Understanding Lupus in Children: Symptoms, Treatments, and Outlook

Understanding Lupus in Children

Lupus is an autoimmune disease that can affect both adults and children. But when lupus strikes in childhood, it presents unique challenges for patients and their families. Here's what parents need to know about lupus in children including the symptoms, diagnosis, treatments, and prognosis.

What is Childhood Lupus?

Childhood lupus technically refers to systemic lupus erythematosus (SLE) diagnosed in children under 18 years old. It's the same chronic autoimmune disease as adult lupus, but with some key differences.

In lupus, the immune system mistakenly attacks the body's own healthy tissues leading to widespread inflammation and organ damage. Both genetics and environmental factors contribute to lupus risk.

Types of Childhood Lupus

There are several different types of lupus that can occur in children:

• Systemic lupus erythematosus (SLE) - The most common and serious type that can affect any part of the body.
• Cutaneous lupus - Causes skin rashes when exposed to sunlight.
• Drug-induced lupus - Triggered temporarily by certain medications.
• Neonatal lupus - Rare condition acquired from mothers with lupus antibodies.

Around 15-20% of all lupus cases are diagnosed in childhood, most often between ages 10-15. Childhood lupus occurs more frequently in females than males.

Childhood Lupus Symptoms

Lupus symptoms in children can vary significantly but often include:

• Fatigue
• Joint pain or swelling
• Rash on the cheeks
• Fever
• Chest pain
• Hair loss
• Sensitivity to sunlight
• Raynaud's phenomenon (fingers turning white or blue in the cold)
• Mouth or nose sores

Sometimes symptoms are misdiagnosed as Juvenile Rheumatoid Arthritis or other conditions. Blood tests are needed to confirm lupus.

Complications of Pediatric Lupus

Without proper treatment, lupus in children can lead to potentially serious complications such as:

• Kidney disease - Up to 80% of pediatric lupus patients develop lupus nephritis, inflammation of the kidneys.
• Blood disorders - Anemia, leukopenia (low white blood cells) or thrombocytopenia (low platelets).
• Central nervous system problems - Headaches, cognitive dysfunction, mood disorders, seizures.
• Heart disease - Inflammation of heart tissue or coronary arteries.
• Lung disease - Pleurisy, pneumonitis, pulmonary hypertension.

That's why early diagnosis and treatment is critical for children with lupus to prevent permanent organ damage over time.

Diagnosing Lupus in Children

Diagnosing lupus in kids can be challenging because early symptoms are vague and mimic other conditions. There's no single test to definitively confirm lupus.

Medical History

A pediatric rheumatologist will start by taking a complete medical history, asking about when symptoms started, family history of autoimmune disease, recent infections, medications, etc.

Physical Exam

During the physical exam, the doctor looks for signs of lupus such as rashes, swollen joints, mouth ulcers, hair loss, or pale fingers.

Blood and Urine Tests

Certain blood and urine tests support a lupus diagnosis. These include:

• Antinuclear antibody (ANA) test - Positive in almost all lupus patients.
• Anti-double-stranded DNA - More specific to lupus.
• Complete blood count - Checks for anemia or low white blood cells.
• Kidney function tests - Assesses for protein or blood in the urine.
• Complement levels - Low in active lupus.
• Erythrocyte sedimentation rate (ESR) - High if inflammation present.

Other Tests

If certain organs are affected, additional tests may be done such as:

• Kidney biopsy - Confirms lupus nephritis.
• Echocardiogram - Evaluates for heart abnormalities.
• Pulmonary function tests - Checks lung function.

Diagnostic Criteria

To diagnose childhood lupus, a pediatric rheumatologist looks for at least 4 out of 11 common criteria from the American College of Rheumatology such as:

• Malar rash
• Discoid rash
• Photosensitivity
• Oral ulcers
• Nonerosive arthritis
• Pleuritis or pericarditis
• Kidney disorder
• Neurologic disorder
• Blood disorder
• Immunologic disorder
• Positive ANA

The presence of these criteria classifies the diagnosis as systemic lupus erythematosus.

Treatment for Lupus in Children

While there is no cure for lupus, getting on the right medications early is crucial to prevent complications. Treatment plans are tailored to each child's specific condition and symptoms.

