Multisystem Burden of Paediatric Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis of Neuropsychiatric, Renal, Ocular, and Immunological Outcomes.
Mona Atef Alatar, Hesham M Hefny, Ibrahim Fawzy Ezz et al.
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In 30 seconds
This systematic review and random-effects meta-analysis examined observational studies of children with systemic lupus erythematosus (pSLE) and quantified disease activity, assessing associations with multisystem manifestations. Twenty studies involving 4,934 patients were included. Lupus nephritis was the most frequent manifestation (44-76%), followed by neuropsychiatric involvement (16-40%) and ocular findings (5-32%). High disease activity was associated with greater odds of lupus nephritis (OR 3.7, 95% CI 2.8-4.9), neuropsychiatric involvement (OR 2.9, 95% CI 2.2-3.9), and immunological abnormalities (OR 3.4, 95% CI 2.5-4.6).
Key findings
- Lupus nephritis was reported in 44-76% of patients, making it the most frequent manifestation.
- High disease activity was associated with lupus nephritis (OR 3.7, 95% CI 2.8-4.9).
- High disease activity was associated with neuropsychiatric involvement (OR 2.9, 95% CI 2.2-3.9) and immunological abnormalities (OR 3.4, 95% CI 2.5-4.6).
- Subgroup analyses found higher disease burden in Asian and Middle Eastern cohorts.
Why it matters
The findings link higher measured disease activity with important renal, neuropsychiatric, and immunological outcomes in paediatric SLE. This supports attention to multisystem burden when assessing disease activity and underscores the relevance of coordinated monitoring. Differences across regional cohorts also suggest that disease burden may not be uniform across populations.
What to keep in mind
The analysis included observational studies, and heterogeneity was moderate to substantial across outcomes; the reported associations therefore do not establish causation.