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Clinical Phenotype of Filipino Childhood-Onset Systemic Lupus Erythematosus: 12-Year Study in a Tertiary Hospital

Jasper A. Borromeo*, Ma.Theresa M. Collante, Christine B. Bernal

Back ground: Systemic lupus erythematosus (SLE) is a chronic autoimmune multi-systemic inflammatory disorder that starts at childhood in 10%-20% of patients. There is paucity of reports of childhood-onset SLE (cSLE) from developing countries, with little data from Southeast Asia. The purpose of this study is to describe the clinical features at onset and disease manifestation patterns of Filipino patients with cSLE seen in a tertiary hospital in the Philippines.

Methods: This study included patients diagnosed with SLE (age of onset<18 years) seen in the Section of Rheumatology from 2008 to 2019. In-patient and out-patient clinic files of the study population were reviewed. Data collected included demographic profile as well as clinical and laboratory manifestations at initial presentation and during disease course.

Results: A total of 304 cases of cSLE were reviewed. Predominantly affected were females (89.1%). The median age at diagnosis was 13 years (range 3-18 years). The most common presenting features were fever (48.4%), anemia (45%), and arthralgia (40.1%). Predominantly affected systems at diagnosis were hematologic (56.9%), mucocutaneous (55.9%), musculoskeletal (43.4%), and renal (42.1%). Disease activity at diagnosis was generally high (average SLEDAI-2K 12.8). In terms of disease damage, the most common organ damage accrued was renal (20.7%), neuropsychiatric (8.6%), and musculoskeletal (4.6%). All patients were given corticosteroids and hydroxychloroquine, while the most common therapy used for renal disease was intravenous cyclophosphamide.

Conclusion: Among Filipino cSLE patients, the most common features at disease onset and diagnosis were fever, anemia, and arthralgia. Renal involvement occurs in 67.8% of patients throughout the disease course, and is the most predominantly affected in terms of disease damage. Clinical and laboratory features observed were relatively similar to cSLE patients from other series.