Generic placeholder image

Current Rheumatology Reviews

Editor-in-Chief

ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

Research Article

Clinical Features and Disease Damage Risk Factors in an Egyptian SLE Cohort: A Multicenter Study

Author(s): Naglaa Afifi*, Samah A. El Bakry, Nevine Mohannad, Iman H. Bassyouni, Nahla F. Abou Elezz, Reem El-Shazly and Safaa A. Hussein

Volume 17, Issue 2, 2021

Published on: 26 November, 2020

Page: [222 - 231] Pages: 10

DOI: 10.2174/1573397116666201126161244

Price: $65

Abstract

Background: Systemic lupus erythematosus (SLE) has a variable natural history and clinical characteristics. Objectives: This study aims to evaluate the clinical and immunological characteristics, and assess the disease accrual of an Egyptian SLE cohort.

Methods: The study included 569 SLE patients who were collected from three different centers; demographic, laboratory data, cumulative manifestations, and comorbidities were assessed (characteristics at the time of diagnosis were recorded retrospectively, while current clinical data were recorded cross-sectionally). Evaluation of disease activity was done using Systemic Lupus Erythematosus Disease Activity Index score (SLEDAI) and damage by Systemic Lupus International Collaborative Clinics/American College of Rheumatology Damage Index (SDI).

Results: The median age of patients at disease onset was 25.0±10.5 years, the median disease duration was 4.0 (6.5) years, the female to male ratio was (12.5:1), and the median SLEDAI was 12.0±14.0. Family history of SLE was noticed in 4%. Antinuclear antibody was positive in all patients and 86% had positive anti-double-stranded DNA. Arthritis/arthralgia was the most frequent presenting symptom (44%) followed by fever (39%). Along the disease course; alopecia was the most common clinical manifestation (76.1%), followed by constitutional symptoms (75.9%), and nephritis (65.7%). Three hundred and five patients encountered organ damage (SDI >1); kidney damage was the most frequent (32%), followed by cardiovascular damage (24.3%). Neutropenia, hypocomplementemia, arthritis, hypertension, longer disease duration, and higher disease activity were found to be independent risk factors for disease damage.

Conclusions: There are some diversities and similarities in our findings compared to the previously reported data. Arthritis is the most common presenting symptom, while alopecia is the most frequent clinical finding, and a higher prevalence of nephritis was reported. Renal damage is the most frequent outcome.

Keywords: Systemic lupus erythematosus, disease damage, Egypt, SLE, cohort, autoimmune disease.

