DEVELOPMENT OF IRREVERSIBLE CHANGES IN ORGANS AND SYSTEMS IN CHILDREN WITH SYSTEMIC LUPUS ERYTHEMATOSUS
Summary. The aim of the study was to determine the frequency and character of irreversible changes (damage index) in children with systemic lupus erythematosus (SLE) depending on the duration of the disease, the type of the course and the activity of the pathologic process. Materials and methods. 53 patients with SLE at the age of 7–18 years and with disease duration of more than one year were examined twice with an interval of 12 months. Changes in the cardiovascular system (using ECG, ultrasound, 6-minute walk test), kidneys (in terms of glomerular filtration rate, serum creatinine concentration, proteinuria level and range of daily changes in urine specific gravity) and pulmonary system (according to X-ray and spirometry data) were determined. We studied the presence of pathology of the organ of vision, the nervous system (assessment of the neurological status, conduction, sensitivity of the cranial and peripheral nerves, EEG, MRI of the brain, the use of the Montgomery-Asberg scale), changes in the musculoskeletal system (according to X-ray, ultrasound, MRI studies of joints and bone densitometry). We researched the lipid spectrum of the patients’ blood (total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, VLDL cholesterol, atherogenic index). Results. In 52.83% of children and adolescents with SLE potentially irreversible organs’ damage was found, among which lesions of the nervous system dominate during the initial examination, and eye lesions and growth retardation are added with a second examination, that is a feature inherent in SLE with juvenile debut. The accumulation of irreversible organ damage occurs with an increase in the duration of the disease and is associated with persistent activity of the lupus and long-term cytostatic therapy, which was confirmed by the corresponding correlations. Conclusions. The findings indicate the advisability of using the Pediatric Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (Pediatric Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index) pediatric index for an objective assessment of the severity of the disease, clarifying the prognosis, nature and degree of damage organs and systems, which will allow timely correction of therapy.
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