C3 and systemic lupus erythematosus: The impact of age at onset and puberty on JSLE severity was consistent across studies, showing similar trends of more severe disease in patients with earlier onset (pre-pubertal) compared to post-pubertal patients, irrespective of outcome measures used (renal, cardiovascular, pulmonary and haematological involvement; paediatric intensive care unit [PICU] admissions; steroid and cyclophosphamide use; autoantibodies and complement C3 levels, and accrued lupus-related damage).