Complex issues of early diagnosis of systemic lupus erythematosus in children

O.M. Mukvich, L.I. Omelchenko, O.A. Belska, I.V. Dudka, T.A. Ludvik, A.M. Matskevich


Data on the current clinical manifestations of systemic lupus erythematosus (SLE) in children and adolescents are presented with a description of the polymorphism of individual symptoms of skin lesions, musculoskeletal system and internal organs, which are difficult for early diagnosis of the disease. The questions of classification analysis of SLE are highlighted, attention is focused on the fact that classification criteria are not always sufficient for early diagnosis of the disease in childhood, which in some cases leads to the “loss” of patients with not fully formed syndromes and/or atypical forms of the disease. The diagnostic criteria for SLE of Systemic Lupus Collaborating Clinics (2012) are quite informative, but they have not been widely adopted in the clinical practice of pediatric rheumatology. American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria (2017) are provided. The results of dynamic monitoring of 22 patients who were treated in the children’s clinic of the Institute over the past 10 years are presented. It is shown that in 28 % of patients the diagnosis was verified only with repeated hospitalizations, in 10 % — almost 6 years after the onset of the disease. The clinical cases of SLE are described: in a patient with a primary chronic course (lesions of the skin and musculoskeletal systems) and a child with a subacute severe course of the disease with kidney damage. The issues of their diagnosis in the onset of the disease are discussed using the classification criteria for SLE proposed by ACR/EULAR (2017). The use of modern clinical and immunological criteria for the diagnosis of SLE in most cases allows you to establish the diagnosis at an earlier stage of the disease and to start timely the pathogenetic therapy.


systemic lupus erythematosus; diagnosis; children


Alexeeva EA, Dvoryakovskaya TM, Nikishina IP, Denisova RV, Podchernyaeva NS, Sukhorukikh OA, Shubina LS. Systemic lupus erythematosus: clinical recommendations, Part 1. Voprosy sovremennoj pediatrii. 2018;17(1):19–37. doi: 10.15690/vsp.v17i1.1853.

O'Gorman WE, Kong DS, Balboni IM, et al. Mass cytometry identifies a distinct monocyte cytokine signature shared by clinically heterogeneous pediatric SLE patients. J Autoimmun. 2017;S0896-8411(16)30412-7. doi:10.1016/j.jaut.2017.03.010.

Benseler SM, Silverman ED. Systemic lupus erythematosus. Pediatr Clin North Am. 2005;52(2):443–467. doi:10.1016/j.pcl.2005.01.010.

Alarcón GS, McGwin G, Bertoli AM, et al. Effect of hydroxychloroquine on the survival of patients with systemic lupus erythematosus: data from LUMINA, a multiethnic US cohort (LUMINA L). Ann Rheum Dis. 2007;66(9):1168–1172. doi:10.1136/ard.2006.068676.

Zhang CX, Cai L, Shao K, et al. Serum IP-10 is useful for identifying renal and overall disease activity in pediatric systemic lupus erythematosus. Pediatr Nephrol. 2018;33(5):837–845. doi:10.1007/s00467-017-3867-1.

Haddon DJ, Diep VK, Price JV, Limb C, Utz PJ, Balboni I. Autoantigen microarrays reveal autoantibodies associated with proliferative nephritis and active disease in pediatric systemic lupus erythematosus. Arthritis Res Ther. 2015;17(1):162. Published 2015 Jun 17. doi:10.1186/s13075-015-0682-6.

Hiraki LT, Benseler SM, Tyrrell PN, Hebert D, Harvey E, Silverman ED. Clinical and laboratory characteristics and long-term outcome of pediatric systemic lupus erythematosus: a longitudinal study. J Pediatr. 2008;152(4):550–556. doi:10.1016/j.jpeds.2007.09.019.

Bogmat LF, Nikonova VV, Shevchenko NS, Bessonova IM. Features of renal dysfunction in children with systemic lupus erythematosus and juvenile idiopathic arthritis. Zdorov`e rebenka. 2017;12(6):663–669. doi: 10.22141/2224-0551.12.6.2017.112834.

Churylina AV. The Diagnosis and Treatment of Systemic Lupus Erythematosus. Mizhnarodnyi zhurnal pediatrii, akusherstva ta hinekolohii. 2018;12(2):23-32.

Brinks R, Fischer-Betz R, Sander O, Richter JG, Chehab G, Schneider M. Age-specific prevalence of diagnosed systemic lupus erythematosus in Germany 2002 and projection to 2030. Lupus. 2014;23(13):1407–1411. doi:10.1177/0961203314540352.

Deutsche Gesellschaft für Rheumatologie e. V. Diagnostik und Klassifikation. Available from: Accessed:19 March 2015.

Cozzani E, Drosera M, Gasparini G, Parodi A. Serology of Lupus Erythematosus: Correlation between Immunopathological Features and Clinical Aspects. Autoimmune Dis. 2014;2014:321359. doi:10.1155/2014/321359.

Pan N, Amigues I, Lyman S, et al. A surge in anti-dsDNA titer predicts a severe lupus flare within six months. Lupus. 2014;23(3):293–298. doi:10.1177/0961203313515763.

Sakthiswary R, Suresh E. Methotrexate in systemic lupus erythematosus: a systematic review of its efficacy. Lupus. 2014;23(3):225–235. doi:10.1177/0961203313519159.

Maneiro JR, Lopez-Canoa N, Salgado E, Gomez-Reino JJ. Maintenance therapy of lupus nephritis with mycophenolate or azathioprine: systematic review and meta-analysis. Rheumatology (Oxford). 2014;53(5):834–838. doi:10.1093/rheumatology/ket429.

Kuhn A, Sigges J, Biazar C, et al. Influence of smoking on disease severity and antimalarial therapy in cutaneous lupus erythematosus: analysis of 1002 patients from the EUSCLE database. Br J Dermatol. 2014;171(3):571–579. doi:10.1111/bjd.13006.

Gemeinsamer Bundesausschuss. Dossier zur Nutzenbewertung gemäߧ35a SGBV - Belimumab (Benlysta) Modul 1. Available from: Accessed: 19 March 2015.

Xu L, Cai M, Shi BY, Li ZL, Li X, Jin HL. A prospective analysis of the effects of enteric-coated mycophenolate sodium and mycophenolate mofetil co-medicated with a proton pump inhibitor in kidney transplant recipients at a single institute in China. Transplant Proc. 2014;46(5):1362–1365. doi:10.1016/j.transproceed.2014.01.012.

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