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 Analysis of SLE outcome in Kyrgyz patients under long-term observation.
Methods The study involved 50 patients under prospective study treated in the NCCIM from January 2012 to August 2016 with SLE at the age of 27 years (median - 27 [23; 36])., with disease duration about 1 year (median - 1 [0.3, 3.0]), including 45 women and 5 men. The outcome of SLE was estimated as the number of exacerbations based on the SFI index (moderate or severe), irreversible organ damage by SDI, death, remission (complete or drug related). Remission was defined as complete if for the patients, who were not receiving any treatment, no clinical and immunological SLE activity was recorded. Drug remission was registered when clinical and immunological disease activity was absent in patients receiving supporting doses of prednisolone (from 5 mg to 10 mg) and receiving the following cytostatic drugs: 200 - 400 mg per day of PLQ or 100 - 150 mg per day of AZA or 7.5 mg of MTX per week.
Results During the 3-year-long dynamic monitoring, in 50 patients observed 2 years after the initial examination 62 cases of exacerbation of SLE were registered (median, 2.0 [1.5, 2.5]). Out of these there were 36 severe (58%) and 26 moderate outbreaks (42%). Severe exacerbations were mainly related to kidneys - in 42 patients (84%), 7 out of which experienced simultaneous exacerbation of articular syndrome, 5 lupus dermatitis, 2 patients had CNS damage in the form of visual and audial hallucinatory syndrome with encephalopathy and bilateral pyramidal insufficiency (1) and encephalopathy with anxiety disorders (1). Moderate exacerbations were mainly caused by the lesions of skin and joints (20), myositis (1), in one case there was a necrotizing vasculitis of the lower extremities. The main causes of SLE breakouts were: for 33 patients (66%) - low compliance (when the patients themselves stop taking GC and cytostatics), for the remaining 17 patients (34%) - exacerbation of the SLE process.
Towards the end of monitoring the development SDI was the result of accumulation of organ damage caused by the disease itself (61%) as a result of: ischemic stroke (3), reduced GFR less than 50 ml per minute (4) due to heavy lupus nephritis, paresis of the right motor oculi (1), changes in the retina (1), pulmonary fibrosis (1), and pulmonary arterial hypertension (1). Over the entire period of careful dynamic study of the 50 patients no fatalities were recorded. Remission was achieved in 10 patients (20%) out of 50. The majority of patients had drug remission (9), except for one patient with baseline nephritis, dermatitis, arthritis, which was in complete remission during three years.
Conclusions During the three years of medical observations remission was achieved in 20% of patients, most of them with drug remission (90%). 62 cases of SLE exacerbation were registered, with a predominance of severe outbreaks (58%), mainly caused by low compliance (53.2%). Development SDI was mainly due to the accumulation of organ damage caused by the disease itself (61%).
It is necessary to improve the rheumatology service in the regions of the country.
Disclosure of Interest None declared
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