Children can develop lupus, a chronic autoimmune disease where the body’s immune system mistakenly attacks its own healthy tissues and organs. While more commonly diagnosed in adults, lupus can affect individuals of any age, including children.
Understanding Juvenile Lupus
Lupus that begins before age 18 is called juvenile-onset lupus, pediatric lupus, or childhood-onset systemic lupus erythematosus (cSLE). This form is less common than adult-onset lupus, accounting for 15% to 20% of all cases. While it can start at any point, the most common age of onset for cSLE is around 11 to 12 years, though it is rare before age five.
cSLE often presents with distinct characteristics and can be more severe than adult lupus. Children with lupus may experience more aggressive disease progression, more frequent flare-ups, and a higher likelihood of organ involvement, particularly affecting the kidneys and brain. The disease’s impact on developing bodies can also lead to unique challenges related to growth, physical development, and school attendance.
Recognizing Symptoms in Children
Recognizing lupus symptoms in children can be challenging because they are often varied, non-specific, and can mimic other common childhood illnesses. Persistent fatigue, despite adequate rest, is a common early sign, often accompanied by unexplained fevers above 100 degrees Fahrenheit. Children may also experience a loss of appetite and unintended weight loss.
Joint pain and swelling, known as arthritis, are frequently observed symptoms, affecting multiple joints and causing stiffness. Skin manifestations are also prevalent, including a distinctive butterfly-shaped rash across the cheeks and nose, called a malar rash, or rashes that appear or worsen with sun exposure. Hair loss, sometimes leading to noticeable thinning or bald spots, and sores inside the mouth or nose are other potential indicators. These symptoms can fluctuate, with periods of heightened activity known as flares, and periods of reduced activity or remission.
Diagnosing Lupus in Children
Diagnosing lupus in children can be complex due to the wide range of symptoms that may resemble other conditions. The process begins with a thorough review of the child’s medical history and a comprehensive physical examination. Doctors inquire about symptom duration and nature, and any family history of autoimmune diseases.
Specific blood tests are important for diagnosis, including the antinuclear antibody (ANA) test, which detects autoantibodies. While a positive ANA test is common in lupus, it can also appear in healthy children or those with other conditions, so further tests are needed.
Other important blood tests include:
- Anti-double-stranded DNA (anti-dsDNA) antibodies
- Complement levels (C3 and C4)
- A complete blood count (CBC) to check for low levels of red or white blood cells
- Inflammatory markers like erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP)
Urine tests also check for protein or blood, indicating kidney involvement, a common complication. In some instances, imaging studies or biopsies of affected tissues, such as the skin or kidneys, may be necessary to assess organ damage and confirm the diagnosis.
Managing Lupus in Children
Managing lupus in children focuses on controlling inflammation, preventing flare-ups, minimizing organ damage, and alleviating symptoms to support overall well-being. Treatment plans are individualized, tailored to the child’s specific symptoms and condition severity. Medications are a primary component of management and fall into several categories.
Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce pain, swelling, and fever, especially for joint symptoms. Antimalarial drugs, such as hydroxychloroquine, help reduce flare frequency and protect against long-term complications. Corticosteroids manage severe inflammation and organ involvement, with long-term use carefully monitored due to potential side effects. Immunosuppressants calm the overactive immune system for more severe cases or organ involvement.
Regular monitoring through blood and urine tests is important to track disease activity, assess treatment effectiveness, and watch for medication side effects. A multidisciplinary care team, including pediatric rheumatologists, nephrologists, and other specialists, provides comprehensive support for the child’s physical and emotional health.