Egyptian Systemic Lupus Erythematosus Patients Research Articles

Vitamin D Deficiency in Egyptian Systemic Lupus Erythematosus Patients: How Prevalent and Does It Impact Disease Activity?

BACKGROUNDThe emerging role of vitamin D in immunology and autoimmune disorders has been a worldwide interest in the last decade. Systemic lupus erythematosus (SLE) patients are particularly at a delicate position predisposing them to suffer from vitamin D deficiency due to the multiple risk factors accompanying the disease. Whether vitamin D deficiency is also involved as a risk factor for developing SLE and affecting its course is a considerable concern.OBJECTIVESThe objective of this study was to estimate the prevalence of vitamin D deficiency in SLE patients and its relation to disease.MATERIALS AND METHODSIn our observational cross-sectional study, serum levels of vitamin D [25(OH)D] in 60 SLE patients and 30 age- and sex-matched healthy controls were assessed and estimated for deficiency and insufficiency at 10 and 30 ng/mL, respectively. Disease activity was evaluated by SLE disease activity index (SLEDAI), irreversible organ damage by Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR DI), and severity by Severity of Disease Index. Fatigue was measured by visual analog scale.RESULTSSignificantly lower levels of 25(OH)D were found in SLE patients (17.6 ± 6.9 ng/mL) in comparison to controls (79.0 ± 28.7 ng/mL), with a statistically high significant difference (t = −11.2, P < 0.001). High prevalence of vitamin D insufficiency and deficiency was detected as 73.3% and 23.3%, respectively. Vitamin D had a highly significant negative correlation with SLEDAI (r = −0.495, P < 0.001), SLICC (r = −0.431, P < 0.05), and fatigue (r = −0.436, P < 0.05).CONCLUSIONVitamin D deficiency and insufficiency were found to be prevalent in SLE patients in our study and related to disease activity and fatigue. If needed, routine screening and consequent repletion of vitamin D are recommended in SLE patients. Restoring adequate vitamin D levels in SLE patients should be more explored as a potential yet simple measure to their usual management to improve their condition.

Expression of Toll‑like receptors3 and9 in Egyptian systemic lupus erythematosus patients.

Systemic lupus erythematosus (SLE) is acommon complex disease characterized by chronic generalized inflammation which may involve several tissues and organs. The aim of this work was to study the expression of Toll-like receptors (TLR)3 and9 in SLE patients, and to investigate their relationship to clinical features, disease activity, and damage. The current study included 24Egyptian female SLE patients and 15matched controls. Disease activity was assessed using the SLE Disease Activity Index (SLEDAI) and damage using the Systemic Lupus International Collaborating Clinics (SLICC) index. Expression of TLR3 and TLR9 in B- (CD19-positive) and T-lymphocytes (CD3-positive) was studied using flow cytometry. Patient age ranged between 17and 42years (mean 26.17 ± 5.78years). There was asignificant difference between patients and controls regarding TLR3/CD3, TLR3/CD19, TLR9/CD3, and TLR9/CD19 expression (p <0.0001). There were significant correlations of TLR3/CD3, TLR3/CD19, and TLR9/CD19 with serum creatinine (r = 0.52, p = 0.009; r = 0.504, p = 0.012; and r = 0.58, p = 0.003; respectively) and negative correlations with ALT levels (r = -0.42, p = 0.04; r = -0.49, p = 0.016; and r = -0.472, p = 0.02; respectively). The results of the study suggest that TLR3 and TLR9 play arole in the pathogenesis of SLE, and have an impact on organ involvement in this disease. More studies concerning the biology and function of TLRs are required in larger patient cohorts, and may lead to development of anew class of drugs.

