Delay in Referral, Diagnosis, and Treatment in Pediatric Patients With Juvenile Systemic Lupus Erythematosus: A Systematic Review.

Abstract

Background/objective: The delay in managing patients with juvenile systemic lupus erythematosus (jSLE) is one of the most important determinants impacting outcomes.

Methods: We conducted a systematic review regarding the delay in referral, diagnosis, and treatment of patients with jSLE, and the barriers and facilitators related to these processes. Electronic searches were conducted in Scopus, PubMed, and Web of Science for studies published up to March 4, 2025; additionally, reports were identified through a citation search. The project followed the PRISMA guidelines, and the critical appraisal was based on the Joanna Briggs Institute Checklist (JBI). Meta-analyses, using random effects models, were conducted to estimate the delay.

Results: The review included 24 papers from Europe, Asia, the Americas, and Africa. The median JBI quality score was 5 (IQR=4.75 to 6). Only one study presented a definition for the delay to diagnosis of jSLE. The estimated mean time from onset to diagnosis was 3.5 months (95% CI=2.73-4.27, I2 =93.4%, p <0.0001). Only 3 studies reported a referral delay. Two studies indicated that all patients received therapy at diagnosis. There was no difference in the time to diagnosis between countries from the Global North and the Global South. The most common barriers identified for timely diagnosis were male sex, low anti-nuclear antibody titers, low family income, and patients presenting mild clinical manifestations.

Conclusions: Currently, no consensus exists on defining the delays in referral, diagnosis, or treatment for jSLE patients. Common barriers are related to both sociodemographic and clinical factors.