English abstract
Objectives: Children with childhood-onset systemic lupus erythematosus (cSLE) enter
adulthood with considerable morbidity. Of the recognized morbidities, growth failure is
unique to cSLE. The aim of this study was to evaluate the growth pattern in children with
cSLE longitudinally and identify possible risk factors. Methods: Serial anthropometric
measurements of cSLE patients were obtained over two years and expressed as z-scores.
Parental heights were obtained to calculate target height. Parent-adjusted height z-score
was calculated as the difference between height z-score and target height. Growth failure
was defined as parent-adjusted height z-score < -1.50. Risk factors that might have
contributed to growth failure were evaluated including the presence of growth failure at
baseline, disease activity, disease duration, and cumulative steroid doses. Results: Twentyfive patients were included in the study. Growth failure was observed in eight patients with
an overall incidence of 32.0% (95% confidence interval (CI): 14–50%). When comparing
the cohort with and without growth failure, the factors that determined growth failure
was the pre-existence of growth failure at the time of diagnosis (z-score < -1.95 vs. 0.35;
p < 0.001); higher cumulative steroid dose (15.8 vs. 9.1 g ; p = 0.061); and tendency for
longer disease duration (5.4 vs. 3.7 years; p = 0.240). However, the severity of disease
activity at the time of diagnosis was not a significant contributing factor (12 vs. 14;
p = 0.529). Conclusions: Children with cSLE are at risk of having a negative effect on
height including patients with pre-existing growth failure, high cumulative steroid dose,
and longer disease duration. However, longitudinal prospective studies are needed to
examine damage over time to improve health-related quality of life
