Lupus Erythematous Disease Activity Index Research Articles

Systemic lupus erythematosus disease activity and neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio: a cross-sectional case-control study.

One hundred sixty people, divided equally into two groups: SLE patients, diagnosed according to the 2010 American College of Rheumatology/European League Against Rheumatism criteria, and healthy controls matched in age and gender, attending the University Hospitals between April 2019 and January 2021. White blood cells count, neutrophils count, lymphocytes count, platelet count, erythrocyte sedimentation rate, C-reactive protein, serum complements (C3 and C4), anti-double-stranded deoxyribonucleic acid, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and the SLE disease activity by using Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) was compared between the patient group and the control group. Demographic data were collected from all participants, and data on the disease, including disease durations and disease activity, were only collected from the patients. The age of the patients was 30.49±10.979 years, while it was 34.54±13.710 years in the control group (P=0.249). In all, 90% were females and 10% were males in the patient's group, while 85% were female and 15% were males in the control group. NLR and PLR were significantly higher in SLE patients compared to healthy control. A significant relation was found between SLEDAI and NLR and PLR. The NLR and PLR are correlated with disease activity while also being cost-effective.

The Spectrum of C4d Deposition in Renal Biopsies of Lupus Nephritis Patients.

ObjectivesThis study aimed to determine the prevalence and localization of complement factor C4d in renal biopsies from patients with lupus nephritis (LN), as well as its associations with the disease’s clinico-pathological features. The correlation between arteriolar C4d deposition and renal microvascular lesions (RVLs) was further analyzed.MethodsA total of 325 biopsy-proven LN patients were enrolled, and their clinico-pathological data were collected. C4d staining of renal biopsies was performed by immunohistochemistry. The associations between C4d deposition and the clinico-pathological features were further analyzed.ResultsC4d deposition was present in most (98.8%) renal specimens in our cohort. These deposits were localized in the glomeruli (98.2%), tubular basement membrane (TBM) (43.7%), arterioles (31.4%), and peritubular capillary (33.8%). Patients with TBM C4d staining had higher disease activity (measured with the Systemic Lupus Erythematous Disease Activity Index) and higher National Institutes of Health pathological activity and chronicity indices (all P < 0.01). Patients with arteriolar C4d deposition were more likely to develop RVLs (91.2%) compared to those with no arteriolar C4d deposition (78.0%; P = 0.004), especially with two or more types of RVLs (P < 0.001). During the mean follow-up of 55.8 months, arteriolar C4d was related to worse renal outcomes [hazard ration (HR): 2.074, 95% confidence interval (CI) 1.056–4.075, P = 0.034]. Multivariate Cox hazard analysis showed that co-deposition of arteriolar C4d and C3c was an independent risk factor (HR: 3.681, 95% CI 1.519–8.921, P = 0.004) for predicting renal outcomes.ConclusionsC4d deposition was common in renal tissues from LN patients. TBM C4d deposition was related to the disease activity, and arteriolar C4d deposition was associated with RVLs and worse renal outcomes.

Deformación miocárdica evaluada por ecocardiografía bidimensional en pacientes lúpicos de un hospital nacional

