Background Systemic lupus erythematosus (SLE) is an autoimmune disease driven by the activation of autoreactive T and B cells. Decreased levels of CD4 counts were found in these patients, although there are conflicting data on whether CD4 is associated with SLE disease activity.1,2,3
Objectives To investigate the associations between CD4 and CD8 counts with (1) active SLE and (2) infection in patients with SLE.
Methods This was a cross-sectional study conducted in a rheumatology referral centre in Malaysia. Inclusion criteria included patients who fulfilled SLICC SLE classification and was admitted to rheumatology ward for active SLE or infection. We excluded patients who had overlap syndrome, retroviral disease or underlying malignancy. SLE Disease Activity Index (SLEDAI) score was assessed by the same rheumatologist.
Statistical analysis was performed using SPSS 20 and a p-value of <0.05 was considered significant. Pearson correlation was used to analyse associations between 2 continuous variables, while comparison between 2 continuous data was performed using student's t test.
Results Forty-two patients participated in this study. Majority (90.5%) were females with a mean age of 33.05 (±11.42) years and SLE duration of 8.69 (±5.26) years. There were 40 (95.2%) ANA positive, 23 (54.8%) anti-dsDNA positive, 13 (31.0%) anti-smith positive, 24 (57.1%) low C3 and 16 (38.1%) low C4 in this cohort.
There were significant correlations between SLEDAI score and CD4 (r=-0.59, p<0.01) and CD8 counts (r=-0.57, p<0.01). CD4 and CD8 counts were significantly lower in patients with clinically active SLE vs non-active, however, there were no significant differences in CD4 and CD8 counts in patients with infection vs no infection. We also found significantly high anti-dsDNA level and low complement 3, but not complement 4, in active SLE. White cell count was significantly higher in patients with infection. The details are tabulated in Table 1.
Conclusions There were significant negative correlations between SLEDAI score and CD4 and CD8 counts, with low CD4 and CD8 counts found in patients with active SLE. There were no significant differences in CD4 and CD8 counts during infection.
Ferreira S, Vasconcelos J, Marinho A et al. CD4 lymphocytopenia in systemic lupus erythematosus. Acta Rheumatol Port 2009; 34: 200–206.
Bonelli M, Savitskaya A, von Dalwigk K et al. Quantitative and qualitative deficiencies of regulatory T cells in patients with systemic lupus erythematosus (SLE). Int Immunol 2008; 20: 861–868.
Liu MF, Wang CR, Wu CR. Decreased CD4+CD25+ T cells in peripheral blood of patients with systemic lupus erythematosus. Scand J Immunol 2004; 59: 198–202.
Disclosure of Interest None declared