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Disease outcomes and ovarian function of childhood-onset systemic lupus erythematosusDivision of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA, Division of Clinical Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA, hermine.brunner{at}cchmc.org
Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Division of Immunology, University of Cincinnati Medical Center, Cincinnati, OH, USA
Division of Immunology, University of Cincinnati Medical Center, Cincinnati, OH, USA
Division of Immunology, University of Cincinnati Medical Center, Cincinnati, OH, USA
Division of Immunology, University of Cincinnati Medical Center, Cincinnati, OH, USA
Division of Immunology, University of Cincinnati Medical Center, Cincinnati, OH, USA
Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA The objective of this study was to determine the medical outcomes including the ovarian function childhood-onset SLE (cSLE). The medical records of all patients diagnosed with cSLE in the Greater Cincinnati area between 1981 and 2002 were reviewed. Patient interviews were performed to obtain additional information on current medication regimens, disease activity [SLE Disease Activity Index (SLEDAI-2k)], and damage [Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI)]. The occurence of premature ovarian failure (POF) and reduction of the ovarian reserve was assessed by timed gonadotropin levels. There were 77 patients (F: M = 70: 7, 53% Caucasian, 45% African-American and 2% Asian) with a mean age at diagnosis of 14.6 years. Nine patients died (88.3% survival) during the mean follow-up of 7.1 years (standard deviation [SD] 5.6) and 88% of the patients continued to have active disease (SLEDAI-2k mean/SD: 6.6/6.7), with 42% of them having disease damage (SDI mean/SD: 1.62/2.1); Non-Caucasian patients had higher disease activity (mean SLEDAI-2k: 10 versus 3.4; P < 0.0001) and more disease damage (mean SDI: 2.1 versus 1.2; P < 0.02) than Caucasian patients. Cyclophosphamide was given to 47% of the patients during the course of their disease and associated with the presence of significantly reduced ovarian reserve (RR = 2.8; 95% CI: 1.7-4.8; P = 0.026). Patient mortality and disease damage with cSLE continue to be high. Although overt POF with cyclophosphamide exposure is rare, it is a risk factor for significantly decreased ovarian reserve cSLE.
Key Words: children • cyclophsophamide • damage • gonadal function • POF • prognosis • SLE
Lupus, Vol. 15, No. 4,
198-206 (2006) This article has been cited by other articles:
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