Sangeeta Sule, M.D., with a young patient.

“Lupus” in Latin means “wolf,” and like the wily predator the autoimmune disease aggressively and relentlessly attacks its prey, in this case pediatric patients. Children with the disorder suffer symptoms like aches and pains, fatigue, rashes, ulcers in the nose or mouth, and, for many patients, kidney disease that may lead to heart and lung problems and even death. The cause of lupus and much of its activity is unknown, though theories abound ranging from hormones to infection and stress.

“All we know for certain is that the immune system attacks the body and creates inflammation,” says pediatric rheumatologist Sangeeta Sule, “but no one knows why it starts or why it occurs in certain organs.”

Sule aims to find out through her research focus on the mechanics of systemic lupus erythematosus (SLE), the most common and serious form of lupus. Her main goal is to identify predictors of disease activity, especially the “flares” that signal worsening disease and damage to body organs. About 80 percent of children with lupus have kidney disease manifestations but there’s no way of knowing which patients are at risk.

“Right now there’s no good data on what precipitates flares or causes kids to have kidney disease vs. heart and lung disease vs. skin disease,” says Sule.

To get at the answers, Sule and her collaborators are categorizing a large cohort of pediatric lupus patients by clinical data, history, labs and phenotype. That data may lead to the identity of novel biomarkers that have predictive value – that may, for example, show up as lab test abnormalities a month before patients begin to experience flares. The identity of these biomarkers may in turn lead to targeted treatments more effective than the current mainstay therapies – immunosuppressives and anti-inflammatory steroids – which work well but are associated with side effects and increased risk of infection.

“In theory, if you started treatment once you noticed these abnormalities, you could prevent the flare and organ damage from happening,” says Sule. “That’s the goal.”

For more information about Sangeeta Sule’s cohort study, call 410-955-6145.