Antecedentes. Los pacientes con lupus eritematoso sistémico (LES) tienen alto riesgo de compromiso cardíaco con elevada mortalidad, por lo que el diagnóstico subclínico podría mejorar su sobrevida. Se ha observado que el strain (deformación) miocárdico longitudinal (SGL) puede ser de utilidad para la evaluación de la función cardíaca en estos pacientes.&#x0D; Objetivos. Evaluar la función miocárdica mediante el análisis del strain longitudinal bidimensional (2D), comparar el strain longitudinal entre pacientes con LES y controles, y determinar la correlación con el índice de actividad del LES.&#x0D; Material y métodos. Se estudiaron a 44 pacientes con LES (50 ±13 años) y 50 controles (49 ±12 años) pareados por edad y sexo, a quienes se les realizó un ecocardiograma transtorácico bidimensional. Se valoró el strain longitudinal mediante el método de speckle tracking, y la actividad del LES se estimó mediante el Systemic Lupus Erythematous Disease Activity Index (SLEDAI). Se definió como LES activo con una puntuación ≥ 4.&#x0D; Resultados. El strain longitudinal global2D fue menor en pacientes con LES que los controles (– 17,3% ± 1,9% vs. – 20%, ± 1,9%; p=0,00). No hubo diferencias en la fracción de eyección de ventrículo izquierdo entre ambos grupos, ni en 2D (p=0,650), ni en 3D (p=0,718). En los pacientes lúpicos, el SLEDAI varió entre 0 y 10, y el 63,8% estuvieron inactivos. Se halló correlaciones negativas significativas entre el puntaje de SLEDAI y la FEVI bidimensional (r de Pearson=-0,372, p=0,017); no se encontró correlación entre el puntaje de SLEDAI y el strain longitudinal global 2D (rho de Spearman=- 0,091 p =0,582). &#x0D; Conclusiones. El strain longitudinal global 2D se encontró disminuida en aquellos afectados con LES, lo que sugiere que podría ser una herramienta útil para evaluar la función cardíaca en estos pacientes.&#x0D; &#x0D;

Urinary Soluble Alpha Chain of the Interleukin-2 Receptor as a Biomarker of Active Lupus Nephritis in Egyptian Children With Juvenile Systemic Lupus Erythematosus

Objectives This study aims to assess the urinary soluble alpha chain of the interleukin-2 receptor (sCD25) concentrations in patients with juvenile systemic lupus erythematosus (JSLE) and to evaluate its validity to be a possible marker of disease activity in patients with lupus nephritis (LN). Patients and methods We assessed sCD25 concentrations in urine samples obtained from 53 JSLE patients (15 males, 38 females; median age 11 years; range, 7 to 17 years) and 30 age- and sex-matched apparently healthy controls (10 males, 20 females; median age 10 years; range, 6 to 16 years). Concentrations were normalized according to urinary creatinine excretion. JSLE patients were subjected to clinical examination and assessment of overall disease activity by Systemic Lupus Erythematous Disease Activity Index (SLEDAI), while evaluation of LN activity was preformed using Systemic Lupus International Collaborating Clinics (SLICC) renal activity score.Results The JSLE patients had significantly higher normalized urinary sCD25 concentrations compared to the healthy controls (p=0.001). Patients with active LN had significantly higher normalized urinary sCD25 levels than active JSLE patients without LN (p=0.002) and JSLE patients with inactive disease (p<0.001). A significant positive correlation was found between normalized urinary sCD25 concentrations with different activity parameters such as proteinuria (p=0.004), SLEDAI (p<0.001), renal SLEDAI (p<0.001), and SLICC renal activity score (p<0.001). A significant negative correlation was found between urinary sCD25 and complement 3 (p<0.001).ConclusionUrinary concentrations of sCD25 were significantly elevated in JSLE patients, particularly in those with active LN. The remarkable association between urinary sCD25 concentrations and different renal disease activity parameters implies that urinary sCD25 can be a beneficial marker to monitor active nephritis in JSLE patients.

