| Objective This study aimed to investigate the clinical and serological characteristics of SLE with AIHA and to analyse the risk factors in AIHA and the development of chronic organ damage in patients with AIHA.This study aimed to provide a basis for the clinical management of SLE with AIHA.Methods 3554 patients with SLE and 151 SLE patients with AIHA(4.24%)were retrospectively collected from July 2013 to July 2022 at the Affiliated Hospital of Qingdao University,of whom 110 met the inclusion criteria and had complete data(SLE-AIHA),and 2718 were non-anaemic patients.Of the 2718 non-anaemic SLE patients,110 were selected as the control group(SLE-non AIHA).The patients in the SLE-AIHA group were divided into mild,moderate,severe and very severe anaemia according to the severity of anaemia,and the differences between the groups were analysed.According to SDI Index,the SDI≥1 group(with one or more chronic organ damage)was analysed for risk factors for developing chronic organ damage in SLE-AIHA patients.Results1.The occurrence rate of SLE with AIHA in this study was 4.24%(151/3554).Patients with SLE-AIHA compared to SLE-non AIHA patients did not differ in gender composition,had a younger age of onset(18.18% of patients ≤18 years)and had high disease activity at onset(SLEDAI=9.29±6.63).In terms of clinical manifestations,patients with SLE-AIHA were more likely to have fever(51.82%),palpitations(4.55%),nausea and vomiting(6.36%),abdominal pain(9.09%),jaundice-related symptoms(15.45%),dizziness and headache(13.64%),fatigue(42.73%)and less likely to have arthralgias and oedema of the face and lower limbs.Regarding systemic involvement,patients in the SLE-AIHA group were more likely to have lupus encephalopathy(8.18%)and less likely to have multiple plasma cavities,arthritis,lymph node enlargement and venous thrombosis than patients in the non-AIHA group.The incidence of lupus pneumonia was not statistically significant.However,patients with SLE-AIHA were predisposed to lupus pneumonia in three cases in the SLE-AIHA group.Alveolar haemorrhage occurred in two cases,including one death in a patient with an alveolar haemorrhage.Regarding other autoimmune diseases,patients in the SLE-AIHA group were more likely to have APS(12.73%).The difference in SLEDAI between patients with different degrees of anaemia was not statistically significant;the difference in SDI score was statistically significant.The proportion of very severe anaemia selected with SDI ≥1 was 100.00%,choosing SDI ≥ 1 was 48.84%,which would be significantly higher than the mean of 37.27%.The probability of chronic organ damage was higher in patients with severe and very severe anaemia.The differences in clinical presentation and autoantibodies between patients with different degrees of anaemia were not statistically significant.Regarding medication,the frequency of gammaglobulin application was higher in patients with moderate to severe SLE-AIHA((21.57%,41.68%)).2.Patients in the SLE-AIHA group had higher titres of antinuclear antibodies,with34.55% of the SLE-AIHA group having an ANA titer of 1:1000 and 25.45% having a titer of 1:3200.In terms of autoantibodies,the SLE-AIHA group had a higher rate of positive anti-Sm antibodies(22.73%),a CL IgG(28.18%)and a CL IgM(34.55%).The SLE-AIHA group had higher CRP(3.915(0.9,14.8)mg/L)and lower complement C3(0.57±0.33g/L)and complement C4(0.110(0.1,0.2)g/L)inflammatory parameters.3,Logistic regression analysis of SLE-AIHA showed that fever(OR=4.507),lupus encephalopathy(OR=19.745),APS(OR=7.706),and low complement C3(OR= 0.085)would have a significant positive effect relationship on AIHA.4.Patients in the SDI≥1 group were more likely to develop facial and lower limb oedema at the initial onset.Regarding systemic involvement,the SDI≥1 group was more likely to develop lupus nephritis(48.78%)and patients in the SDI≥1 group were less likely to develop lupus encephalopathy(19.51%)and vasculitis(1.45%).The mean level of haemoglobin in the SDI≥1 group(59.00g/L)was lower than the mean level in the SDI=0 group(73.36g/L).Anti-ribosomal P protein antibodies were more likely to be present in patients in the SDI≥1 group for autoantibodies.Logistic regression analysis of SDI≥1 showed that lupus encephalopathy(OR=43.425)and lower Hb(OR=0.909)would have a significant positive effect relationship.Conclusion1.The occurrence rate of SLE with AIHA was 4.24%.SLE-AIHA have an earlier age of onset and higher disease activity,independent of the severity of the anaemia.They are more likely to have a fever,fatigue,palpitations,dizziness and headache,gastrointestinal symptoms,less likely have arthralgias and facial or lower limb oedema,more likely to have APS and lupus encephalopathy.2.The SLE-AIHA group had a high rate of positive anti-Sm antibodies,a CL IgG and IgM,higher ANA titres and lower complement C3.3.Fever,lupus encephalopathy,APS,and low complement C3 are independent risk factors for SLE-AIHA.4.Decreased Hb and with lupus encephalopathy are independent risk factors for the development of chronic organ damage in SLE-AIHA patients. |
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