Disease activity burden in childhood- vs adult-onset SLE: An Australian retrospective cohort study

Results from a retrospective multicenter cohort study using data from the Australian Lupus Registry and Biobank (ALRB) were published in Lupus Science & Medicine by Koelmeyer et al. The study compared long-term outcomes between 519 adults with childhood-onset systemic lupus erythematosus (cSLE; n = 68) and adult-onset SLE (aSLE; n = 451). 

Key data: At baseline, adults with cSLE had higher rates of renal involvement (61.8% vs 37.3%; p < 0.001) and greater existing damage compared with those with aSLE. At a median follow-up of 4.8 years, adults with cSLE demonstrated higher time-adjusted mean SLE Disease Activity Index 2000 (SLEDAI-2K) scores (adjusted mean score [AMS], 5.0 vs 3.6; p < 0.001), were more likely to experience High Disease Activity Status (HDAS; 58.6% vs 42.0%; p = 0.017), and spent less time in Lupus Low Disease Activity State (LLDAS; 34.7% vs 50.2%; p = 0.003) compared with aSLE. Damage accrual rates during follow-up were comparable between groups.  

Key learning: Adults with cSLE experienced higher baseline damage and sustained disease activity than those with aSLE, highlighting the need for early recognition, consistent monitoring, and timely therapeutic escalation to reduce long-term disease burden.