Timing of Childhood-onset Systemic Lupus Erythematosus Diagnosis Relative to Menarche Impacts Final Height.

OBJECTIVE The aim of this study was to examine the impact of timing of childhood-onset systemic lupus erythematosus (cSLE) diagnosis relative to menarchal status, on final height, accounting for and disease associated factors. METHODS A cohort study of female cSLE patients <18 years of age at diagnosis, followed at a tertiary care, pediatric center from July 1982 to March 2016, restricted to patients with documented age of menarche and final height. We compared final height between patients diagnosed pre- and post-menarche. We tested the association of timing of cSLE diagnosis with final height, adjusted for ethnicity, in linear regression models. We performed subgroup analyses of patients with growth during follow-up, additionally adjusting for average daily corticosteroid dose and disease activity. RESULTS Of 401 female cSLE patients in the study, 115 patients (29%) were diagnosed pre-menarche and 286 (71%) post-menarche. Patients diagnosed pre-menarche were older at menarche compared with patients diagnosed post-menarche (13.5 ± 1.4 vs. 12.5 ± 1.3 years; p < 0.001). The mean final height for females diagnosed post-menarche (161.4 cm [SD 6.9 cm]) was greater than those diagnosed pre-menarche (158.8 cm [SD 7.3 cm], P=0.001). In regression analysis, those diagnosed post-menarche were significantly taller than those diagnosed pre-menarche, adjusted for ethnicity, and disease severity (Beta=2.6cm, [SD 0.7cm], P=0.0006). CONCLUSION In this large cohort study of females with cSLE, patients diagnosed post-menarche achieved a taller final height than those diagnosed pre-menarche even after accounting for ethnicity and disease severity.