Pediatric systemic lupus erythematosus in Thammasat University Hospital.

Systemic lupus erythematosus (SLE) is a common autoimmune disease in children. Current standard therapies carry high adverse effects. Refractory SLE to conventional therapies is not uncommon. Rituximab, anti-CD20 monoclonal antibody, has been used as an adjunctive therapy in children with refractory SLE with limited reports. This study described pediatric SLE patients in a single center, Thailand. To determine the clinical manifestations, treatments, and outcome of SLE patients, the authors retrospectively studied 19 patients (age <15 years) diagnosed with SLE at Thammasat University hospital, from January 01, 2002 through March 31, 2010. The mean age was 12.9 +/- 1.6 years; mean follow-up 3.3 +/- 2.6 years. Seventeen (89.5%) patients were female. Clinical manifestations were hematological (89.5%), dermatologic (73.7%), and renal involvement (68.4%). SLE was diagnosed 1 year after systemic onset juvenile rheumatoid arthiris in one patient. Lupus nephritis (LN) class II was observed in 30.8%, class III (15.4%), and class IV (53.8%) of patients with LN. Overall, mean SLEDAI score at presentation was 14.9 +/- 2.2 and significantly decreased to 6.8 +/- 1.6 (p < 0.0001) at 1 month after treatment. Complete remission at 1 year demonstrated in 11 (68.7%) patients. Infection was the most common complication followed by ophthalmological complications. All patients survived during follow-up period. Rituximab induced remission of SLE after refractory diffuse alveolar hemorrhage in one patient, and rapidly progressive glomerulonephirits leading to end stage renal failure in one patient. Clinical outcome of pediatric SLE was favorable in the present study. Complications from corticosteroid and anti-inflammatory therapy were high. Rituximab may be a good adjunctive therapy for refractory SLE in children. Large controlled trials to establish safety profile and optimal regimen of rituximab in childhood SLE are required.