Characterization of patients with lupus and fever: Flares, infection or both

ObjectiveTo describe the clinical characteristics and laboratory findings of patients over 15 years old, diagnosed with Systemic Lupus Erythematosus (SLE) that were hospitalized with fever and with a final diagnosis of infection, lupus flare, or both (disease activity and infection). MethodsA retrospective, desriptive study was conducted, including patients with a diagnosis of SLE, who presented with fever and were admitted to the Emergency Department of Hospital Universitario Clinica San Rafael. Clinical and paraclinical variables were analyzed and the patients were divided into three groups: patients with disease flare-up, infection, or both, in accordance with the final diagnosis upon discharge. Clinical and laboratory variables were analyzed, and a description of the population was submitted based on the 3 presentations. ResultsA total of 115 patients were assesed, and 108 were included in the final analysis. The mean age was 36 years old and 86% were females. The median SLEDAI (Systemic Lupus Erythematous Disease Activity Index) was 6 (R 1-15) for the entire population. In patients with both infection and disease activity, the median score was 9.5 (R 6-15). There were no significant differences betweent the clinical symptoms and the laboratory findings in the various groups. The use of prednisolone during the last 3 months was higher in the infection group (p=0.001), but with no significant differences as compared against other immonusupressive therapies. ConclusionThe use of steroids over the last 3 months, the SLEDAI score, and the time elapsed sinde the SLE diagnosis, could be helpful variables to discriminate between infection and disease activity in patients with a history of SLE and fever. The clinical and paraclinical findings fail to discriminate between these two conditions.

Carotid artery atherosclerosis and ECG changes in patients with systemic lupus erythematosus: relation to disease activity and severity

AimThis study aimed to detect atherosclerotic changes in the carotid arteries of systemic lupus erythematous (SLE) patients as an indicator of cardiovascular risk factors and to correlate the findings with disease severity and activity parameters as well as to study specific ECG changes in these patients to elucidate possible associations between these variables.Patients and methodsThis study included 30 SLE patients who met the Systemic Lupus International Collaborating Clinics (SLICC) criteria (group I), 30 rheumatoid arthritis (RA) patients diagnosed according to the American College of Rheumatology/European league against rheumatism (EULAR) 2010 criteria (group II), and 30 apparently healthy volunteers age and sex matched to the SLE patients’ group (group III). All patients were subjected to full history taking, thorough clinical examination, assessment of disease activity using the Systemic Lupus Erythematous Disease Activity Index (2 K) score and assessment of damage by the SLICC/American College of Rheumatology Damage Index (SDI). Laboratory investigations included: complete blood count, erythrocyte sedimentation rate, lipid profile, immunological profile (antinuclear antibodies, anti-double-stranded DNA antibody, anticardiolipin antibody, and complements C3 and C4). The right common carotid artery was scanned by ultrasound and the average of carotid intima media thickness (CIMT) was calculated (mean of four readings) for all participants participating in the study. ECG was also done for all participants.ResultsThe mean CIMT was higher in RA patients (0.71±0.194 mm) with a nonsignificant difference compared with SLE patients (0.68±0.197 mm) and a high statistically significant difference (P<0.001) compared with healthy controls (0.34±0.09 mm). There was no statistically significant correlation of the mean CIMT (mm) with SLICC damage index (P=0.09) and disease activity score (P>0.05). Abnormal ECG findings were observed in 3/30 SLE patients (10%), 10/30 RA patients (33.3%), and one/30 healthy control (3.3%), with statistically significant difference (P<0.03) among groups. The presence or absence of abnormal ECG findings showed statistically insignificant differences regarding patients’ disease activity and mean CIMT.ConclusionAlthough ECG changes were present in 10% of our SLE patients, association of specific ECG changes could not be confirmed. A greater prevalence of increased CIMT was observed in SLE patients, emphasizing the important role of this disease in the development of premature atherosclerosis which did not correlate with disease activity or severity parameters.