Urinary and serum neutrophil gelatinase-associated lipocalin as a biomarker in Egyptian systemic lupus erythematosus patients: Relation to lupus nephritis and disease activity

BackgroundNeutrophil gelatinase-associated lipocalin (NGAL) is an excellent structural biomarker for the early diagnosis of acute kidney injury, prognosis, dialysis requirement and mortality in several common clinical scenarios. Aim of the workThe aim of this work is to detect the levels of both urinary and serum NGAL in SLE patients with and without lupus nephritis (LN) and to correlate their levels with renal biopsy class and disease activity. Patients and methodsThe study included 35 SLE patients; 22 with LN and 13 without as well as 30 matched controls. The SLE Disease Activity Index (SLEDAI) was assessed and the renal biopsy class determined. Urinary and serum levels of NGAL were assessed by ELISA. ResultsThe 35 patients had a median age of 30years and disease duration of 4years. They were 31 females and 4 males. The SLE patients had an elevated urinary NGAL (UNGAL) (median 19ng/ml, IQR 8–87) as compared to controls (median 2ng/ml, IQR 1–18.3) (p<0.006). Levels of UNGAL were higher in patients with LN than those without (p<0.023). In patients with LN, serum levels of NGAL were not significantly different from controls (p=0.6). The UNGAL level significantly correlated with the renal score of SLEDAI (r=0.54, p=0.001) but serum NGAL level did not (r=0.25, p=0.15). UNGAL significantly correlated with grade III and IV of renal biopsy (r=0.67, p=0.009). The sensitivity of UNGAL levels for the diagnosis of LN was 85.7%, with a specificity of 80%. ConclusionUrinary NGAL is a sensitive marker of proliferative nephritis in SLE and disease activity.

Transforming growth factor-β1 in systemic lupus erythematosus patients and its relation to organ damage and disease activity

Aim of the workThe aim of our study was to assess the serum levels of transforming growth factor-β1 (TGF-β1) in Egyptian systemic lupus erythematosus (SLE) patients in order to determine whether these levels are associated with disease activity and organ damage. Patients and methodsSerum level of TGF-β1 was assessed in 70 Egyptian SLE patients and 60 healthy subjects using ELISA. The levels were related to clinical features, disease activity as assessed by the SLE disease activity index (SLEDAI) and damage assessed by the Systemic Lupus International Collaborating Clinics (SLICC) index. ResultsSerum levels of TGF-β1 were significantly reduced in patients with SLE compared to levels in healthy controls (875.8±292.2pg/ml vs 1140±301pg/ml, respectively) (p<0.001). TGF-β1 levels significantly correlated with hemoglobin content, platelet counts, and inversely with the erythrocyte sedimentation rate (ESR), serum creatinine and urea. Significantly lower TGF-β1 levels were found in patients with high disease activity (SLEDAI>10) while the level tended to be lower in those with organ damage. TGF-β1 was significantly lower in patients with serum creatinine >1.2mg/dl than in those with <1.2mg/dl (p=0.003), and also in patients with glomerular filtration rate (GFR) <50ml/min than in those with >50ml/min (p=0.038). ConclusionThis study demonstrated significantly reduced serum levels of TGF-β1 in patients with SLE compared with healthy subjects. Lower serum TGF-β1 levels were associated with high disease activity and organ damage in SLE patients. A prominent role in renal damage was observed.

Predictive potential of the disease activity index and C-reactive protein for infection in systemic lupus erythematosus patients

Aim of the workThe aim of the present work was to determine the prevalence of infections in a cohort of Egyptian Systemic lupus erythematosus (SLE) patients and to describe their sites and relation to clinical characteristics, laboratory features and disease activity. Patients and methodsMedical records of 250 Egyptian SLE patients attending the Rheumatology department, Cairo University hospitals were reviewed retrospectively for the clinical and laboratory features, SLE disease activity index (SLEDAI) and treatment received. ResultsInfection was found in 119 (47.6%) patients, with bacterial infection being the commonest in 99 (83%) followed by fungal infection in 30 (25%) and viral infection in 22 (18.5%). The commonest site of infection was the skin (37%) followed by the urinary tract (31%) and chest (19%). In SLE patients with infection there was a significant increase in the frequency of malar rash (p=0.001), photosensitivity (p=0.01), oral ulcers (p<0.001), alopecia (p=0.017) and Raynauds (p=0.017) compared to those without infection. Pulmonary and neuropsychiatric manifestations were also significantly increased in those with infection (p=0.001 and p<0.001). A significantly higher number of patients with infection were receiving pulse steroids (p=0.016), cyclophosphamide (p=0.011) and a higher oral prednisolone dose (p=0.03). The SLEDAI was significantly higher (26.02±8.23) in those with infection compared to those without (15.57±6.43) (p<0.001). C-reactive protein (CRP) was significantly higher in those with infection (p<0.001). On performing a logistic regression analysis, only SLEDAI (p<0.001) and CRP (p<0.001) were significant predictors of infection. ConclusionDisease activity and CRP are important predictors for infection in SLE patients.

