Different Clinical Features in Children with SLE

Children with lupus present with diverse and often severe manifestations. Children most frequently present with fever, fatigue, hematologic abnormalities, arthralgia or arthritis, rash, and renal disease. Symptoms may be intermittent or persistent.

Cutaneous manifestations are frequently present. The characteristic malar or butterfly rash involves the cheeks and nasal bridge and varies from an erythematous blush to thickened epidermis to scaly patches . Rashes may be photosensitive and extend to all sun-exposed areas.

Mucous membrane changes ranging from vasculitic erythema to ulcers occur, particularly on palatal and nasal mucosa.

Musculoskeletal findings include arthralgia, arthritis, tendinitis, and myositis. Deforming arthritis is unusual, although hand arthritis can lead to ligament damage and severely lax joints.

Serositis can affect pleural, pericardial, and peritoneal surfaces. Hepatosplenomegaly and lymphadenopathy are often found. Other gastrointestinal manifestations, most often resulting from vasculitis, include pain, diarrhea, melena, infarction, inflammatory bowel disease, and hepatitis.

Cardiac involvement may affect all cardiac tissues with manifestations that include valvular thickening and verrucous endocarditis (Libman-Sacks disease), cardiomegaly, myocarditis, conduction abnormalities, heart failure, and coronary artery vasculitis and thrombosis.

Neurologic manifestations involve both the central and peripheral nervous system. Many patients with lupus experience memory loss or other cognitive dysfunction in their disease course. Neuropsychiatric manifestations can be severe, and patients may fulfill diagnostic criteria for psychosis.

Renal disease is manifest by hypertension, peripheral edema, retinal vascular changes, and other clinical manifestations associated with electrolyte abnormalities, nephrosis, or acute renal failure.