Diagnosing lupus in children

Lupus Foundation of America

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Lupus is a highly variable disease. Some children have obvious lupus symptoms with fever, rash, and kidney involvement. Others may only complain of not feeling well, or of being tired or achy. Some children look fine, but have blood in their urine or other unseen problems that lead their physicians to make the diagnosis of lupus.

Although a positive antinuclear antibodies (ANA) lab result is generally required to make the diagnosis, there are many children with positive ANAs who do not have lupus. Most physicians rely on the American College of Rheumatology criteria for the diagnosis of definite lupus in children, so it is important to be aware of these. However, some physicians assume anyone who does not fulfill four or more of these criteria could not have lupus. Especially in children, it is important to remember that more problems may develop over time. 

Given these complications, the first step for every family is to be sure the diagnosis is correct. 

Once the diagnosis is established, parents are understandably immediately concerned about what will happen to their child. While lupus can be a severe and life-threatening disease, many children with lupus will do very well. 

The prognosis of lupus in childhood depends on the severity of the internal organ involvement. 

Lupus in children is the same disease as lupus in adults; however, children diagnosed with lupus often have been ill for a longer period before the diagnosis is made. Because they often have been ill longer before their lupus was recognized, children with lupus are more likely to have significant internal organ involvement when the diagnosis is made.

Children with significant kidney or other internal organ disease require aggressive treatment. Whereas, the disease in children with just mild rash and arthritis may be easily controlled. However, because lupus is unpredictable, your physician will not able to predict with absolute certainty what the long-term outcome is for a specific child.

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