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Systemic lupus erythematosus (SLE) in children: Treatment, complications, and prognosis

Thomas JA Lehman, MD
Section Editor
Marisa Klein-Gitelman, MD, MPH
Deputy Editor
Elizabeth TePas, MD, MS


Systemic lupus erythematosus (SLE) is a chronic inflammatory disease of unknown cause that can affect the skin, joints, kidneys, lungs, nervous system, serous membranes, and/or other organs of the body. SLE in children is fundamentally the same disease as in adults, with similar etiology, pathogenesis, clinical manifestations, and laboratory findings. However, the care of children and adolescents with SLE is different from that of adults because of the impact of the disease and its therapy on physical and psychologic growth and development. (See "Overview of the clinical manifestations of systemic lupus erythematosus in adults".)

The treatment, complications, and prognosis of SLE in children are reviewed here. The epidemiology, clinical features, diagnosis, and classification of SLE in children are discussed separately. (See "Systemic lupus erythematosus (SLE) in children: Clinical manifestations and diagnosis".)


The goals of therapy for patients with SLE are to ensure long-term survival, achieve the lowest possible disease activity, prevent organ damage, minimize drug toxicity, improve quality of life, and educate patients and their families about their role in disease management [1,2].

Treatment of SLE is individualized based upon patient preferences, disease activity and severity, and comorbidities [3,4]. Patients require monitoring at regular intervals by a rheumatologist to optimize both nonpharmacologic and pharmacologic therapies and achieve treatment goals. Patients often have multiorgan system involvement and may require multidisciplinary care. Assessment of disease activity and severity and nonpharmacologic interventions are reviewed in detail separately. (See "Overview of the management and prognosis of systemic lupus erythematosus in adults", section on 'Assessment of disease activity and severity' and "Overview of the management and prognosis of systemic lupus erythematosus in adults", section on 'Nonpharmacologic and preventive interventions'.)

Clinicians caring for children must be especially conscious of the effects of medications, such as glucocorticoids, on growth and physical appearance in children and adolescents. The unique problems related to growth and development effect both the need for and the impact of aggressive therapy [5-7]. Failure of therapy of childhood SLE frequently results from efforts to care for a child or adolescent with a complex and chronic disease without considering the special needs of the growing individual and his or her family. As a result, clinicians who are unprepared to deal with these needs should refer these patients to a pediatric rheumatology center. (See 'General considerations' below.)

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Literature review current through: Nov 2017. | This topic last updated: Nov 29, 2017.
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