Clinical Manifestations, Immunological Profile and Short-Term Outcome in Pakistani Pediatric Lupus Patients

Abstract

Background: Childhood-onset systemic lupus erythematosus (cSLE) is a rare but clinically aggressive autoimmune disease with substantial variability in its presentation across different geographic and ethnic populations. Data on pediatric lupus in Pakistan, particularly in outpatient settings, remain limited, hindering timely diagnosis and targeted management strategies. Objective: To evaluate the clinical manifestations, immunological profile, and short-term outcomes in Pakistani pediatric lupus patients managed in specialized rheumatology outpatient clinics. Methods: This retrospective, cross-sectional study analyzed electronic medical records from three tertiary rheumatology centers in Lahore, Pakistan, between November 2021 and August 2024. Patients under 18 years of age meeting ACR/EULAR 2019 SLE classification criteria and followed for at least six months were included. Data on demographics, clinical features, immunological markers, treatment regimens, and disease outcomes were collected. Statistical analyses were performed using SPSS 23, with significance set at p<0.05. Results: A total of 34 patients were included, 85.3% of whom were female, with a mean age of 13.8 ± 2.91 years. Polyarthritis (64.7%) was the most common clinical feature, followed by nephritis and hematological involvement (44.1% each). Anti-dsDNA antibodies were positive in 79.4% of patients. At a mean follow-up of 17.1 ± 11.6 months, 44.1% achieved clinical remission (SLEDAI=0), with minimal serious complications or hospitalizations. Conclusion: Pediatric lupus in Pakistan presents with a distinctive clinical and immunological profile, with favorable short-term outcomes under specialist outpatient care. Early diagnosis and immunologically guided treatment can mitigate disease burden in this high-risk population.