Systemic lupus erythematosus (SLE) is a chronic multisystem disorder. Lupus nephritis (LN) is a common serious complication of SLE. LN needs prolonged care and complex therapeutic modalities. This study assessed the characteristics of Persian SLE patients with LN (LN subgroup) and an SLE subpopulation without LN (non-LN subgroup). Furthermore, the association of LN with extrarenal manifestations of SLE was studied. This study assessed 2355 SLE patients from the electronic database of the Rheumatology Research Center (RRC), Tehran University of Medical Sciences (TUMS). The clinical and laboratory data of enrolled patients was retrieved. The chi-square test was used to compare extrarenal manifestations of the LN and non-LN subgroups. Odds ratios (OR) were used to present the strength of associations. The LN subgroup included 1604 cases (68.1%) with a mean age at SLE onset of 24.6±12.5 years and a female-to-male ratio of 8.7/1. Class IV nephritis was the most common type of LN (53.1%). The comparison of extrarenal manifestations revealed statistically significant differences between LN and non-LN subgroups. Major organ involvement including cardiopulmonary, hematologic, musculoskeletal and neuropsychiatric features was significantly more common in LN patients. On the contrary, discoid rash was significantly more common in the non-LN subgroup. This study revealed that LN is positively associated with musculoskeletal, mucocutaneous, and neuropsychiatric features of SLE.
Inequalities in features and severity of ankylosing spondylitis (AS) have been noticed between men and women, suggesting a possible influence of gender on disease phenotypes. Comparing disease features and characterization of gender differences in clinical features and medications could help elucidate the potential influence of gender on the severity of AS in patients. This study aims to assess the influence of gender on disease patterns in Iranian patients with AS. Three hundred and twenty patients diagnosed with primary AS were assessed for demographic variables, clinical manifestations, HLA status, disease severity, functional capacities, quality of life, and treatment status. Sixty-seven women and 253 men were included corresponding to a male to female ratio of 3.78:1. Both groups were similar regarding ethnicity, positive family history, and juvenile onset AS. HLA-B27 was more frequent among males (78.3 vs. 55.2%; p < 0.001). There was a higher proportion of female patients with overall enthesitis (p < 0.05). Extra-articular manifestations and treatment modalities presented similar frequencies in both genders. No difference in gender-associated diagnostic delays was observed. Female disease was at least as severe as male disease, and in some aspects, females presented with more severe disease. Despite a relatively similar disease profile, we observed a higher rate of enthesitis among women. Together with the equally high rate of disease activity indices in both genders, these findings indicate an overall longer delay to diagnosis in our country. Early detection and specialized care would be of great practical importance.
To investigate the impact of gender on expression of systemic lupus erythematosus (SLE) in a cohort of 2355 SLE patients as one of the largest series of cases among the present reports.
In this retrospective study we used medical records of all patients (239 male and 2116 female) of the SLE registry of Rheumatology Research Center (RRC), Tehran University of Medical science (TUMS), Iran. Both clinical and paraclinical manifestations of SLE patients have been registered in this database since 1976 and updated during their follow-up. Chi-square test was used to compare the clinical and paraclinical manifestations in men and women at disease onset and during the disease course. We used logistic regression to compute odds ratios with 95% confidence intervals. A P-value < 0.05 was considered as statistically significant.
Mean age at disease onset was 25 ± 11.8 and 24.5 ± 10.3 years in men and women, respectively (P = 0.48). Comparison of clinical and immunological manifestations showed that male patients had a higher prevalence of mucocutaneous (43.5% vs. 33.7%, P = 0.005) and a lower prevalence of musculoskeletal symptoms (44% vs. 54.7%, P = 0.003) as the initial manifestation. During the disease course, discoid rash (25.9% vs. 13%, P = 0.000) and type IV lupus nephritis (23.4% vs. 18.1%, P = 0.03) were significantly more common, whereas arthritis (61.1% vs. 71.7%, P = 0.01) and leukopenia (28.5% vs. 35.8%, P = 0.024) were significantly less common in men.
This study reveals gender influence on some manifestations of SLE. Considering sex differences is recommended in diagnostic and therapeutic features of the disease.
زمینه و هدف: بیماری لوپوس اریتماتوی سیستمیک (SLE) یک بیماری التهابی مولتی سیستم و خود ایمن با تولید اتو آنتیبادی علیه اجزای مختلف سلول است. این بیماری اتیولوژی ناشناخته و تظاهرات بالینی و آزمایشگاهی متفاوتی داشته، در نقاط مختلف کره زمین انتشار جغرافیایی وسیعی دارد. تظاهرات بیماری در بین گروههای نژادی و جغرافیایی مختلف متفاوت است. هدف این مطالعه ارائه چهره بیماری SLE در بیماران ایرانی است.
روش بررسی: این مطالعه آیندهنگر توصیفی بر اساس اطلاعات ثبت شده بیماران SLE مراجعهکننده به مرکز تحقیقات روماتولوژی دانشگاه علوم پزشکی تهران در طی سالهای 1355 تا 1386 انجام شده است.
یافتهها: تعداد 2143 بیمار مطالعه شدند. نسبت زن به مرد 8:1/8 و میانگین سنی در هنگام شروع بیماری 10±2/24 سال بود. شیوع تظاهرات بالینی در این بیماران شامل درگیری عضلانی- اسکلتی 2/85%، پوستی 1/83%، کلیوی 6/66%، عصبی- روانی 24%، ریوی 3/22%، قلبی 5/17% و خونی 1/67% بود. FANA مثبت در 3/78% و Anti- DNA بالا در 70% بیماران گزارش شد. سندروم همپوشانی و سابقه فامیلی مثبت بهترتیب در 9/14% و 5/3% بیماران دیده شد.
نتیجهگیری: در مقایسه با بیماران لوپوسی سایر مناطق دنیا، شیوع تظاهرات پوستی- مخاطی و کلیوی در بیماران ایرانی همانند کشورهای منطقه (با عوامل محیطی مشابه) و شیوع تظاهرات خونی و مفصلی همانند کشورهای اروپایی (با نژاد یکسان) بود. این نتایج میتواند تاثیر متفاوت فاکتورهای ژنتیکی و یا محیطی را در بروز تظاهرات بالینی مختلف لوپوس مطرح نماید.
Objective: Systemic lupus erythematosus (SLE) as a chronic autoimmune disease has a worldwide distribution. There is a wide variation in the natural history of SLE among different ethnic and geographic groups.
The aim of this study was to show the manifestations of SLE in Iranian patients.
Methods: The study was on manifestations of SLE according to the database of the Rheumatology Research
Center (RRC), Tehran, Iran, on registered patients during the period of 1976 to 2009.
Results: A total of 2280 SLE patients (2052 female and 228 male) were studied. The female : male ratio was
9 : 1 and the mean age at presentation was 24.4 10.4 years. Prevalence of manifestations included: musculoskeletal (83.2%), cutaneous (81.1%), renal (65.4%), neuropsychiatric (23.4%), pulmonary (21.5%), cardiac
(17.2%), and hematologic (66.4%) symptoms. There was positive antinuclear antibodies in 86.4% and antiDNA in 82.3% of patients. Overlap syndrome and positive family history with other autoimmune diseases
were detected in 7.6% and 3.4% of patients, respectively.
Conclusion: In our patients the prevalence of cutaneous involvement was similar to those of nearby countries (with similar climate). Renal involvement was seen more than some other countries especially more than European countries, while other manifestations (such as hematologic and joint involvement) were similar to European countries (with similar ethnicity). We may conclude that genetic and/or climatic factors may lead
to different presentations of lupus.