Access: Lupus Research -- Pediatric Lupus
Research Summaries from 2012
Depression Among Girls With Lupus
Children with lupus often require high-dose steroid therapy and immunosuppressive drugs due to the severity of lupus that they experience. This scenario puts children with lupus at risk for a wide range of physical (including obesity) and psychological side effects since adolescence is marked by an increased sensitivity to concerns about their appearance and even emotional disturbances. The findings of this study indicate that adolescent girls with lupus scored significantly lower on measures of positive body image and felt increases in negative mood, negative self-esteem, and depressive symptoms. The results highlight the degree to which adolescent girls with lupus can be negatively affected, psychologically, by the physical side effects of their lupus treatments.
Academic Performance in Children With Lupus
Lupus in children is associated with decreased quality of life, including significant impairments in academic performance. The specific reasons for this impaired academic performance are not fully understood, but more research is being done in this area. This impaired academic performance may arise due to differences in cognitive, behavioral, and/or emotional functioning, or may be related to more specific factors such as memory. The results of this study highlight the role of increased lupus disease activity, and the possible role of school absenteeism is discussed, in the context of academic performance.
Predictors of Bone Density Changes in Children with Lupus
People with lupus are at increased risk of osteoporosis, the thinning or loss of bone tissue over time. Children with lupus may be especially susceptible to osteoporosis because they are genetically influenced to acquire over 90% of their bone growth by the end of adolescence (during which time, lupus disease-related mechanisms may work to reduce bone growth). Other factors, however, such as physical activity and vitamin D intake are also known to influence bone development in children. The degree to which children reach their genetically-influenced degree of bone growth is largely unknown. The results of this study identify a trajectory of bone growth over time in children newly diagnosed with lupus, and identify specific factors that influence this trajectory.
Reduced Bone Density in Newly Diagnosed Children with Lupus
Sun avoidance, vitamin D deficiency, and steroid treatments are associated with thinning of the bones, or "osteoporosis." Children with lupus may be especially susceptible to osteoporosis because they are often being treated with steroids at a time when most of their initial bone development is still taking place. It would be useful for children with lupus (as well as their family members) to know whether they may be experiencing osteoporosis early on in their disease course due to steroid treatments or other factors. The results of this study highlight risk factors for developing osteoporosis, as well as the relative importance of lupus disease mechanisms and steroid treatments in the likelihood of a child newly diagnosed with lupus developing osteoporosis.
First Ever Study of Cholesterol-Lowering Drugs in Children With Lupus
Adults with lupus are at increased risk for developing cardiovascular disease as compared to the general population. Increased levels of blood cholesterol can result in atherosclerosis, or hardening of the arteries, which is itself a risk factor for cardiovascular disease. Previous studies indicate that subclinical atherosclerosis may be present in children with lupus. Since atherosclerosis is now known to begin in childhood, even in healthy people, the risk of developing atherosclerosis and cardiovascular disease has become a growing concern for the health of children with lupus. This study examined the safety and efficacy of atorvastatin (Lipitor®), a cholesterol-lowering drug, in children with lupus over a three-year period. The results suggest that lipid-lowering drugs like atorvastatin can safely and effectively reduce cholesterol levels in children with lupus. However, the effects of this treatment regimen do not warrant administration of lipid-lowering drugs to all children with lupus and future studies may indicate specific subpopulations that could benefit most.
Research Summaries from 2011
Reduced Growth and Delayed Puberty in Children with Lupus
Children with lupus often face unique challenges because their disease can be more severe and may require more aggressive treatments. Lupus or its treatments may have lasting biological effects. However, little is known about growth and development in children with lupus. The researchers examined possible impairments in growth, such as height, among children with lupus of varying ages and also depending on how long they have had lupus. Possible effects of steroid treatments on height were also specifically examined.
New Blood Tests May Improve the Tracking of Lupus Kidney Disease in Children
Current treatments for lupus nephritis in children are toxic and sometimes ineffective. New tests for proteins that might be abnormal in lupus nephritis could help make the diagnosis earlier (when treatments have a better chance to work more quickly) and might also point to new ways of treating the disease (possibly with fewer side effects). In this study, the researchers hoped to find new tests for lupus nephritis in children.
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New Combination of Antibodies May Better Predict Childhood Neuropsychiatric Lupus
Neuropsychiatric lupus (NPSLE) is difficult to diagnose and can be present when disease activity in other organs cannot be identified. The researchers hoped to learn whether antibodies to ganglioside M1, a fat found throughout the brain, could predict childhood NPSLE any better than standard laboratory measures currently in use. At the time of initial evaluation (and before NPSLE developed), 83% and 50% of children who later developed NPSLE had anti-ganglioside M1 and anti-ribosomal P antibodies, respectively. None of the 18 patients who did not develop NPSLE had either one of these antibodies. This study suggests that anti-ganglioside M1 antibodies might help to predict NPSLE in children with lupus, especially when paired with anti-ribosomal P antibodies.
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Research Summaries from 2010
Earlier Steroid Treatment In Pediatric Lupus Patients Is Related to Higher Risk of Bone Disease
Steroids are frequently used to treat moderate-to-severe lupus flares because they are highly effective and work quickly. However, steroids have many serious side effects, including potentially severe damage to joints or “osteonecrosis,” which is an interruption of the blood supply to the bone. The researchers hoped to learn whether starting steroids at a younger age is a risk factor for osteonecrosis. The results of this study suggest the possibility that steroids might contribute to a serious bone complication in some children with lupus.
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Potential New Indicators of Lupus Being Studied in Children
Since the 1970s, researchers have known that lupus patients are at risk for hardening of the arteries (“atherosclerosis”). Some of this risk may be from the increased inflammation that lupus patients have in the bloodstream over many years, but some of it is from the same reasons that hold true for everybody: especially high blood pressure, high blood glucose (sugar), or low levels of "good cholesterol."
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Research Summaries from 2008
More Promising News About Tacrolimus
Tacrolimus is an immunosuppressant drug that helps control inflammation. It was originally developed and approved to help prevent rejection of the new organ in transplant patients, but in recent years tacrolimus has been used to treat adults with lupus or rheumatoid arthritis. The researchers wanted to know if tacrolimus could be used safely to control lupus nephritis in pediatric-onset lupus patients with long-standing disease.
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Research Summaries from 2007
As Teenage Girls with Lupus Mature
Women with lupus may have problems with their menstrual cycle. Early menopause is often the result of treatments for lupus, in particular cyclophosphamide (CYC). This study wanted to see if adolescent females with juvenile lupus were also at risk for these kinds of problems. This research study confirms some earlier studies which suggest that cyclophosphamide is less likely to put younger patients into menopause than older women.
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As Teenage Girls with Lupus Mature #2
There is some research showing that adult women with lupus are at greater risk for abnormalities of the cervix. The researchers for this study wanted to see if this risk also applied to adolescent lupus patients. There was no difference in the number of abnormal PAP smears among the two groups, those with or without lupus; fifty percent of each group had normal results. However, within the group of patients who had lupus, those who had more lupus disease activity were twice as likely to have inflammatory changes in their cervix.
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Concensus Developed on Definition of Improvement in Juvenile Lupus
Thirty-seven pediatric rheumatologists from 27 countries studied information about 128 children with lupus and came to an agreement about whether each child was clinically improved or not improved after treatment. The goal of this was to develop precise definitions of improvement for childhood lupus that can be used in clinical trials and to help doctors better evaluate their patients in clinic.
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