Systemic lupus erythematosus in the Fars Province of Iran

Abstract

Clinical features of systemic lupus erythematosus (SLE) have been described from different geographical regions in the world. However, data from many Middle East countries, including Iran, are scarce. This study aims to demonstrate the demographic, clinical, and laboratory characteristics in Iranian patients with SLE. In this prospective study, all the patients referring to Shiraz educational hospitals (Nemazi-Hafez) with SLE (American College of Rheumatology criteria) during a 5-year period (2001 to 2006) were included. A complete history was taken; physical examination and routine hematological, serological, and immunological tests were done for each patient. There were 356 women and 54 men with an average age of 30.27 years at the onset of disease. Of the patients, 78% had hematological abnormalities, 65.5% had articular involvement, 54.5% had photosensitivity, and 60.5% had malar rash. Serositis occurred in 38% of patients of whom 12% had pericarditis and 26% had pleuritis. Nephritis was diagnosed in 48% of the cases and consisted always of glomerular nephritis. Biopsy-proven lupus nephritis was in most cases class IV(49.7% of all the biopsies). Oral ulcers were observed in 28% of patients. Neuropsychiatric manifestations, gastrointestinal involvement, and lymphadenopathy were observed in 31.5%, 8.3%, and 14.2% of patients, respectively. In all, 93% of patients were positive for antinuclear antibodies, whereas antidouble-stranded DNA was positive in 83% of patients. Coomb's positive hemolytic anemia appeared in 12.4% of the cases. Rheumatoid factor was detected in 9.7% of patients, and lupus erythematosus cell was seen in 32.5% of them. In all, 196 (47.8%) patients represented hypocomplementemia. Regarding hematological manifestations, 74.5% had microcytic hypochromic anemia, 64.6% had leukopenia, and 44.6% had thrombocytopenia; 18 (4.4%) patients died during the study period of which eight (2%) died because of cardiopulmonary involvement. Generally, there was more cutaneous, serositis, and neuropsychiatric involvement in our population than other Middle East countries. Serositis was associated with poorer prognosis, and the pattern of disease in these patients was much more sever than patients without serositis (P = 0.001). This is the first study of its kind in Iran. More multicenter studies should be undertaken in Iran to describe the pattern of SLE.

Clinical picture of lupus nephritis in patients with systemic lupus erythematosus (SLE): Results of a large survey

“…This study identified a lupus nephritis prevalence rate significantly higher than that reported in a previous study (48%) conducted in Fars province of Iran between 2001 and 2006 [17]. This comparison may be indicative of an alarming incremental pattern of nephritis in the Persian SLE population or of a more elaborate examination of patients in the current study.…”

Comorbidity and pathogenic links of chronic spontaneous urticaria and systemic lupus erythematosus – a systematic review

“…Tables 1 and 2 A systematic literature search was conducted using PubMed and Google Scholar databases and 'urticaria' and 'systemic lupus erythematosus' as keywords, covering a period from 1950 to 2015. In most of the studies CSU or chronic urticarial rash in patients with SLE was termed 'chronic urticaria' [18,124], 'urticaria' [19][20][21][22][23]27,54,56,[125][126][127][128][129][130][131], 'urticarial eruptions of varying duration' [73], 'hives' [28,30,132,133], 'non-vasculitic urticaria' [25], 'urticarial lesions' [134,135] and 'chronic urticaria-like lesions' [26,53]. We did not include in the table reports where information on urticaria as a cutaneous manifestation of SLE was not reported in the paper [34, 74,136,137].…”

“…The distinction between CSU and UV was made only in some studies [25,35,53,55,57,58,124,138]. Many other studies had no clear differentiation between CSU and UV but the latter may have been termed 'vasculitis' [20,23,54,125,128,129], 'vasculitic rash' [139], 'dermal vasculitis' [28,133] or 'cutaneous vasculitis' [28,37,126,127,140] that allowed us to assume that most of the patients with urticarial rash in these studies are patients with CSU. Almost all authors in these studies used Gilliam and Sontheimer classification of SLE skin manifestations [32] that support this suggestion.…”

Autoantibodies involved in neuropsychiatric manifestations associated with systemic lupus erythematosus: a systematic review

“…Nine studies [44][45][46][47][48][49][50][51][52] studies were excluded because it was not possible to extract the exact numbers of syndromes and/or patients resulting positive for autoantibodies tested or because they were not relevant for the purpose of this review.. Four studies [53][54][55][56] were also excluded as they focused on other biomarkers than autoantibodies.…”