NSAIDs and Antimalarials

Non-steroidal anti-inflammatory drugs like ibuprofen help reduce pain, swelling, and fever. Antimalarials such as hydroxychloroquine protect against lupus flares.

Immunosuppressants

Drugs that suppress an overactive immune system are often used to treat more severe lupus. These include azathioprine, mycophenolate mofetil, cyclosporine, and methotrexate.

Corticosteroids

Steroid medications like prednisone control inflammation caused by lupus. But long-term use can lead to side effects.

Biologic Drugs

Newer biologic agents like belimumab (Benlysta) block autoantibody activity linked to lupus. Rituximab targets certain immune cells.

Plasmapheresis

This blood filtering technique removes autoantibodies from the blood. Its used if lupus is rapidly damaging vital organs.

Treatment plans are constantly adjusted based on any disease flares and side effects.

Lupus Nephritis Treatment

Lupus nephritis requires more aggressive immunosuppressant therapy, often a combination of cyclophosphamide and corticosteroids. This helps avoid end-stage renal disease requiring dialysis or kidney transplant.

Alternative Therapies

Some complementary therapies like stress reduction, fish oil, and turmeric may help reduce lupus symptoms. But more evidence is needed on their efficacy and safety.

Living with Childhood Lupus

Coping with childhood lupus can be challenging for the entire family. Ongoing care and lifestyle adjustments help children manage this chronic disease.

Monitoring Disease Activity

Routine checkups allow the doctor to assess disease status using blood work, urinalysis, vital signs, and symptoms. Catching flares early helps prevent complications.

Avoiding Triggers

Sunlight, infections, stress, certain drugs, hormones, and exhaustion can all trigger lupus flares. Identifying and reducing personal triggers helps stabilize the condition.

Managing Medications

Taking medications on schedule, keeping track of side effects, and getting periodic lab tests helps ensure treatment stays on track.

Physical & Mental Health

Gentle exercise, nutritious foods, rest, social interaction, and therapy support childrens overall health and resilience.

School Accommodations

Adjustments to help students like reduced hours, tutoring, and exemptions from outdoor activities allow kids to excel in school.

Outlook for Pediatric Lupus Patients

Thanks to medical advancements over the past decades, most children with lupus today can live fairly normal lives with proper care. Survival rates continue to improve.

Life Expectancy

In the 1950s, only around 50% of children with lupus lived past age 16. Now over 80-90% survive into adulthood. With close monitoring and preventative care, normal life expectancy is possible.

Remission

Many pediatric lupus patients experience periods of remission when symptoms disappear completely. About 20-30% may eventually achieve permanent remission later in life.

Relapses

Flare ups of symptoms are common but can be minimized by avoiding triggers, sticking to treatment, and working closely with the medical team.

Long-Term Outlook

Children diagnosed today can expect to live long, fulfilling lives. Remaining compliant with medications and preventive care is key to the most optimal long-term prognosis.

Supporting Your Child with Lupus

Learning your child has lupus impacts the whole family. Here are some tips for providing support.

Educate Yourself

Read up on childhood lupus so you understand what your child is going through. Knowledge is empowering.

Communicate Openly

Have honest age-appropriate conversations about your childs diagnosis, treatment plan, and emotions surrounding lupus.

Encourage Independence

As much as feels safe, allow your child autonomy in managing their disease. This promotes confidence and responsibility.

Limit Special Treatment

While accommodations are needed, be wary of overprotecting your child. Encourage them to enjoy normal activities when possible.

Connect with Other Families

Support groups allow kids with lupus to feel less alone. Parents can exchange practical advice.

Enlist a Psychologist

A therapist can help your child cope with difficult emotions and self-esteem issues related to living with lupus.

Plan for Transitions

Prepare older kids for the transition to managing lupus more independently as adults.

Stay Hopeful

Focus on the positive and celebrate every small triumph. With your support, your childs future is bright.

The Takeaway

Childhood lupus poses unique challenges but medical science has come a long way in improving prognosis. While constant vigilance is needed, most children today can live happy and relatively healthy lives in spite of lupus, especially with a strong support system.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.