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Systemic Lupus Erythematosus in Libyan Children: Diagnosis and Management

Khawaja ES and Zletni MA

Background: Childhood Systemic lupus erythematosus (cSLE) is a complex, chronic multisystem autoimmune inflammatory disease, 20% of SLE patients are diagnosed during childhood. The aim of this study is to evaluate disease characteristics; clinical manifestations, laboratory characteristics and treatment in patients with cSLE.

Methods: We reviewed the medical files of children with diagnosis of cSLE who are following at Tripoli children hospital, rheumatology department over the last 7 years (January 2011- April 2018). The diagnosis of SLE was based on 1997 revised American college criteria (ACR) for the classification of SLE. All children fulfilled at least 4 of the ACR criteria and had been diagnosed for at least 6 months were included. The following parameters were collected: age at onset of the disease, age at diagnosis, gender, Initial diagnosis (diagnosis at referral), disease duration, diagnosis time interval (period between disease onset to diagnosis), clinical manifestations at the onset and during the evolution of the disease. Laboratory results at diagnosis, and treatment modalities received were also evaluated.

Findings: Twelve children were studied, 10 Females (83.3%), two males (16.7%) with F:M ratio of 5:1, mean ages at lupus onset and diagnosis were 11.6 year, 12.5 year respectively. Diagnosis time Interval was ranged between 6 months to 8 yr. The most frequent Mucocutaneous manifestations was the Malar rash in 8 (66.7%) followed by photosensitivity in5 (41.7%), Oral ulcer in 4 (33.3%) and, Discoid rash in 1(8.3%) patient. 10 patients (83.3%) had arthritis. Hematological manifestations in 9(75%), Renal involvement was found in 6(50%), kidney biopsy was done to 5 of them, dominated by class IV (Diffuse proliferative glomerulonephritis) World health organization (WHO) nephritis stage classification. Serositis was found in 5 (41.7%), Neurological manifestations in 3 (25%), Positive anti-nuclear antibody in 11 (91.7%). positive Anti ds-DNA 12 (100%), low complement in 4 (33.3%) of patients.

Conclusion: SLE in children has a wide range of presentations and a high index of suspicion should be maintained in order to make an early diagnosis. Better recognition of the age specific manifestations of this disease is required to improve its outcome.