[Systemic lupus erythematosus in Tunisia. A multicentric study. About 295 cases]

Systemic lupus erythematosus (SLE) is an autoimmune disease with a great clinical polymorphism. Wide variety of genetic, hormonal, immunological and environmental contributes to release the disease. Our objective was to describe and precise the epidemiological, clinical and immunological profile of this disease in Tunisia.

It is a retrospective study conducted by the Tunisian society of internal medicine during the period from January 1990 to December 1999. All patients fulfilled at least four of the revised American Rheumatism Association's criteria for SLE.

Two hundred and ninety-five SLE have been examined (271 women, 24 men). The most frequent clinical manifestations were: articular 90%, malar rash 62%, photosensitivity 46%, seritis 32% and glomerulonephritis 56%, dominated by WHO class III and IV: 60 cases (renal biopsy was performed in 95 patients). Neurological features were observed in 14.5%. The abnormal laboratory findings were leucocytopenia 45%, lymphopenia 47%, thrombocytopenia 16% and hemolytic anemia in 6.7%. Antinuclear antibodies, anti-ds DNA and anti-Sm were at 92%, 74% and 57%, respectively. Eighty-three percent of patients were treated by steroids, and in 52 cases (18%), we added immunosuppressive drugs. Two hundred and eighteen patients were followed up with a mean follow-up duration of 51 months. Twenty-eight percent were in complete remission and in 60%, the SLE was active. In contrast, death occurred in 29 cases.

Our study confirmed the clinical polymorphism of SLE, the great similarity with other studies apart the world, the gravity of renal and cardiac features and the infectious complications induced by corticosteroids.