Graphical Abstract
[1]
Thong B, Olsen NJ. Diagnosis and Management of Systematic Lupus Erythematosus (SLE). Egypt J Hosp Med 2017; 67(2): 672-8.
[http://dx.doi.org/10.12816/0037820]
[2]
Shaikh MF, Jordan N, D’Cruz DP. Systemic lupus erythematosus. Clin Med (Lond) 2017; 17(1): 78-83.
[http://dx.doi.org/10.7861/clinmedicine.17-1-78] [PMID: 28148586]
[3]
Rees F, Doherty M, Grainge MJ, Lanyon P, Davenport G, Zhang W. Mortality in systemic lupus erythematosus in the United Kingdom 1999-2012. Rheumatology (Oxford) 2016; 55(5): 854-60.
[http://dx.doi.org/10.1093/rheumatology/kev424] [PMID: 26748350]
[4]
Pons-Estel GJ, Ugarte-Gil MF, Alarcón GS. Epidemiology of systemic lupus erythematosus. Expert Rev Clin Immunol 2017; 13(8): 799-814.
[http://dx.doi.org/10.1080/1744666X.2017.1327352] [PMID: 28471259]
[5]
Hopkinson ND, Doherty M, Powell RJ. Clinical features and race-specific incidence/prevalence rates of systemic lupus erythematosus in a geographically complete cohort of patients. Ann Rheum Dis 1994; 53(10): 675-80.
[http://dx.doi.org/10.1136/ard.53.10.675] [PMID: 7979581]
[6]
Sliem H, Tawfik G, Khalil KA, Ibrahim N. Pattern of systemic lupus erythematosus in Egyptian patients: the impact of disease activity on the quality of life. Pan Afr Med J 2010; 6: 14.
[PMID: 21734922]
[7]
El Hadidi KT, Medhat BM, Abdel Baki NM, et al. Characteristics of systemic lupus erythematosus in a sample of the Egyptian population: a retrospective cohort of 1109 patients from a single center 2018; 27(6): 1030-8.
[http://dx.doi.org/10.1177/0961203317751856]
[8]
Mansour M, Helaly M. Clinical Features Clusters in Systemic Lupus Erythematosus. Egyptian Journal of Hospital Medicine 2018; 71(5): 3136-41.
[9]
Petri M, Orbai AM, Alarcón GS, et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum 2012; 64(8): 2677-86.
[http://dx.doi.org/10.1002/art.34473] [PMID: 22553077]
[10]
Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH. The Committee on Prognosis Studies in SLE. Derivation of the SLEDAI. A disease activity index for lupus patients. Arthritis Rheum 1992; 35(6): 630-40.
[http://dx.doi.org/10.1002/art.1780350606] [PMID: 1599520]
[11]
Gladman D, Ginzler E, Goldsmith C, et al. The development and initial validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index for systemic lupus erythematosus. Arthritis Rheum 1996; 39(3): 363-9.
[http://dx.doi.org/10.1002/art.1780390303] [PMID: 8607884]
[12]
Al Dhanhani AM, Agarwal M, Othman YS, Bakoush O. Incidence and prevalence of systemic lupus erythematosus among the native Arab population in UAE. Lupus 2017; 26(6): 664-9.
[http://dx.doi.org/10.1177/0961203316678677] [PMID: 27831539]
[13]
Zian Z, Maamar M, El Aouni M, et al. Immunological and clinical characteristics of systemic lupus erythematosus: a series from morocco. BioMed Research International 2018.
[14]
Heller T, Ahmed M, Siddiqqi A, Wallrauch C, Bahlas S. Systemic lupus erythematosus in Saudi Arabia: morbidity and mortality in a multiethnic population. Lupus 2007; 16(11): 908-14.
[http://dx.doi.org/10.1177/0961203307081112] [PMID: 17971366]
[15]
Khanfir MS, Houman MH, Cherif E, et al. TULUP (TUnisian LUPus): a multicentric study of systemic lupus erythematosus in Tunisia. Int J Rheum Dis 2013; 16(5): 539-46.
[http://dx.doi.org/10.1111/1756-185X.12152] [PMID: 24164841]
[16]
Uthman I, Nasr F, Kassak K, Masri AF. Systemic lupus erythematosus in Lebanon. Lupus 1999; 8(9): 713-5.
[http://dx.doi.org/10.1191/096120399678841016] [PMID: 10602442]
[17]
Al Arfaj AS, Khalil N. Clinical and immunological manifestations in 624 SLE patients in Saudi Arabia. Lupus 2009; 18(5): 465-73.
[http://dx.doi.org/10.1177/0961203308100660] [PMID: 19318403]
[18]
Nazarinia MA, Ghaffarpasand F, Shamsdin A, Karimi AA, Abbasi N, Amiri A. Systemic lupus erythematosus in the fars province of Iran. Lupus 2008; 17(3): 221-7.
[http://dx.doi.org/10.1177/0961203307086509] [PMID: 18372364]
[19]
AlSaleh J, Jassim V, ElSayed M, Saleh N, Harb D. Clinical and immunological manifestations in 151 SLE patients living in Dubai. Lupus 2008; 17(1): 62-6.
[http://dx.doi.org/10.1177/0961203307084297] [PMID: 18089686]
[20]
