Ethnicity May Not Contribute to Clinical Differences Between Adult-, Childhood-Onset SLE

Lupus diagnosis
Researchers sought to determine whether ethnic differences contribute to the differences in clinical presentation between patients with childhood-onset vs adult-onset SLE.

Study data published in Rheumatology identified several clinical differences between childhood-onset systemic lupus erythematosus (cSLE) and adult-onset SLE (aSLE), although none of the differences were attributable to ethnicity.

Investigators abstracted data from the 1000 Canadian Faces of Lupus Study, a prospective observational cohort that enrolled incident and prevalent cases of SLE from 14 participating centers across Canada, including 8 adult rheumatology clinics and 4 pediatric rheumatology clinics. Patients with a diagnosis of SLE before the age of 18 years were considered to have childhood-onset SLE. The present cross-sectional analysis used baseline patient data from the pediatric and adult centers. As the primary outcome variable, investigators measured clinical manifestation of disease according to American College of Rheumatology classification criteria. Ethnicity, disease duration, and geographic location were also extracted as covariables. Ethnicity was self-selected by patients on baseline intake questionnaires. Multivariable regression was performed to assess the relationship between these covariates and disease activity and damage at baseline.

Related Articles

The final patient cohort comprised 552 patients with aSLE and 276 patients with cSLE. Patients with aSLE had a mean age at diagnosis of 37.0 years and a mean disease duration of 10.9 years. Among patients with cSLE, mean age at diagnosis was 12.7 years and mean disease duration was 5.6 years. Patients were primarily Caucasian in the aSLE cohort (69.0%), although not in the cSLE cohort (36.6%; P <.0001). Disease activity and damage accrual scores were higher in patients with aSLE compared with patients in the cSLE cohort.

However, these differences were not clinically significant when adjusted for disease duration. According to multivariable regression analysis, aSLE was associated with decreased odds of having a neurologic disorder (odds ratio [OR], 0.49; P =.037) and increased odds of having anticardiolipin antibodies (OR, 1.85; P =.024). Ethnicity was not associated with any differences in clinical presentation or autoantibody frequency between aSLE and cSLE.

Ethnicity was not associated with differences in clinical manifestations and autoantibody profiles between aSLE and cSLE. Further research is necessary to explore these differences in disease profile between aSLE and cSLE.


Kim H, Levy DM, Silverman ED, et al. A comparison between childhood and adult onset systemic lupus erythematosus adjusted for ethnicity from the 1000 Canadian Faces of Lupus Cohort [published online February 25, 2019]. Rheumatology (Oxford). doi:10.1093/rheumatology/kez006