Diagnosis and management of systemic lupus erythematosus in children

Systemic lupus erythematosus in children is uncommon, but not rare. It should be considered in any child (particularly an older child) who has been unwell for more than 1 week with multisystem clinical features without a diagnosis. The most common presentation is a febrile child with fatigue, an erythematosus malar rash and arthritis. Leukopenia, thrombocytopenia and a raised ESR is suggestive, as is a urinalysis indicative of nephritis. The presence of anti-DNA antibodies confirms the diagnosis, but its absence does not exclude this possibility.Although a life-long and serious disease with a high morbidity and substantial mortality, the prognosis has dramatically improved recently, largely because of the aggressive use of high-dose corticosteroids at onset and with disease flares, combined with other potent anti-inflammatory agents. The early empirical use of antibiotics for possible sepsis is essential. Early referral and frequent follow-up by a team specialized in the management of the condition has probably been critical in improving outcome.