The management of lupus in young people

THE FACTS ABOUT JSLE

JSLE is a chronic autoimmune disease that can affect any part of the body including skin, joints, and the major organs. It most commonly presents around adolescence (median age at diagnosis 12–14 years). The female preponderance is less marked in adolescents than in adults.¹

JSLE patients have a more aggressive disease than adults. They have higher rates of organ involvement including renal and liver disease, are more likely to die in the acute phase of the illness, and sustain more organ damage. In contrast with some juvenile arthritis patients, JSLE patients do not ‘grow out’ of the disease. They will therefore have a lengthy disease duration and incur a great burden of medication and its unwanted effects.

JSLE patients are still about 18 times more likely to die than their peers (standardised mortality rate [SMR] JSLE 18.3, confidence interval [CI] = 11.8 to 28.3), in contrast with adults (SMR 3.1, CI = 2.6 to 3.9).¹ Deaths usually relate to active JSLE with organ involvement, often in the context of suboptimal treatment adherence. Counselling patients with organ involvement about the controllable but serious nature of the illness is difficult but essential.

WHEN TO SUSPECT JSLE AND WHAT DIFFERENTIAL TO CONSIDER

JSLE symptoms are highly variable from a relatively mild disease such as a rash with joint pains and fatigue, to a …