Red blood cell distribution width to estimate lupus activity

Objective The aim of the study was to study red blood cell distribution width (RDW) in systemic lupus erythematous (SLE) patients as a lupus activity marker. Background SLE is a multifactorial systemic autoimmune disease that can affect multiple organs. The general pathogenesis of this disease still needs a better understanding. RDW is a measure of the red blood cell size variation. Patient and methods This prospective study was carried in the Internal Medicine Department, Menoufia University Hospital, from March 2016 to August 2016. Our study included 58 patients with SLE activity, which was measured using the Systemic Lupus Erythematous Disease Activity Index. RDW was measured as one of the parameters of complete blood count. RDW was reported on the Sysmex XT. In this study we excluded any other causes of anemia and other connective tissue diseases. Results The study included 58 SLE patients: 20 systemic lupus patients with high activity and 38 systemic lupus patients with very high activity. RDW was higher in systemic lupus patients with very high activity than in systemic lupus patients with high activity. There was a highly significant correlation between RDW and Systemic Lupus Erythematous Disease Activity Index. There was a highly significant correlation between RDW and erythrocyte sedimentation rate. Conclusion There was statistically higher RDW in lupus patients with very high activity than in those with high activity; therefore, RDW can be used as a lupus activity marker. RDW was associated with the inflammatory process of SLE.

Influence of air pollution on airway inflammation and disease activity in childhood-systemic lupus erythematosus.

Exposure to fine particles may trigger pulmonary inflammation/systemic inflammation. The objective of this study was to investigate the association between daily individual exposure to air pollutants and airway inflammation and disease activity in childhood-onset systemic lupus erythematosus (cSLE) patients. A longitudinal panel study was carried out in 108 consecutive appointments with cSLE patients without respiratory diseases. Over four consecutive weeks, daily individual measures of nitrogen dioxide (NO2), fine particulate matter (PM2.5), ambient temperature, and humidity were obtained. This cycle was repeated every 2.5 months along 1year, and cytokines of exhaled breath condensate-EBC [interleukins (IL) 6, 8, 17 and tumoral necrose factor-α (TNF-α)], fractional exhaled NO (FeNO), and disease activity parameters were collected weekly. Specific generalized estimation equation models were used to assess the impact of these pollutants on the risk of Systemic Lupus Erythematous Disease Activity Index 2000 (SLEDAI-2K) ≥8, EBC cytokines, and FeNO, considering the fixed effects for repetitive measurements. The models were adjusted for inflammatory indicators, body mass index, infections, medication, and weather variables. An IQR increase in PM2.5 4-day moving average (18.12μg/m3) was associated with an increase of 0.05pg/ml (95% CI 0.01; 0.09, p=0.03) and 0.04pg/ml (95% CI 0.02; 0.06, p=0.01) in IL-17 and TNF-α EBC levels, respectively. Additionally, a short-term effect on FeNO was observed: the PM2.5 3-day moving average was associated with a 0.75ppb increase (95% CI 0.38; 1.29, p=0.03) in FeNO. Also, an increase of 1.47 (95% CI 1.10; 1.84) in the risk of SLEDAI-2K≥8 was associated with PM2.5 7-day moving average. Exposure to inhalable fine particles increases airway inflammation/pulmonary and then systemic inflammation in cSLE patients.

Urinary interleukin 22 binding protein as a marker of lupus nephritis in Egyptian children with juvenile systemic lupus erythematosus.

Juvenile systemic lupus erythematosus (JSLE) is a multi-system autoimmune inflammatory disease. Generally, 60% of patients will develop lupus nephritis (LN); thus, early recognition and treatment is associated with better outcome. Interleukin 22 (IL-22) is involved in tissue inflammation and is regulated by interleukin 22 binding protein (IL-22BP). This study aimed to use IL-22BP as a non-invasive marker for disease activity in JSLE and LN. This is a cross-sectional study conducted on 82 subjects: 51 JSLE patients and 31 healthy controls of matched age and gender. Urinary IL-22BP was measured using enzyme-linked immunosorbent assay, and its level was correlated with different clinical and laboratory data in JSLE as well as Systemic Lupus Erythematous Disease Activity Index 2000 (SLEDAI-2k), renal SLEDAI-2k, and Systemic Lupus International Collaborating Clinics (SLICC) renal activity score which were used to assess overall disease and renal activity. Our results showed that urinary IL-22BP level was significantly higher in JSLE patients with mean level of 4.13±1.10, as compared to controls 1.63±0.61 (P value<0.001); also, patients with active LN had urinary levels of IL-22BP (5.47±1.03) higher than patients with active JSLE without LN (4.23±0.72) and patients with non-active JSLE/LN (3.5±0.65) with a highly significant P value <0.001. There was a positive correlation with SLEDAI-2k, renal SLEDAI, and renal activity scores (P<0.001). Urinary IL-22BP may be used as a non-invasive marker for assessment of disease activity in children with JSLE and LN.

