Roughly 40% of children and adolescents with systemic lupus erythematosus (SLE) experience at least mild physical disability, a study shows.
The study, published in Lupus, also revealed that those with lower household income, arthritis, and higher pain scores were significantly more likely to have reduced physical function.
Titled “Predictors of disability in a childhood-onset systemic lupus erythematosus cohort: results from the CARRA Legacy Registry,” the research highlights the need to address clinical factors like pain and arthritis to improve physical outcomes in these patients.
Patients with childhood-onset SLE (cSLE) usually have more severe disease than adult patients because of a higher frequency of renal and neuropsychiatric involvement. The physical burden of the disease may manifest as an increased physical disability, in addition to a reduced health-related quality of life.
Disability in adult lupus patients is associated with sociodemographic factors, coexisting diseases, and certain clinical symptoms of the disease, including pain and fatigue. But little is known about the prevalence and contributing factors for disability among children and adolescents with lupus.
“Our identification of predictors of disability in a large cohort of cSLE patient offers important insights into this population and may help direct strategies around improving functional outcomes,” the researchers said.
The team analyzed clinical and demographic records of 939 cSLE patients in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Legacy Registry between May 2010 and October 2014. The registry included patients across 65 pediatric rheumatology centers in the United States and Canada, who were diagnosed with SLE before age 18.
All participants were asked to respond to the Childhood Health Assessment Questionnaire (CHAQ), which was used to assess disability and physical functioning. Disability was defined as a score higher than zero.
About 93% of patients classified their quality of life as ‘‘excellent, very good, or good,’’ with mean pain scores of 2.4 and median CHAQ score of zero (on a scale of 0-3). However, 41% of patients had at least mild disability.
Patients who had arthritis in the six months prior to registry enrollment reported higher pain scores, and were 1.58 times more likely to have disability than those without arthritis. Higher pain scores were linked to a 1.48 times higher risk for disability.
“Pain may be an important modifiable factor to address in children with cSLE” in order to reduce “disease burden and disability,” the researchers said.
“Optimal disease control, ensuring psychosocial supports and addressing pain may reduce disability in cSLE,” they concluded.