Abstract
BackgroundSystemic lupus erythematosus (SLE) is a multi-organ autoimmune disorder with wide variety of clinical presentations. Recently, red blood cell distribution width (RDW) has been used as an inflammatory marker, similar to the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) where systemic inflammation has been linked to increased RDW. Many researches have assessed independently selective different hematological markers that may reflect disease activity.Our study aims to examine a number of hematological parameters that could reflect disease activity and to assess if there is a relationship between different hematological parameter (RDW, neutrophils and lymphocytes) to reflect SLE activity using Systemic Lupus Erythematosus Disease Activity Index (SLEDAI).ResultsThe study comprised 60 SLE patients (52 females and 8 males) with a mean age of 34.53 years and mean disease duration was 4.085 years. The RDW values were significantly higher (p < 0.001) when comparing active patients (16.64 ± 4.7) versus inactive patients (13.16 ± 2.67) and controls (12.7 ± 1.13). Otherwise, insignificant differences were reported when comparing inactive SLE patients versus the control group (p = 0.242). There were no significant correlations (p > 0.05) between neutrophil count and lymphocyte count with C3, C4, SLEDAI score, 24 h urinary proteins, platelets count but significant only with hemoglobin level (p = 0.001).ConclusionIncreased RDW is connected with active disease status of SLE patients. RDW could be used as a surrogate marker of the inflammation rather than neutrophil and lymphocyte count. It is a simple and easy testing included in CBC thus RDW could be used as a possible indicator to assess disease activity.
Highlights
Systemic lupus erythematosus (SLE) is a multi-organ autoimmune disorder with wide variety of clinical presentations
Patients The study included 90 subjects, 60 patients with SLE diagnosed by Systemic Lupus International Collaborating Clinics (SLICC) criteria [18] who were admitted to Rheumatology and Rehabilitation Inpatient Department, University Hospital, from the period 2018 to 2019, and were classified into 2 groups according to Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score with cutoff point 3 the first group I included 30 SLE patients in an active stage (SLEDAI > 3), and the second group II included 30 SLE patients in an inactive stage (SLEDAI ≤ 3), and thirty healthy volunteers matching for age and sex were included as a control group
There was no significant difference between groups regarding presence of discoid lupus erythematosus (DLE); only 1inactive SLE case had current oral/ nasal ulcer; 56.7% of active and inactive cases had oral/ nasal ulcer by history with high significant difference; from the past history 16.7% of active cases and 20% of inactive cases had pleurisy/pericarditis during the disease course with significant difference; and we found that only 3 active cases had current psychosis/seizures, 5 active cases had psychosis/seizures by history, with highly significant difference (Table 1)
Summary
Systemic lupus erythematosus (SLE) is a multi-organ autoimmune disorder with wide variety of clinical presentations. Our study aims to examine a number of hematological parameters that could reflect disease activity and to assess if there is a relationship between different hematological parameter (RDW, neutrophils and lymphocytes) to reflect SLE activity using Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Systemic lupus erythematosus (SLE) is a multisystem autoimmune connective tissue disorder with a broad spectrum of clinical presentations. The peak age of onset among young women is between the late teens and early 40s with a female to male ratio of 9:1 Those with African or Asian ancestry are more at higher risk of developing the disease and it may be associated with severe organ affection compared to Caucasian patients. It has been found that increased rate of RDW, as well as RDW changes in the first year after diagnosis, is correlated with a high risk of cardiovascular accident (heart failure, ischemic heart disease, or cerebrovascular accident), and the significant correlation remained after adjusting for sex and age [4]
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