The characteristics of systemic lupus erythematosus. A study in a general hospital

OBJECTIVE: There is a wide variation in the natural history of Systemic Lupus Erythematosus among different ethnic and geographical groups. Studies in Arabs are few. This study aims to demonstrate the clinical characteristics of Systemic Lupus Erythematosus patients in Jordanians.

METHODS: A retrospective review of the records of the cases diagnosed as Systemic Lupus Erythematosus in a tertiary referral centre (King Hussein Medical Centre) over the years 1991-1997. The records were analyzed for age, sex, presentation, diagnostic criteria, investigations, complications and treatment.

RESULTS: Seventy-six records were analyzed. The patients were from all parts of Jordan, with a mean age of 20 years. The female: male ratio was 24:1. The presentation was arthralgia-arthritis in 68 (89%) patients; skin manifestations in the form of malar rash in 32 (42%), photosensitivity in 19 (25%). Central nervous system manifestations were also noted in 21 (27%) of the patients. Anti-nuclear antibodies were positive in 71 (93%) patients, anti double stranded DNA (DsDNA) positive in 80%. Anemia and leukopenia or both were noted in 52 patients(69%). Erythrocyte Sedimentation Rate was more than 30mm in the first hour in 49 (88%) patients. Lupus anticoagulants were negative in 75% of patients, renal impairment was documented in 46% of the patients (35 patients) with positive correlation to DsDNA. All the patients received steroids, 95% (73) in the form of prednisolone and 5% in the form of methylprednisolone; cytotoxics either cyclophosphamide or azathioprine mainly for renal disease were prescribed to 25 patients, Complications were hypertension (18 patients), renal failure (7 patients), cerebral vascular disease (3 patients). Death was recorded in 3 subjects within 1-4 years of diagnosis.

CONCLUSION: This study demonstrates the presentations of Systemic Lupus Erythematosus patients with a high incidence of complications, which may be due to late presentation or late diagnosis. Further studies are needed on the natural history of this disease in Jordanians.