Cognitive dysfunction in active and remitted Egyptian non-neuropsychiatric systemic lupus erythematosus patients

Cognitive dysfunction in active and remitted Egyptian non-neuropsychiatric systemic lupus erythematosus patients

Incidence and risk of infection in egyptian patients with systemic lupus erythematosus.

BACKGROUNDInfection in systemic lupus erythematosus (SLE) is common and is one of the leading causes of morbidity and mortality.OBJECTIVETo study the risk and occurrence of infection in Egyptian SLE patients and to determine its characteristics.METHODSA total of 200 SLE patients were followed up for 1 year at monthly intervals, undergoing clinical and laboratory evaluation. Disease activity was assessed by SLE disease activity measurement (SLAM) score. Infections were diagnosed on basis of clinical findings, medical opinion, positive blood and urine cultures, Gram stain results, and specific serological assays as measurement of CMV and EBV antibodies.RESULTSA total of 55% of patients developed infection, 45% had one infection, and the rest had multiple infection episodes. Total number of infections was 233 infections/year, 47.2% were major and 52.8% were minor infections. Urinary tract was the most commonly involved site with bacterial infection being the commonest isolated organism (46.4%), and E. coli the commonest isolated bacteria (14.2%). There were 51 episodes caused by systemic viral infection (CMV in 25, EBV in 22, HCV in 3, and 1 in HBV).CONCLUSIONThere is a high rate of infection among SLE patients. Disease activity, leukopenia, high CRP level, positive anti-dsDNA, consumed C3, and cyclophosphamide therapy are independent risk factors for infection in SLE.

Association of FcγRIIB and FcγRIIA R131H gene polymorphisms with renal involvement in Egyptian systemic lupus erythematosus patients

Identification of the genetic basis of systemic lupus erythematosus (SLE) may contribute to the discovery of effective drugs before renal involvement. Our aim of this study was to estimate the association between Fc gamma receptor (FcγR) polymorphisms and SLE and renal involvement in Egyptian patients. FcγRIIB and FcγRIIA R131H gene polymorphisms were genotyped in 180 Egyptian adults. Genotyping for FcγRIIA R131H was performed using allele-specific PCR and FcγRIIB-Ile232 Thr polymorphism was genotyped using polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP). The study showed that the homozygous genotype (Thr/Thr) of FcγRIIB significantly increased in all SLE patients (90 patients) and in SLE patients complicated with nephritis (61 patients). The Thr allele was significantly associated with an increased risk of the disease in all the patients and in patients complicated with nephritis. Our study demonstrated an association of FcγRIIB polymorphisms with SLE and lupus nephritis and a lack of association of FcγRIIA polymorphisms with SLE in the Egyptian patients.

TRAIL mRNA expression in peripheral blood mononuclear cells of Egyptian SLE patients

Although the definite etiopathogenesis of systemic lupus erythematosus (SLE) remains unclear, many different mechanisms may contribute to its pathogenesis. Tumor-necrosis factor-related apoptosis-inducing ligand (TRAIL) is a member of the tumor necrosis factor (TNF) family with pro-apoptotic activity. The accumulation of apoptotic cell debris has been hypothesized to induce the autoimmune inflammation in SLE, and TRAIL may trigger this programmed cell death. We investigated TRAIL mRNA expression levels in peripheral blood mononuclear cells (PBMCs) from 60 SLE patients and 40 controls using quantitative real-time reverse transcription-polymerase chain reaction (RT-PCR), and we studied the association between the results and clinical and laboratory parameters of the patients. Expression levels of TRAIL mRNAs in SLE patients were significantly higher than in controls (p<0.001). A statistically significant association was detected between TRAIL mRNA expression and SLE activity (p=0.001).

