Autoantibody Profile of Childhood Onset Systemic Lupus Erythematosus: An Audit of Immunopathology Laboratory of a Tertiary Care Centre

Introduction: Systemic Lupus Erythematous (SLE) is an autoimmune disease, which commonly affects females and is associated with formation of various Antinuclear Antibodies (ANA). Childhood onset SLE has some similarities and differences in immunological profile and clinical manifestations from adult onset SLE patients.

Aim: To study the spectrum of clinical manifestation and autoantibody profile of childhood onset SLE patients and to compare with adult SLE patients.

Materials and Methods: This was a retrospective observational study conducted from October 2017 to March 2021 in Department of Immunopathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India. This includes 74 patients of childhood onset SLE and 91 patients of adult SLE. Detailed clinical and laboratory data were collected from medical records. Serum ANA and anti-dsDNA (Deoxyribonucleic Acid) detection was done by solid phase enzyme immunoassay methods. Antibodies to extractable nuclear antigen were detected by dot blot immunoassay. Chi-square test {International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) version 21.0} was used to compare categorical data of childhood onset SLE and adult SLE patient groups.

Results: The mean age of childhood onset SLE patients was 13.05±4.26 years with female:male ratio of 3.93:1. Malar rash (p=0.001) and renal involvement (p=0.021) was significantly more frequent in childhood onset SLE but oral ulcer was significantly more frequent (p=0.038) in adult patients. Anti-ds DNA positivity and reduction in complements C3 and C4 were more commonly seen in childhood onset SLE patients.

Conclusion: Age is an important influence on clinical manifestations and autoantibody profile of SLE. Childhood onset SLE showed more frequent renal and skin involvement and more significant activity measured by reduction of complements. Awareness of the same will help our clinicians to detect renal involvement at an early stage and develop organ specific management protocol.