Growth impairment in patients with childhood-onset systemic lupus erythematosus

By Samar Mahmoud, MS
Published February 2, 2022

Key Takeaways

  • This study found that one-fourth of patients with childhood-onset systemic lupus erythematosus developed growth impairment, with male patients being more likely to have a growth impairment than female patients. 

  • The duration of corticosteroid use as well as the dose administered before the late phase of puberty were predictive of growth impairment. 

  • Investigators recommend that physicians decrease corticosteroid use, whenever possible, and administer alternative immunosuppressive medications to maintain quality of life for cSLE patients.

Childhood-onset systemic lupus (cSLE) accounts for 10-20% of all causes of systemic lupus (SLE) and is associated with higher disease severity and more intensive treatment requirements.  A common adverse effect of cSLE treatment is growth suppression which is affected by disease duration and severity, age at disease onset, nutrition, and corticosteroid use.

Why This Study Matters

Previous work has suggested that ethnicity plays a role in determining the final adult height (FAH) of cSLE patients. While Asian patients typically present with more severe disease and require more intensive treatment, studies on the growth trajectory in Asian patients during treatment for cSLE are limited. To address this need, this retrospective, cohort study sought to evaluate predictors of growth in cSLE patients treated at Ramathibodi Hospital in Thailand.

Study Design

This study enrolled 106 patients, who were diagnosed with SLE before the age of 15, between 2006 and 2016. Investigators collected the following baseline characteristics from medical records: height; weight; clinical manifestations; disease activity score; and medications. Adult voice appearance in boys, age at menarche in girls, and parental height were collected by interview. Parent-adjusted FAH scores were calculated and patients were classified into two groups: normal growth; and growth impairment. 

Results and Conclusions

Out of the 106 cSLE patients enrolled in the study, 87 (82%) were female and 19 (18%) were male. Investigators found that 52.6% of boys and 17.2% of girls had a growth impairment. Male gender, duration of disease before menarche in girls and adult voice appearance in boys, and corticosteroid dose ≥230 mg/kg received before the late phase of puberty were predictors of growth impairment. 

Related Research

Consider these findings from similar research studies:

  • Among girls with childhood-onset SLE, patients diagnosed postmenarche achieved a greater final height than those diagnosed premenarche (Source). 

  • Patients with childhood-onset SLE achieved a shorter-than-expected final  height (Source).

Original Source 

Ponin L, Poomthavorn P, Pirojsakul K, et al. Long-term growth and final adult height outcome in childhood-onset systemic lupus erythematosus. Pediatr Rheumatol. 2022;20(1):4.

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