Cervera R, Khamashta MA, Font J, et al. Systemic lupus erythematosus: clinical and immunologic patterns of disease expressionin a cohort of 1000 patients. The European working party onSystemic lupus erythematosus. Medicine (Baltimore) 1993; 72: 113-24.
[http://dx.doi.org/10.1097/00005792-199303000-00005] [PMID: 8479324]
[21]
Pons-Estel BA1, Catoggio LJ, Cardiel MH, et al. Grupo Latinoamericano de Estudio del Lupus. The GLADEL multinational Latin American prospective inception cohort of1,214 patients with systemic lupus erythematosus: ethnic and disease heterogeneity among “Hispanics”. Medicine (Baltimore) 2004; 83: 1-17.
[http://dx.doi.org/10.1097/01.md.0000104742.42401.e2] [PMID: 14747764]
[22]
Alarcón-Segovia D, Alarcón-Riquelme ME, Cardiel MH, et al. Grupo Latinoamericano de Estudio del Lupus Eritematoso (GLADEL). Familial aggregation of systemic lupus erythematosus, rheumatoid arthritis, and other autoimmune diseases in 1,177 lupus patients from the GLADEL cohort. Arthritis Rheum 2005; 52(4): 1138-47.
[http://dx.doi.org/10.1002/art.20999] [PMID: 15818688]
[23]
Akbarian M, Faezi ST, Gharibdoost F, et al. Systemic lupus erythematosus in Iran: a study of 2280 patients over 33 years. Int J Rheum Dis 2010; 13(4): 374-9.
[http://dx.doi.org/10.1111/j.1756-185X.2010.01547.x] [PMID: 21199473]
[24]
Alarcón GS, McGwin G Jr, Petri M, Reveille JD, Ramsey-Goldman R, Kimberly RP. PROFILE Study Group. Baseline characteristics of a multiethnic lupus cohort: PROFILE. Lupus 2002; 11(2): 95-101.
[http://dx.doi.org/10.1191/9612332lu155oa] [PMID: 11958584]
[25]
Cervera R, Piette JC, Font J, et al. Euro-Phospholipid Project Group. Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum 2002; 46(4): 1019-27.
[http://dx.doi.org/10.1002/art.10187] [PMID: 11953980]
[26]
Mohamed DF, Habeeb RA, Hosny SM, Ebrahim SE. Incidence and risk of infection in egyptian patients with systemic lupus erythematosus. Clin Med Insights Arthritis Musculoskelet Disord 2014; 7: 41-8.
[http://dx.doi.org/10.4137/CMAMD.S15346] [PMID: 25125988]
[27]
Hammad M, Eissa M, Fathi S. Possible risk factors associated with greater damage in systemic lupus erythematosus patients: an Egyptian multicenter study. Lupus 2016; 25(9): 1019-27.
[http://dx.doi.org/10.1177/0961203316636465] [PMID: 26957352]
[28]
Frodlund M, Reid S, Wetterö J, Dahlström Ö, Sjöwall C, Leonard D. The majority of Swedish systemic lupus erythematosus patients are still affected by irreversible organ impairment: factors related to damage accrual in two regional cohorts. Lupus 2019; 28(10): 1261-72.
[http://dx.doi.org/10.1177/0961203319860198] [PMID: 31296137]
[29]
Shaharir SS, Hussein H, Rajalingham S, et al. Damage in the Multiethnic Malaysian Systemic Lupus Erythematosus (SLE) Cohort: Comparison with Other Cohorts Worldwide. PLoS One 2016; 11(11): e0166270.
[http://dx.doi.org/10.1371/journal.pone.0166270] [PMID: 27846298]
[30]
Thumboo J, Feng PH, Soh CH, Boey ML, Thio S, Fong KY. Validation of a Chinese version of the Medical Outcomes Study Family and Marital Functioning Measures in patients with SLE. Lupus 2000; 9(9): 702-7.
[http://dx.doi.org/10.1191/096120300666529212] [PMID: 11199926]
[31]
Mok CC, Ho CT, Wong RW, Lau CS. Damage accrual in southern Chinese patients with systemic lupus erythematosus. J Rheumatol 2003; 30(7): 1513-9.
[PMID: 12858450]
[32]
Sung YK, Hur NW, Sinskey JL, Park D, Bae SC. Assessment of damage in Korean patients with systemic lupus erythematosus. J Rheumatol 2007; 34(5): 987-91.
[PMID: 17361986]
[33]
Rabbani MA, Habib HB, Islam M, et al. Survival analysis and prognostic indicators of systemic lupus erythematosus in Pakistani patients. Lupus 2009; 18(9): 848-55.
[http://dx.doi.org/10.1177/0961203309103410] [PMID: 19578112]
[34]
Ghazali WSW, Daud SMM, Mohammad N, Wong KK. Slicc damage index score in systemic lupus erythematosus patients and its associated factors. Medicine (Baltimore) 2018; 97(42): e12787.
[http://dx.doi.org/10.1097/MD.0000000000012787] [PMID: 30334968]
[35]
Petri M, Purvey S, Fang H, Magder LS. Predictors of organ damage in systemic lupus erythematosus: the Hopkins Lupus Cohort. Arthritis Rheum 2012; 64(12): 4021-8.
[http://dx.doi.org/10.1002/art.34672] [PMID: 22932985]

Rights & Permissions Print Export Cite as
© 2023 Bentham Science Publishers | Privacy Policy