R620W polymorphism of protein tyrosine phosphatase PTPN22 in Egyptian children and adolescents with systemic lupus erythematosus: relation to thyroid autoimmunity

Some studies showed associations of the minor T allele of the C1858T single nucleotide polymorphism (SNP) corresponding to the R620W amino acid substitution of protein tyrosine phosphatase (PTPN22) with multiple autoimmune diseases, including systemic lupus erythematosus (SLE). To study the frequency of PTPN22 R620W polymorphism among Egyptian patients with SLE and to test the association of the T allele with autoimmune thyroid disease in such patients. Clinical evaluation, measurement of thyroid hormones and antibodies, and genotyping of PTPN22 R620W polymorphism were done for 60 SLE patients and 60 age- and sex-matched healthy subjects. Nineteen SLE cases (31.67%) had thyroid dysfunction with subclinical hypothyroidism being the most frequent form of thyroid dysfunction (20%) followed by primary hypothyroidism (6.67%), subclinical hyperthyroidism (3.33%) and primary hyperthyroidism (1.67%). Autoimmune thyroid disease was detected in 36.67% of cases. Systemic lupus erythematosus disease activity index (SLEDAI) score did not differ between patients with thyroid dysfunction and euthyroid patients (p=0.061) nor with the frequency of positive thyroid peroxidise antibodies (TPOAb, p=0.092) and antithyroglobulin antibodies (ATGAb, p=0.1). T allele frequency did not differ between cases and controls (p=1.19) and was associated with autoimmune thyroid disease in Egyptian SLE patients (p=0.002). R620W polymorphism of the PTPN22 gene is not a major risk allele for SLE susceptibility among Egyptian SLE patients but appears to be a risk factor for concurrent autoimmune thyroid disease and SLE.

Evaluation of B-cell subsets in Egyptian systemic lupus erythematosus patients

Evaluation of B-cell subsets in Egyptian systemic lupus erythematosus patients

TNF-α-308 promoter G/A and PTPN22 (1858 C/T) genes polymorphisms in Egyptian patients with systemic lupus erythematosus

Tumor necrosis factor alpha (TNF-α) promoter gene polymorphism at position 308 and that of the protein tyrosine phosphatase nonreceptor type 22 (PTPN22) at position 1858 C/T have been inconsistently implicated as genetic risk factors for systemic lupus erythematosus (SLE) in some populations. We investigated the possible association of these polymorphisms with SLE susceptibility, and whether serum TNF-α level is related to different genotypes and disease activity in Egyptian SLE patients. TNF-α-308 G/A and PTPN22 C1858T polymorphisms were determined by PCR-restriction fragment length polymorphism analysis in 40 SLE patients and 40 unrelated healthy controls. Serum TNF-α level was measured by ELISA method. The median serum TNF-α was significantly higher in SLE patients than in controls (P < 0.001). A significant positive correlation was detected between serum TNF-α and SLE activity index (r = 0.723, P < 0.001). There was no significant difference in TNF-α-308 G/A genotypes or allele frequency between SLE cases and controls (P = 0.108 and P = 0.133, respectively). Diabetes was the only clinical feature in SLE patients that showed significant higher frequency with GA genotype than with GG genotype (P = 0.001). Risk estimation for the TNF-α-308 genotypes was of no significant (odds ratio = 2.429; 95 % CI = 0.8–7.2; P = 0.108). Concerning PTPN22 1858 C/T, there was no significant difference in PTPN22 C/T genotypes or allele frequency between SLE cases and controls (P = 0.152 and P = 0.155, respectively). TNF-α-308 G/A and PTPN22 (1858 C/T) polymorphisms do not exhibit a significant influence on the susceptibility of SLE in Egyptian patients. However, serum TNF-α level could be a sensitive marker of SLE disease activity.

