Systemic Lupus Erythematosus in Greece. Clinical Features, Evolution and Outcome: a Descriptive Analysis of 292 Patients

Abstract

The purpose of this study was the descriptive analysis of patients with systemic lupus erythematosus (SLE) with a particular focus on initial clinical features, evolution and outcome of disease, prevalence of clinical and serological manifestations and identification of clinicoserological associations indicative of renal and CNS involvement. The methodology applied was the following: retrospective analysis of the clinical charts of 292 unselected patients (246 female (84.2%) and 46 male (15.7%)) with SLE examined between 1982 and 1992. Multivariate analysis and hierarchical log linear models were used to examine for clinicoserological associations. Descriptive analysis was based on the prevalence of main clinicoserological features and disease outcome. The outcome was examined on the basis of the number of flares, the presence of chronic renal failure, the presence of central nervous system (CNS) involvement with subsequent disability and deaths. Flares were considered the severe alterations in disease status, requiring additional therapy to be controlled. The disease begins most frequently in the second and third decade of life with cutaneous and joint manifestations, while renal and CNS involvement developed later. The prevalence of serious renal, pulmonary and CNS involvement as well as the prevalence of RF, anti-Sm and anti-nRNP antibodies remain low. Multivariate analysis revealed the associations of renal involvement with leukopenia and serositis, of anti-Sm with leukopenia, of secondary Sjogren's syndrome with RF and of thromboembolic events with anticardiolipin antibodies. Patients with childhood onset SLE have a higher tendency for developing renal involvement than adult onset SLE patients. In addition, anti-Ro(SSA) antibodies were associated with anti-La(SSB) and RF, while anti-Sm antibodies were associated with anti-nRNP and RF. Flares occurred with a frequency of 0.07 per patient per year. Only 63.6% of flares were accompanied by positive anti-dsDNA reactivities. Reported deaths were 0.0047 per patient per year. Hierarchical log linear models indicated that the main variables of the disease were sufficient to describe our disease model and that the order of the interaction between the variables was insignificant. We conclude that the prevalence of various clinical features associated with SLE is similar, although the prevalence of CNS and pulmonary involvement as well as anti-Sm and anti-nRNP antibodies are less prominent in Greek SLE patients than that reported in the literature. The various clinicoserological associations detected do not appear to be of major significance as they are not powerful enough to subgroup the disease.

Factors and comorbidities associated with central nervous system involvement in systemic lupus erythematosus: a retrospective cross-sectional case–control study from a single center

“…About the clinical-serologic profile, our study substantially confirms what has been previously reported by some authors [12][13][14], but not by all [15], who had emphasized how skin involvement (especially discoid rash) and joints symptoms (arthritis) seem to be negatively related to the presence of NP manifestations. In our study, also leukopenia and hemolytic anemia were more frequently found among SLE patients without NP involvement.…”

Autoantibodies to human recombinant erythropoietin in patients with systemic lupus erythematosus. Correlation with anemia

“…All patients fulfilled the American College of Rheumatology criteria for the classification of SLE (4). Sera from 80 patients with rheumatoid arthritis (RA) (5), 40 with anemia (hemoglobin [Hgb] 5 1 2 gmidl) and 40 without anemia, were used as disease controls. No patients in this study received EPO for therapeutic use.…”

Increased levels of autoantibodies against catalase and superoxide dismutase associated with oxidative stress in patients with rheumatoid arthritis and systemic lupus erythematosus

“…SLE is accompanied by arthritis/arthralgias, cutaneous rash, vasculitis, and involvement of the central nervous system, with renal and cardiopulmonary manifestations (7,8), whereas the common feather of RA is a predominant synovial proliferation, a destruction of the articular cartilage associated with macrophages and activated T-cell infiltration in and around the joints (9). The relationship between different types of autoantibodies and especially their relationship to RA or SLE remain unclear.…”