Follow up and Management of Serologically Active Clinically Quiescent Cases in Pediatric Systemic Lupus Erythematosus

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Submission ID :
ESPR395
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Abstract: :

Background: Systemic Lupus Erythematous (SLE) is a chronic autoimmune disease characterized by a variety of clinical manifestations and serologic changes, classically following an undulating course of activity and quiescence, often resulting in multisystem organ damage. In 1979 Gladman et al identified a subset of adult SLE patients who presented with serologic abnormalities in the absence of clinical symptoms. There is ongoing research regarding the efficacy of treatment for these serologically active and clinically quiescent (SACQ) patients. This patient population requires a tailored approach to management because treatment protocols should depend on the existence of pathological consequences to the SACQ episodes. These considerations are especially pertinent in patients with pediatric-onset SLE. Pediatric-onset SLE patients have a greater risk for renal, central nervous system (CNS), and hematologic manifestations, as well as more organ damage. 

Objective: We sought to identify the presence of serologically active clinically quiescent (SACQ) episodes in pediatric Systemic Lupus Erythematosus (SLE) patients. We looked at serologic biomarkers associated with SACQ episodes and discuss risks and benefits of escalating treatments.

Methods: We evaluated 25 pediatric SLE patients, 13 of whom experienced SACQ episodes. SACQ was defined as two consecutive clinic visits without any clinical symptoms or clinical exam findings of a lupus flare, but either elevated anti-dsDNA antibodies and/or low complement (C3 or C4) levels. 

Results: Among the 13 patients who experienced a SACQ episode, there were a total of 24 episodes, with each patient experiencing 1-4 SACQ episodes. ESR (erythrocyte sedimentation rate) was the most commonly elevated laboratory marker in a SACQ episode, followed by low hemoglobin levels, and then elevated anti-dsDNA antibodies. Of the 17 episodes treated during a SACQ episode, 15 (88%) did not progress to a clinical flare within six months, while two did. Furthermore, of the 7 patients who were not treated during their SACQ episode, 2 (29%) continued to be SACQ without flare, whereas 5 led to a clinical flare within six months. 

Conclusion: SACQ episodes were identified in pediatric SLE patients, suggesting that the presence of SACQ is not limited to adults with SLE. Serologic markers such as increased ESR, hemoglobin, and elevated anti-dsDNA antibodies are preliminarily associated with pediatric SACQ episodes. Treating these SACQ episodes in pediatric SLE patients was less likely to lead to a clinical flare within six months when compared to not treating (P<0.05). More research with a larger sample size is needed to define SACQ episodes, determine the prevalence in pediatric SLE patients, and establish SACQ treatment guidelines. 



Jacobs School of Medicine and Biomedical Sciences
Jacobs School of Medicine and Biomedical Sciences
Oishei Children's Hospital
Oishei Children's Hospital
Oishei Children's Hospital
Oishei Children's Hospital
Oishei Children's Hospital

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