Endothelial nitric oxide synthase (eNOS) genetic polymorphisms among Egyptian systemic lupus erythematosus and rheumatoid arthritis patients

Several genetic polymorphisms in the endothelial nitric oxide (eNOS) gene have been associated with different vascular, infectious, and autoimmune disease in some populations. These polymorphisms may alter the levels of eNOS expression, thus being relevant either to the pathogenesis or progression of these diseases. We aimed to assess the prevalence of eNOS genetic polymorphisms namely, the 27-bp repeat in intron 4 by polymerase chain reaction (PCR) and T-786C mutation by PCR-RFLP, among Egyptian systemic lupus erythematosus patients (SLE) and rheumatoid arthritis (RA) patients. The study included 34 SLE and 34 RA patients. Forty-six age, sex, and ethnically matched healthy volunteers were included in the current study as a control group. The frequencies of intron 4 and T-786C polymorphisms in the SLE patient group were 73.5 % for the wild type versus 26.5 % for the polymorphic types and 38.2 % for the wild type versus 50 % for the heteromutant type and 11.8 % for the homomutant type, respectively. As for the RA group the frequencies of intron 4 and T-786C polymorphisms in the patient group were 76.5 % for the wild type versus 23.5 % for the polymorphic types and 44.1 % for the wild type versus 55.9 % for the polymorphic type, respectively, with no statistically significant difference in the distribution of the genotypes between SLE and RA patients and the control group. No association was detected between these genetic polymorphisms and the clinical features of the patients apart from an association between the T-786C genetic polymorphism and the extra-articular manifestations of RA.

Angiotensin-converting enzyme (ACE) serum levels and gene polymorphism in Egyptian patients with systemic lupus erythematosus

To investigate the association of angiotensin-converting enzyme (ACE) gene polymorphism and serum ACE level among Egyptian SLE patients and its relation to disease activity parameters. We enrolled 50 Egyptian female systemic lupus erythematosus (SLE) patients and 29 healthy controls. Measurement of serum ACE level was done using ELISA, and the ACE genotype was determined by polymerase chain reaction using genomic DNA from peripheral blood. A significant difference was found in ACE genotypes between SLE patients and controls (χ(2 )= 7.84, p = 0.02). The frequency of ACE DD versus (DI and II) genotypes was significantly higher in SLE patients compared with controls (χ(2 )= 5.57, p = 0.018 and OR for risk of SLE was 3.1 with 95% confidence interval: 1.198.06). Mean serum ACE level was significantly higher in the SLE group compared with controls (p = 0.006). Subjects with DD genotype had a significantly higher mean level than those with DI (p = 0.015) and II genotypes (p = 0.02). Lupus nephritis patients had a significantly higher frequency of DD versus DI and II genotypes compared with lupus patients without nephritis (Fisher's exact test, p = 0.025) and controls (χ (2) =8.74, p = 0.003). SLE patients with vasculopathy had a significantly higher frequency of DD versus DI/II genotypes compared with SLE patients without vasculopathy (Fisher's exact test, p = 0.04) and controls (χ(2 )= 9.84 and p = 0.002). Mean serum ACE level was significantly higher in the lupus nephritis and SLE patients with vasculopathy compared with controls (p = 0.008, p = 0.001, respectively). Significant positive correlations were found between serum ACE level and serum creatinine and 24 h proteinuria (p = 0.03, 0.009, respectively). SLE patients with DD genotype had a statistically significant higher mean SLEDAI score than those with (DI/II) genotypes (p = 0.02). Significant positive correlation was found between serum ACE levels and SLEDAI scores (p = 0.04). ACE genotype and subsequently serum ACE level could be associated with the disease activity of Egyptian SLE patients; in addition, ACE deletion polymorphism might be used as one of the predictive factors for the activity of SLE. Further studies on a larger number of patients should be done to determine the exact prevalence of ACE gene polymorphism among Egyptian SLE patients.

Shrinking lung syndrome in systemic lupus erythematosus patients; clinical characteristics, disease activity and damage

To detect the prevalence of shrinking lung syndrome (SLS) among systemic lupus erythematosus (SLE) patients and study their clinical, laboratory and radiological characteristics and differences in disease activity and damage. The study included 200 Egyptian SLE patients and SLS was considered in those with exertional dyspnea, restrictive pulmonary function tests (PFTs) and elevated copula of the diaphragm. Full history taking, thorough clinical examination, laboratory and relevant radiological investigations were performed for all the patients. High-resolution computed tomography scans of the chest were performed for patients with radiological findings consistent with SLS and those with pulmonary manifestations. The mean age of the patients was 29.3 ± 8.4 years, mean disease duration 5.81 ± 4.32 years and female to male ratio was 9 : 1. SLS was present in 27 patients (13.5%) with a female to male ratio of 3.5 : 1.0. The demographic features, clinical and laboratory manifestations, renal biopsy class, disease activity and damage scores, PFTs and radiological findings of the SLE patients are presented. Shrinking lung syndrome is not rare and presents a considerable subset of SLE patients. In SLE patients with dyspnea or chest pain, SLS should be looked for and PFTs are highly suggestive.