Semaphorin 5A, Anti-Nucleosome Antibodies and Ferritin: Disease Activity Markers in Patients with Systemic Lupus Erythematosus

Background: Systemic Lupus Erythematosus (SLE) is a multi-factorial, chronic autoimmune disorder characterized by dysfunction of T and B lymphocytes. Although the prognosis of SLE has improved in the past few decades, the absence of biomarkers for residual activity in various organs and the early detection of disease flares hamper further management. Conventional serologic markers of SLE, such as anti-dsDNA and complement levels, are not ideal, as they are not sufficiently sensitive and specific for the diagnosis of the disease and monitoring of disease activity. Thus, novel biomarkers for SLE activity have to be developed. Semaphorin 5A (Sema 5A), antinuclosome antibody (Anu A) and ferritin may fall into this category of novel bio markers.Objective: To evaluate the role of serum Sema 5A, Anu A and ferritin in detection of SLE activity.Methods: The present study included 40 patients with SLE divided according to Systemic Lupus Erythematous Disease Activity Index (SLEDAI) into two groups: 20 active SLE and 20 inactive SLE patients. They were compared with 20, sex and age matched healthy individuals for control. Levels of Sema 5A, Anu A were measured by Enzyme- Linked Immunosorbent Assay (ELISA) and serum ferritin levels were measured by Electrochemiluminescence immunoassay (ECLIA).Results: There was highly significant increase in Sema 5A, Anu A and ferritin levels inactive when compared within active SLE patients and control subjects (P=0.000 and P=0.000 and P=0.000 respectively). There was a significant increase in ferritin level in inactive SLE patients when compared with control subjects (P=0.045) with no significant difference regarding Sema 5A, Anu A (P3=0.089 and 0.225 respectively). There were positive correlations between Sema 5A, Anu A, ferritin and each of SLEDAI, and CRP. Positive correlation also found between Sema 5A and each of Anu A and ferritin and between AnuA and ferritin. Negative correlation was found between Sema 5A and C3 and between Anu A, ferritin and C4. Significant relation was found between Sema 5A, Anu A, ferritin and each of ANA and anti-dsDNA in active SLE patients. Area under the curve (AUC) for ferritin, Sema 5A and Anu A were (0.861, 1.0 and 1.0 respectively).Conclusion: Our study showed that the serum proteins semaphorin 5A, antinuclosome antibodies and ferritin may be useful markers in monitoring disease activity in patients with SLE. Regarding area under the curve (AUC), these serum protein markers result in even better sensitivity and specificity profiles in picking up early relapse of SLE.

Increased von Willebrand factor levels in patients with systemic lupus erythematosus reflect inflammation rather than increased propensity for platelet activation

Backgroundvon Willebrand factor (VWF) is involved in platelet plug formation and protein transport. Increased VWF levels in systemic lupus erythematous (SLE) are considered risk factors for vascular events. VWF protein...

