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Unformatted text preview: Making the diagnosis of systemic lupus erythematosus in children and adolescents LB Tucker* Division of Pediatric Rheumatology, Centre for Community Child Health Research, British Columbia’s Children’s Hospital, Vancouver, BC, Canada Approximately 15% of patients with systemic lupus erythematosus (SLE) will have the onset of their disease in childhood or adolescence. Due to the broad range of possible clinical features of SLE, the diagnosis may be difficult to make in a general pediatric or community setting. The common symptoms of SLE in children and adolescents include fever, fatigue, weight loss, arthritis, rash and renal disease. SLE is more common in non-Caucasian ethnic groups and should be considered in the differential diagnosis of a multisystem disease in these patients. In this article, the classification criteria for SLE are discussed, and an approach to making an accurate and timely diagnosis of this disease is considered. Lupus (2007) 16 , 546–549. Key words: diagnosis; pediatric; systemic lupus erythematosus Lupus (2007) 16, 546–549 http://lup.sagepub.com © 2007 SAGE Publications, Los Angeles, London, New Delhi and Singapore 10.1177/0961203307078068 REVIEW Introduction Systemic lupus erythematosus (SLE) is a severe, chronic autoimmune disease, which results in inflam- mation and eventual damage in a broad range of organ systems. SLE is a relatively rare disease in childhood, with estimated incidence ranging from 10 to 20 per 100 000 children, depending on the ethnic population. 1 Approximately 15% of individuals with SLE will have the onset of their disease prior to the age of 18 years; children and adolescents generally have a more severe disease presentation, develop disease damage more quickly than adults with SLE and have a higher overall burden of disease over their lifetimes. 2–4 Early and accurate diagnosis of SLE in children and adolescents is crucial for initiating treatment to prevent damage. In this article, the standard methods for diagnosis of SLE will be reviewed, and important aspects of diagnosis relating to children and adolescents will be considered. Case Jane is a 16-year-old Chinese Canadian adolescent, referred to the Pediatric Rheumatology Clinic by an ophthalmologist for ‘SLE’. This patient first developed disabling headaches, fatigue, weight loss and intermittent fevers one year prior to the consultation. She had been evaluated by a family doctor on multiple occasions for these complaints. Laboratory screening had shown anemia and a mildly decreased white blood cell count. A variety of treatments for the headaches had been tried; the symptoms were so distressing that the girl missed sig- nificant amounts of school and her grades began to drop....
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