Serum interferon-alpha level in first degree relatives of systemic lupus erythematosus patients: Correlation with autoantibodies titers

Background and objectives Interferon-α (IFN-α), a cytokine with both antiviral and immune-regulatory functions, was suggested as a useful tool which can evaluate current systemic lupus erythematosus (SLE) disease activity and identify patients who are at risk of future disease flares. In the current study, serum IFN-α levels and associated demographic, and serological features in Egyptian SLE patients and their first degree relatives (FDRs) in comparison to unrelated healthy controls (UHCs) were examined, in order to identify individuals at the greatest risk for clinical illness. Methods In a cross-sectional study, blood samples were drawn from 54 SLE patients, 93 of their FDRs who consented to enroll into the study and 76 UHCs. Measurement of serum IFN-α by a modified ELISA was carried out. Data were analyzed for associations of serum IFN-α levels with autoantibodies titer. Results Mean serum IFN-α in FDRs was statistically higher than the UHCs and lower than in SLE patients ( P < 0.0001) and it was correlated with ANA titer ( r = 0.6, P < 0.0001) and anti ds DNA titer ( r = 0.62, P < 0.0001). Conclusion IFN-α is a crucial player in the complicated autoimmune changes that occur in SLE and serum IFN-α can be a useful marker identifying persons who are at risk of future disease development.

Reduced serum concentrations of 25-hydroxy vitamin D in Egyptian patients with systemic lupus erythematosus: relation to disease activity.

SummaryBackgroundRecently, vitamin D deficiency has been implicated as a potential environmental factor triggering some autoimmune disorders, including systemic lupus erythematosus (SLE)). In addition, patients with SLE, especially those with increased disease activity, were suggested to have decreased vitamin D level, suggesting that vitamin D might play a role in regulating autoantibody production.Material/MethodsTo assess 25 hydroxy vitamin D [25(OH)D] status in Egyptian patients with SLE and its relation to disease activity. Clinical evaluation and assay of serum 25(OH)D, total calcium, phosphorous, alkaline phosphatase (ALP) and parathyroid hormone (PTH) were done on 60 SLE patients in comparison to 60 matched-healthy subjects. Serum 25(OH)D levels <30 and 10 ng/ml were defined as vitamin D insufficiency and deficiency, respectively.ResultsSerum 25(OH)D was significantly lower in patients than in controls (26.33±12.05 vs. 42.66±9.20 respectively, p<0.0001), with 13.30% and 60% being deficient and insufficient, respectively. Serum 25(OH)D levels were lower with increased disease activity (p=0.03) and frequency of photosensitivity(p=0.02) and photoprotection (p=0.002). Systemic lupus erythematosus disease activity index (SLEDAI) score (OR: 2.72, 95% CI: 1.42–5.18, P=0.002), photosensitivity (OR: 3.6, 95% CI: 1.9–6.8, P<0.01) and photoprotection (OR: 6.7, 95% CI: 2.9–8.8, P<0.001) were significant predictors of 25(OH)D level among SLE cases.ConclusionsLow vitamin D status is prevalent in Egyptian SLE patients despite plentiful exposure to sunlight throughout the year, and its level is negatively correlated to disease activity. Future studies looking at a potential role of vitamin D in the pathophysiology and treatment of SLE are warranted.