Correlations between Serum prohepcidin level disease activity in rheumatoid arthritis and systemic lupus erythematous

The aim of this study was to determine whether there is a relation between serum prohepcidin level and disease activity of rheumatoid arthritis (RA) and systemic lupus erythematous (SLE), and to discover whether it has a role in the anaemia of chronic disease occurring in RA and SLE patients. This study was carried out on 30 patients suffering from RA and 30 patients suffering from SLE. In addition, 20 healthy volunteers were recruited as controls. All patients and controls were subjected to full history taking, thorough clinical examination, locomotor system examination, assessment of the disease activity in RA patients using the Disease Activity Score-28, assessment of the disease activity in SLE patients using Systemic Lupus Erythematous Disease Activity Index, laboratory investigations, including complete blood count, erythrocyte sedimentation rate (ESR), rheumatoid factor and C-reactive protein (CRP), and measurement of serum prohepcidin levels by the enzyme-linked immunosorbant assay. The mean serum prohepcidin concentration was 395.2±551.4ng/ml in RA patients, whereas it was 381.5±88.07 in SLE patients and 121.4±11.1ng/ml in healthy volunteers. The prohepcidin concentration correlated with the rheumatoid factor, Creactive protein, ESR, disease duration, morning stiffness, tender joint count, swollen joint count, Larsen score, haemoglobin level and Disease Activity Score-28 in RA patients. There were positive significant correlations between the mean serum prohepcidin concentration and platelets number, haemoglobin level and ESR in SLE patients and insignificant correlations between the mean serum prohepcidin concentration and Systemic Lupus Erythematous Disease Activity Index. Prohepcidin could be considered as a useful marker for RA, but not for SLE. Prohepcidin may have a role in anaemia of chronic disease occurring in RA and SLE.

Interleukin-17 - association to silent lupus nephritis and disease activity

Background: Systemic lupus erythematosus is a multiorganic, chronic immune disease and lupus nephritis, a severe manifestation, represents the strongest predictor of a poor outcome of this pathology. Cytokines play an important role in lupus nephritis and consequently, their use as biomarkers of active systemic lupus erythematosus disease is of particular interest. The purpose of this work was to study the pro-inflammatory role of interleukin-17 in renal involvement in patients with systemic lupus erythematosus (SLE). Methods: We performed a retrospective study of 87 patients diagnosed with SLE according to the Systemic Lupus International Collaborating Clinics 2012 diagnosis criteria. In this study, we determined the serum levels of interleukin-17 by ELISA. Results: It was observed that 49 patients in the study group presented with positive values of interleukin-17, range (1.12 - 23.66) pg/ml. There was a positive correlation of interleukin-17 with active SLE as assessed by the Systemic Lupus Erythematous Disease Activity Index. No association was found between serum interleukin-17 level and renal pathology at the inclusion or in the clinical history of the patients. Patients with leukocyturia and hematuria presented higher values of serum interleukin-17 than those without these manifestations. In the linear regression model, after adjusting for age, gender and treatment we found an independent association between serum IL-17 levels and leukocyturia presence with OR=2.06, 95% CI range (1.22-2.89). Conclusions: A positive correlation has been observed between serum IL-17 and the SLE disease activity as assessed by the SLEDAI score computed without anti-DNA antibodies. Also, the IL-17 levels was strongly associated with the presence of leukocyturia and hematuria, even in patients with no clinical evidence of renal disease that might have silent lupus nephritis usually associated with a benign renal outcome.

A77: Clinical and Laboratory Features and Systemic Lupus Erythematous Disease Activity Index 2000 (SLEDAI 2K) at Onset and Follow Up in a Cohort of 109 Paediatric Lupus Patients From a Tertiary Level Centre in India

