Multisystem Burden of Paediatric Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis of Neuropsychiatric, Renal, Ocular, and Immunological Outcomes.

Paediatric systemic lupus erythematosus (pSLE) is associated with more aggressive disease and higher rates of organ involvement than adult-onset disease. However, the relationship between disease activity and multisystem manifestations has not been comprehensively quantified. A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Five databases (PubMed, Embase, Scopus, Web of Science, and Cochrane Library) were searched for observational studies published between 2015 and 2024. Studies including paediatric SLE patients with quantified disease activity were eligible. Random-effects meta-analysis was performed to estimate pooled odds ratios (ORs) with 95% confidence intervals (CI). Twenty studies involving 4,934 patients were included. Lupus nephritis was the most frequent manifestation (44-76%), followed by neuropsychiatric involvement (16-40%) and ocular findings (5-32%). High disease activity was significantly associated with lupus nephritis (OR 3.7, 95% CI 2.8-4.9), neuropsychiatric involvement (OR 2.9, 95% CI 2.2-3.9), and immunological abnormalities (OR 3.4, 95% CI 2.5-4.6). Subgroup analyses demonstrated higher disease burden in Asian and Middle Eastern cohorts. Heterogeneity ranged from moderate to substantial across outcomes. High disease activity in pSLE is strongly associated with major organ involvement across multiple systems. These findings support the use of disease activity indices for risk stratification and highlight the need for multidisciplinary monitoring and region-specific management strategies.