus (SLE) onset may impact autoantibodies, disease activity, and damage. A meta-analysis of all studies that directly compared childhood-onset lupus (cSLE) to adult-onset lupus was performed to determine which autoantibodies and whether activity and damage scores vary between adult- and pediatric-onset SLE.

Methods

A literature search of the MEDLINE/PubMed, EMBASE, CINAHL, and SCOPUS databases (until January 2011) was conducted to identify relevant articles. Study quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Two independent reviewers determined eligibility criteria. Pooled odds ratios and mean differences were calculated assuming random effects, and heterogeneity was estimated and presented as (odds ratios; 95% confidence interval).

Results

Of the 484 studies identified, 19 were eligible. The total number of patients was 7519. Mean trial quality was 18/32, ranging from 8 to 29. Several statistically significant differences were found: more frequently positive anti–dsDNA antibody (1.97; 1.31 to 2.96) and IgG/IgM anticardiolipin antibody (1.66; 1.20 to 2.28), and mean disease activity scores (SLE Disease Activity Index) (4.73; 2.13 to 7.32) were higher in cSLE. Disease damage [SLE damage index (SDI)] was lower in cSLE, but not significantly (0.50; −0.13 to 1.14). Rheumatoid factor was increased in adults (0.53; 0.32 to 0.87). The frequency of the autoantibodies and laboratories was not different between the groups (ANA, anti-Smith, anti-RNP, anti-U1RNP, anti-Ro and anti-La, antiphospholipid, lupus anticoagulant, complements, ssDNA, and Coomb's test).

Conclusions

The results of this meta-analysis suggest that cSLE may have different autoantibody profiles (increased anti–dsDNA and anticardiolipin antibody, less rheumatoid factor), and more disease activity than adult-onset SLE. Damage may be less in children, but larger studies are needed.

Section snippets

Identification of Studies

A similar search strategy and methods have been described in a companion meta-analysis of clinical manifestations between cSLE and aSLE (3). A comprehensive literature search of the MEDLINE/PubMed, EMBASE, CINAHL, and SCOPUS databases was conducted (each from database inception to January 2011) using the following search terms: Systemic lupus erythematosus and Age factors/or Onset age/or Age of onset/or Age differences and Adult and Child. In addition, key references were hand searched to

Search Results

The literature search identified 484 articles, which were screened for eligibility (Fig. 1): 221 were repeated citations, 16 were not written in English, 43 were published before 1982, and 151 were deemed irrelevant based on a review of the title/abstract. The remaining 53 articles underwent a full text review, and an additional 37 articles were excluded: 25 had no comparative data on cSLE and aSLE, 9 had comparative data, but not on a variable of interest, 2 focused on a specialized subset of

Discussion

The results of this meta-analysis suggest that there are some differences in the autoantibody profiles, laboratory test results, and activity scores between cSLE and aSLE. As was expected, the majority of cSLE and aSLE patients had a positive ANA test, and there was no difference in the prevalence of a positive test between the 2 age groups. Other autoantibodies that showed no predilection for either age group included anti-Smith, anti-RNP, anti-U1RNP, anti-Ro, and anti-La. These findings are

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