Clinical And Immunological Characteristics Of Patients With Systemic Lupus Erythematosus In Dalian, China

Background and objective: Systemic lupus erythematosus (SLE) is a chronicautoimmune disease characterized by a breakdown of immunological tolerance,production of antibodies and multisystem involvement leading to a broad spectrum ofclinical manifestations. The disease also shows a racial preference, being moreprevalent among African-American blacks, followed by Asians and Caucasians. Thediversity in disease expression of SLE worldwide varies significantly among differentethnic and geographical groups. Despite a large number of published reports, clinicaland laboratory features are still an interesting matter of study, as there are importantvariations in patterns of disease expression. The aim of this study is to determine themain clinical features and serological profile of patients with systemic lupuserythematosus (SLE) seen in Dalian, China.Methods: A retrospective survey was conducted in a cohort of145patientsfulfilling the SLICC (2009) Revision of the ACR Classification Criteria for SLE over a2year period between January2010and January2012. The data included personalinformation, clinical manifestations, laboratory and immunological results, comorbidities and different modalities of treatment employed, course and outcome ofdisease. Results were presented as mean, median+standard deviation or as a percentagewhere required.Results: Among145SLE patients studied,91%were females (132/145) and9%males (13/145). The median age at disease diagnosis was37years (age range15-82years) while the mean age at the time of assessment was44.2+15.6years. Meandisease duration was5.3years (range0to30years). Our study consisted of51newly-diagnosed patients and94known-SLE cases. Arthritis was the most common initialclinical feature,77.2%(112/145) presented with arthralgia or arthritis, followed bycutaneous involvement63.4%(92/145). Other main features analyzed were: oral ulcers 39.3%(57/145), photosensitivity35.2%(51/145), sicca syndrome33.8%(49/145),serositis (33.8%-49/145), alopecia (25.5%37/145), Raynaud’s phenomenon17.9%(26/145), neuropsychiatric disorders16.6%(24/145). Overall, lupus nephritis occurredin43.4%(63/145) of the patients. In newly-diagnosed SLE group,35.2%(20/51)developed LN, while in the known-SLE patients45.7%(43/94) had LN. ANA and anti-dsDNA sensitivity were99.3%(144/145) and62.8%(91/145) respectively. Anti-Smpositivity was recorded at24.8%(36/145), anti-cardiolipin at30%(42/145). MeanSLEDAI score calculated within the newly-diagnosed SLE patients was13.2+6.7SDwhereas in known-SLE cases, it was11.3+7.6SD. Moreover,72.5%(37/51) newly-diagnosed SLE patients had active disease, while43.6%(41/94) in the known-SLEgroup was found to have active disease. In multivariate analysis, lupus nephritis wassignificantly associated with thrombocytopenia (p=0.002<0.01), arterial hypertension(p=0.024), anemia (p=0.038<0.05), hypoprotenemia (p<0.01), serositis (p=0.007<0.01)and high SLEDAI score (p=0.01<0.05). Occurrence of NPSLE significantly correlatedwith serositis (p=0.016<0.05), thrombocytopenia (p=0.045<0.05), and high SLEDAIscore (p=0.042<0.05). Steroid was basis therapy93.8%(136/145) in my study group;patients with mild SLE such as mucocutaneous presentation were mainly treated HCQ35.2%(51/145) whereas patient with major organ involvement such as kidney orneuropsychiatric was pulsed by cyclophosphamide23.4%(34/145) combined with highdose steroids with an excellent outcome. Mortality occurred in5female cases (3.5%).Time from diagnosis to death averaged5.2years. Infection, lupus nephritis and eventualESRD were the leading cause of complication and death in our series.Conclusions:In our study, female: male ratio was10:1; median age at disease diagnosis was37years.Arthritis and cutaneous lesions were the most prominent clinical manifestations(77.2%and63.4%correspondingly). There was a low incidence of neuropsychiatricinvolvement (16.6%) in our series.Lupus nephritis occurred relatively at a higher frequency in known-SLE (45.7%)than in newly-diagnosed SLE patients (35.2%). ANA had a high sensitivity in our study(99.3%).New SLE patients presented with slightly higher SLEDAI score (13.2+6.7SD)compared to old patients (11.3+7.6SD). Lupus nephritis was significantly associated with thrombocytopenia, arterialhypertension, anemia, hypoprotenemia, serositis and high SLEDAI score.Occurrence of NPSLE significantly correlated with thrombocytopenia, serositisand high SLEDAI score.Treatment was tailored according to disease severity and arising complications andhad excellent outcome. Steroids were basic medicine employed in my study. Accordingto patients’ condition and severity of organ involvement, other immunosuppressant(HCQ/MTX/CTX, etc) was used consequently. Low mortality was recorded in ourcohort.