Pediatric Lupus

What is pediatric lupus?

Pediatric lupus is a chronic autoimmune disorder, which means the body's immune system mistakenly attacks its own healthy cells and tissues. This can cause inflammation and damage to various parts of the body, including vital organs like the kidneys, heart, lungs and brain. Lupus can also affect the skin, joints and blood. Lupus is characterized by periods of symptom flare-ups and periods without symptoms.

The most common type of lupus in children and adults is systemic lupus erythematosus (SLE). It can range from mild to severe, but children are typically affected more severely than adults. Children are more likely to have lupus affect their vital organs and may develop damage more quickly.

What are the signs and symptoms of pediatric lupus?

Lupus can be difficult to diagnose due to the wide range of symptoms that vary from person to person. Additionally, symptoms may come and go and can mimic those of other conditions. For this reason, a pediatric rheumatologist is often needed to diagnose pediatric lupus.

Diagnosing lupus can be challenging because its symptoms vary widely between individuals and can resemble those of other conditions. Additionally, symptoms may appear intermittently. As a result, a pediatric rheumatologist is often required to diagnose pediatric lupus. This process typically involves a multidisciplinary approach, where the nephrology and rheumatology teams collaborate to diagnose and treat the condition accurately. Their expertise is particularly crucial in managing vasculitis and systemic lupus erythematosus (SLE) in children.

Symptoms of lupus can include:

• Skin rashes, specifically a malar rash, which is a butterfly-shaped rash across the nose and cheeks; a discoid rash, which is a raised rash found on the head, arms, chest or back; and rashes caused by sun exposure
• Fatigue
• Loss of appetite
• Weight loss
• Joint pain, stiffness or swelling
• Muscle aches
• Fever
• Hair loss
• Mouth ulcers
• Swollen lymph nodes
• Raynaud’s phenomenon, a condition that can cause the fingers to turn blue or white in response to cold or stress
• Fluid around the lungs, heart or other organs
• Low levels of red blood cells, white blood cells or platelets
• Kidney problems, such as dark urine or swelling around the feet, legs and eyelids
• Neurological problems, such as seizures or memory problems

What causes pediatric lupus?

Experts do not know the exact cause of pediatric lupus. They believe it is caused by a combination of genetic and environmental factors.

How is pediatric lupus treated?

There is no cure for pediatric lupus. Treatment focuses on managing symptoms and preventing your child's immune system from attacking vital organs. Your team at Arkansas Children's is experienced in pediatric lupus and will work with you to come up with the best treatment plan for your child.

There are two main types of medicines used to treat pediatric lupus: immunosuppressants and nonimmunosuppressants.

Immunosuppressants work to suppress the immune system and bring it under control. Those used to treat pediatric lupus include:

• Corticosteroids, which suppress the entire immune system to manage inflammation
• Steroid-sparing therapies such as methotrexate, azathioprine, and mycophenolate mofetil
• Biologic medications (such as rituximab, tocilizumab, or belimumab) to target specific parts of the immune system
• Cytotoxins, such as cyclophosphamide, which attack rapidly dividing cells in the overactive immune system

Nonimmunosupressants are milder medicines that are used to treat inflammation and ease symptoms, such as hydroxychloroquine and nonsteroidal anti-inflammatory drugs (NSAIDs). They typically have fewer side effects than immunosuppressants.

Additional treatment of pediatric lupus can include:

• Limiting sun exposure and using sunscreen
• Getting at least 8-10 hours of sleep at night and rest throughout the day when needed
• Eating a well-balanced diet
• Reducing stress and getting enough exercise