Key result
Children with a history of neonatal lupus developed definite rheumatic or autoimmune diseases more frequently than their unaffected siblings (12.2% vs 0%).
Why the study?
Do children with neonatal lupus or their unaffected siblings have an increased risk of developing autoantibodies or rheumatic diseases later in life?
Cohort (n=94)
Yes
Do children with neonatal lupus or their unaffected siblings have an increased risk of developing autoantibodies or rheumatic diseases later in life?
Absolute Event Rate: 12.2% vs 0%
Children with neonatal lupus may have an increased risk of developing autoimmune diseases in early childhood, especially if the mother has an autoimmune disease, but do not appear to have an increased risk of systemic rheumatic diseases in adolescence and young adulthood.
May indicate early autoimmune risk in neonatal lupus offspring of affected mothers; leaves open long-term systemic rheumatic disease risk.
OBJECTIVE: To determine in a longitudinal cohort study whether children with varied manifestations of neonatal lupus or their unaffected siblings later develop autoantibodies and/or rheumatic diseases. METHODS: To obtain information on the health of children ages >or=8 years who had manifestations of neonatal lupus (affected group) and their unaffected siblings (unaffected group), questionnaires were sent to mothers (with anti-SSA/Ro and/or anti-SSB/La antibodies) who were enrolled in the National Institute of Arthritis and Musculoskeletal and Skin Diseases/Hospital for Joint Diseases Research Registry for Neonatal Lupus. Children of healthy mothers referred by the Registry enrollees comprised the control group. Further data were provided by review of medical records. RESULTS: Fifty-five mothers enrolled in the Registry returned questionnaires on 49 children with neonatal lupus and their 45 unaffected siblings. Six children with definite rheumatic/autoimmune diseases were identified: 2 with juvenile rheumatoid arthritis, 1 with Hashimoto thyroiditis, 1 with psoriasis and iritis, 1 with diabetes mellitus and psoriasis, and 1 with congenital hypothyroidism and nephrotic syndrome. All had neonatal lupus, and their mothers had manifestations of autoimmune diseases (Sjögren's syndrome in 4, systemic lupus erythematosus/Sjögren's syndrome in 1, and undifferentiated autoimmune disease in 1). Antinuclear antibodies were present in 4 of 55 sera tested (2 of 33 affected children and 2 of 22 unaffected children). No serum contained antibodies reactive with SSA/Ro or SSB/La antigens. CONCLUSION: These data suggest that children with neonatal lupus require continued followup, especially prior to adolescence and if the mother herself has an autoimmune disease. While there was no apparent increased risk of systemic lupus erythematosus, the development of some form of autoimmune disease (systemic or organ-specific) in early childhood may be of concern. During adolescence and young adulthood, individuals with neonatal lupus and their unaffected siblings do not appear to have an increased risk of developing systemic rheumatic diseases.
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Martin et al. (2002) conducted a cohort in Neonatal lupus (n=94). History of neonatal lupus vs. Unaffected siblings was evaluated on Development of definite rheumatic or autoimmune diseases. Children with a history of neonatal lupus developed definite rheumatic or autoimmune diseases more frequently than their unaffected siblings (12.2% vs 0%).
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