Background/Purpose:Pediatric Rheumatology is a relatively new branch in India. To the best of our knowledge, this is the first paper that has studied SLEDAI 2K in 109 children with SLE at onset, 6 months and annually thereafter for a median follow up of 38 months.Methods:In our unit, disease activity of all children with lupus is captured on disease assessment proformas and completed every 3–6 months. This form captures demographics, clinical assessment, lab results and therapy. All paediatric lupus patients (diagnosed per the ACR criteria 1992) with disease onset &lt;18 years seen at our unit from 2001 were included. The clinical and laboratory features at presentation and the SLEDAI 2K was captured at onset, 6 months and thereafter annually. We chose SLE 2K as an outcome measure as it captures new, recurrent and ongoing disease activity ().The aims of the study were To detail the presentation of cSLE from India To study the SLEDAI 2K at onset and follow up To compare the data from India to that available from the West. available from the West.Results:Demographics: 109 patients identified, 90 were females. The median age at onset was 11.4 (3.4‐18) years and median age at diagnosis 12.1 (3.5‐19). The median duration of follow up was 38 months (3‐152).Clinical presentation at onset: As in table . Nine children had MAS at onset. Table 1. Feature % positive Constitutional fever 83 arthralgia 80 Fatigue 70 myalgia 55 weight loss 43 Lupus features malar rash 62 arthritis 60 alopecia 59 mucositis 56 photosensitivity 39 vasculitis 38 nephritis 35 lymphadenopathy 33 neurologic 17 effusion 14Labs at onset: ANA positive in 97%, DsDNA in 80%, low complements seen in 84%. Anemia, leucopenia and thrombocytopenia present in 37, 31, and 28% respectively. APL antibodies positive in 28%.SLEDAI 2K at onset and follow up: Table SLEDAI 2K in a Cohort of cSLE Patients at Onset and 5 Year Follow Up disease duration months no of patients Median SLEDAI % pts with SLEDAI &lt;4 SLEDAI Range 0 109 16 2 1 to 52 6 107 2 56 0 to 28 12 97 2 66 0 to 16 24 77 2 70 0 to 28 36 58 2 71 0 to 24 48 44 0 75 0 to 50 60 37 2 70 0 to 12Median SLEDAI 2K 16 at onset and subsequently all median SLEDAIs were &lt;4. Patients with inactive disease (SLEDAI 2K &lt;4) () 70–75% after the 6 months. Nineteen patients had a new organ involvement 6 months after disease onset, eight nephritis. Follow up: 54 patients had no flare, 27–1 flare and 28 patients had 2–5 flares each. One patient died, no patient had renal failure/transplant. Seven patients had hypothyroidism and 1 had celiac disease.Comparison with Western data: Of 256 patients with cSLE described from Toronto, the mean SLEDAI was 13 at onset and 2.9 at one year, very similar to our study (). The cohort from Israel studied 102 patients with a higher SLEDAI of 17 at onset, 7.6 at 5 years with 5 patients in renal failure ().Conclusion:80% of patients had fever and 33% had nephritis at onset. The disease burden at onset was high; median SLEDAI fell to &lt;4 within 6 months and remained low through follow up. 17% had new organ involvement after 6 months. 50% had no disease flare. The disease burden is similar to that described in the West.

Predictors of Survival in Systemic Lupus Erythematosus

We conducted the current study to determine the impact of demographic factors, household income, clinical manifestations, disease activity, serologic tests, and calendar year on survival among patients with systemic lupus erythematosus (SLE). In a large prospective cohort of patients with SLE, we used the Kaplan-Meier method to estimate survival probabilities of SLE patients over time since diagnosis. We analyzed the predictors of survival in SLE using Cox proportional hazards models.The study included 1378 patients with SLE, with a median follow-up in the cohort of 6.1 years. One hundred eighteen patients died (8.6%). The overall cumulative probability of survival after disease diagnosis at 5, 10, 15, and 20 years was 95%, 91%, 85%, and 78%, respectively. Based on a multivariable model, age at SLE diagnosis >or=50 years old (hazard ratio [HR]=5.9; p<.001) and male gender (HR=2.4; p=.004) were associated with poorer survival. Patients with annual family income<25,000 dollars had poorer survival (HR=1.7; p=.040). The presence of hemolytic anemia in the first year after disease diagnosis (p=.016) or during the follow-up period (p=.031) increased the risk of death. A low complement level during the first year after diagnosis was the only serologic marker of poorer survival (p=.013 for low C3 level and p=.053 for low C4 level).