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AB0706 The clinical and immunological profile of systemic lupus erythematosus (SLE) patients in a multiethnic malaysian population
  1. R. Jasmin1,
  2. K.J. Goh2,
  3. T.E. Cheah1,
  4. S. Sockalingam1
  1. 1Rheumatology
  2. 2Neurology, University of Malaya, Kuala Lumpur, Malaysia

Abstract

Background Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disease which displays a broad spectrum of clinical and immunological manifestations. The prevalence of SLE in Malaysia has been reported to be 43/100 000.

Objectives Our objective was to study the demographic, clinical and immunological manifestations in our SLE patients. SLE disease activity and treatment received were also assessed.

Methods 150 SLE patients seen at the University Malaya Medical Centre between July 2010 till March 2011 were recruited into the study. Clinical information was obtained from the medical records and the patients using a standardised questionnaire. Nerve conduction studies were performed to assess the presence of peripheral neuropathy. Patients with known causes of neuropathy e.g. diabetes mellitus and chronic renal failure were excluded.

Results Of 150 patients studied, 83(55.3%) were Chinese, 50(33.3%) were Malays, and 17(11.3%) were Indians. Female to male ratio was 8.4:1.Mean age was 38.6 years (range 12-76 years).Mean duration of SLE was 9.6 years (range 2 months to 44 years).The most common clinical manifestation was malar rash (62%), followed by arthritis (52%), oral ulcer (51.3%) and haematological abnormalities (51.3%). 25 patients (16.7%) had antiphospholipid syndrome.

Neuropsychiatric SLE was present in 28 patients (18.7%) of which 11 had seizures and 10 had cerebrovascular disease. 9 out of the 10 patients with cerebrovascular disease had antiphospholipid syndrome. Nerve conduction study was conducted in 148 patients. 37 (25%) had bilateral symmetrical polyneuropathy. 22 (14.9%) had focal neuropathy.

The mean SLEDAI score seen in these patients was 3.53. Majority of patients (70, 46.7%) had mild disease activity (SLEDAI score 1 to 5) or were in remission with no disease activity (51, 34%).

Malar and discoid rash were less frequent among the Indians (p=0.016 and p=0.045 respectively) as compared to the Malays and Chinese. However, arthritis (p =0.032), serositis (p =0.007), renal manifestations (p=0.038) and neuropsychiatric abnormalities (p =0.011) were more commonly seen among the ethnic Indians. Antiphospholipid syndrome was significantly less common in the Chinese compared to Indians and Malays (p=0.033). Therapy included oral corticosteroids (95.3%), hydroxychloroquine (79.3%), azathioprine (47.3%), mycophenolate mofetil (18.7%), cyclophosphamide (26%), intravenous immunoglobulin (7.3%) and rituximab (3.3%).

Conclusions This study suggests that the clinical profiles of SLE were comparable to previous studies done in Malaysia as well as other series. Most of the patients had mild disease activity. Differences in clinical manifestations were detected among the ethnic Indians.

  1. Wang F, Wang CL, Tan CT, Manivasagar M. Systemic lupus erythematosus in Malaysia: a study of 539 patients and comparison of prevalence and disease expression in different racial and gender groups. Lupus March 1997 vol. 6: 248-253.

  2. Goh KJ, Wang CL, MLT S L, Tan CT. Peripheral neuropathy in systemic lupus erythematosus-electrophysiological features in 50 consecutive patients. Neurol J Southeast Asia 1996; 1:47-51.

  3. Julian T, Hwee-Lin W. Systemic lupus erythematosus in Asia: is it more common and more severe? APLAR Journal of Rheumatology 2006; 9:320-326.

Disclosure of Interest None Declared

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