Background Systemic lupus erythematosus (SLE) is a devastating disease affecting different organs, ultimately leading to organ failure and death. To date, there are no data regarding the real-life picture of SLE in Kyrgyzstan.
Objectives To study of clinical symptoms, course and outcome of SLE according to the prospective study among residents of Kyrgyzstan.
Methods An 2-year prospective analysis of patients with SLE with a specially developed research base (BLIPS 8, ADS-Limathon). 60 patients with definite diagnosis of SLE (ACR, 1997; SLICC, 2012), were treated in the department of rheumatology of NCCIM and observed from 2012 to 2015. They were evaluated by sex, age, disease duration, activity of SLE according the SLEDAI-2K, irreversible organ damage by SLICC Damage Index (SDI), quality of life using the SF-36 questionnaire, LupusQoL, HADS, FACIT, therapy, with monitoring of all parameters every six months for 2 years. From the data of the immunological studies immune linear (immunoblot) “ANA-LIA-Max 17” were analyzed with a purpose of detecting the antibodies of double-stranded DNA, Sm D1 antigen and antibodies of double-stranded DNA-linked immunosorbent analyisis (ELISA), C3-C4 components complement, indirect immunofluorescence of the antinuclear antibody cells of line Hep-2.
Results Patients were mainly from the northern region of the republic (81.7%). The vast majority were women (86.7%), with average age 30 years old, with disease duration of about 1.0 years. Periods to verify the diagnosis ranged from 1 month to 9 years. The clinical course was dominated by patients with acute version (47%) and high activity (57%). In the debut of the disease most common clinical symptoms were cutaneous and articular syndrome (84.2% and 72.3%, respectively), the defeat of the serous membranes (88%) and kidney (68%). All patients received glucocorticoids (GC), 79% of them in the form of pulse therapy with methylprednisolone. From immunosuppressive drugs most commonly were used CP (48%), AZA (21%), MTX (10.4%) and plaquenil (11%), to a lesser extent MMF (8%). The proportion of patients receiving biologic therapy (rituximab) was only 2%, IVIG (Octagam) - 3.3%.The development of irreversible organ damage was recorded in half the patients (46%), at average of 6 months from the onset of the disease, mostly with low (36.7%) and the average SDI (21.7%). During the period of 2-year prospective study not only a significant reduction in the activity of the pathological process in many patients (p<0,001) is noted, but also the lack of clinical activity in 18% of patients. In 35% of cases minimal disease activity represented immunological activity. At 2-year follow-up there were 14 fatal cases (19.4%). They were mostly women (72%) with average age 37.9 years, with disease duration around 4 years. The main causes of death were active SLE and its complications: kidney disease (29%), central nervous system (CNS)-21.4% and combined CNS and lung (21.4%).
Conclusions In the debut of the SLE acute onset and high disease activity, which led to the rapid development of organ damage in half the patients was recorded. In the structure of mortality among Kyrgyz cohort of SLE patients with renal involvement prevailed, CNS and CNS combined with lungs.
Disclosure of Interest None declared
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