Is lupus the same in children and adults?
At one time lupus was thought to be more severe in children than in adults, but most physicians no longer believe this. However, children diagnosed with lupus often have been ill for a longer period before the diagnosis is made, and therefore are more likely to have significant internal organ involvement than most adults with lupus. This is because many children are not recognized as having early lupus until the disease has become worse. As a result children with lupus often are required to begin aggressive therapy soon after diagnosis.
The first step for every family is to be sure the diagnosis is correct. Lupus is a highly variable disease. Some children have obvious disease symptoms with fever, rash, and kidney involvement. Others may complain of not feeling well, or of being tired orachey.Some children may look fine, but may have blood in their urine or other unseen problems that lead their physicians to make the diagnosis of lupus. Although a positive ANA is generally required to make the diagnosis, there are many children with positive ANAs who do not have lupus.
Most physicians rely on the American College of Rheumatology criteria for the diagnosis of definite lupus. It is important to be aware of these. However, some physicians assume anyone who does not fulfill four of the criteria could not have lupus. Especially in children, it is important to remember that more problems may develop over time.
Once the diagnosis is established parents are immediately concerned about what will happen to their child. While lupus can be a severe and life-threatening disease, many children with lupus will do very well. The prognosis of lupus in childhood depends on the severity of the internal organ involvement. Children with significant kidney or other internal organ disease require aggressive treatment. Children with mild rash and arthritis may be easily controlled. However, lupus is unpredictable and no one will be able to predict with certainty the long-term outcome for a specific child. Success in every endeavor is a combination of hard work and good luck. None of us can control good luck. This pamphlet is intended to help you get the best outcome for your child by explaining to you the importance and nature of the hard work.