HLA-DRB1*15 Confers Susceptibility to Juvenile SLE But is Not Associated with Disease Presentation: An Egyptian Study

The etiology of Systemic lupus erythematosus (SLE) seems to be multifactorial including environmental as well as genetic factors. Major histocompatibility complex (MHC) genes especially HLA-DRB1 and HLA-DQB1 are strongly implicated in susceptibility to SLE. Moreover ethnicity has been found to have a significant role in both disease susceptibility and disease expression. This study was carried out to determine HLA-DRB1 allele association with SLE susceptibility and disease presentation in Egyptian children with juvenile onset SLE. HLA-DRB1 allele typing was done using polymerase chain reaction-sequence-specific oligonucleotide probe for 65 juvenile Egyptian SLE patients and 150 healthy controls. p-values were corrected for the number of the alleles tested (Pc). HLA-DRB1*15 g allele was significantly increased in SLE children versus controls (OR = 4.76; 95% CI = 1.83–12.4; p = 0.001 and Pc = 0.012). No HLA-DRB1 allele was found to be statistically significant associated with musculoskeletal, cutaneous, hematologic, cardiac or neuropsychiatric manifestations in SLE patients (p > 0.05). Moreover no statistically significant association was found between HLA-DRB1 alleles and clinical presentation or histologic classes of lupus nephritis. The current work suggests that HLA-DRB1*15g allele may be a susceptibility allele in Egyptian children with SLE but is not related to clinical presentation of SLE.

Systemic lupus erythematosus in Egyptian children

The aim of the study was to study the characteristics of systemic lupus erythematosus (SLE) in the Egyptian population, comparing it to other populations. We retrospectively studied 207 patients with SLE diagnosed between 1990 and 2005. We obtained clinical features and laboratory data and analyzed them statistically. We studied 151 female and 56 male SLE patients. The female to male ratio was 2.7 to 1 and the mean age at presentation was 10 +/- 2.7 years (range 2-16). The mean disease duration was 6.47 +/- 3.74 years. At diagnosis, musculoskeletal, constitutional and mucocutaneous manifestations were the commonest features. During follow-up, the prevalence of nephritis (67%), hematological manifestations (44.9%), photosensitivity (44%), arthritis (39%), malar rash (38.2%), serositis (32.9%) and neuropsychiatric manifestations (24.25%) increased significantly. Those whose age of onset of the disease was <or=5 years (nine patients) had significantly more common hematological affection (P value = 0.0005). The characteristics of SLE in Egyptian patients show some similarities to other series of Middle Eastern countries, but with a lower female to male ratio. Disease onset below 5 years is extremely rare (4.35%), commonly presenting with hematological manifestations. The kidney was the commonest major internal organ involved, and also an important cause of death.

Correlation between levels of TNF-α and IL-6 and hematological involvement in SLE Egyptian Patients with lupus nephritis

Systemic lupus Erythematosus (SLE) is a rheumatic autoimmune disease characterized by multisystem organ involvement and by high titers of auto antibodies against several nuclear and cytoplasmic antigens. Numerous abnormalities of the cytokine network have been described in patients suffering from SLE. However the role of cytokines in different organ involvement is not yet well defined. To determine if levels of Interlukin-6 (IL-6) and Tumor necrosis factor (TNF-alpha) correlate with SLE disease activity in Egyptian SLE patients and more specifically with hematological involvement. Levels of TNF-alpha and IL-6 in serum samples from sixty individuals (40 with Systemic lupus Erythmatosus and 20 healthy controls) were determined and renal biopsies were obtained from SLE patients. Levels of TNF-alpha and IL-6 were higher in SLE patients with active compared with inactive hematological disease. Further analysis showed that this association was dependent on inverse correlation (P=0.017, r=-0.49) for IL-6 and (P=0.76, r=-.243) for TNF-alpha. The mean level of TNF-alpha and Il-6 was (766.95+/-357.82 pg/ml) and (135.4+/-54.23 pg/ml) respectively for patients with active disease while it was (314.01+/-100.87 pg/ml) and (47.33+/-18.61 pg/ml) for those with inactive disease and (172.7+/-39.19 pg/ml) and (21.15+/-10.99 pg/ml) for the healthy control group respectively. The difference was statistically significant (P=0.002). We found significant positive correlations between TNF-alpha and IL-6 and the SLE Disease Activity Index (SLEDAI) score. (r=+0.743 and +0.772 respectively). Raised level of Il-6 and TNF-alpha may influence the development of anemia in Egyptian patients with Lupus Nephritis.