Clinical and Immunological Profiles With Treatment Patterns in Systemic Lupus Erythematosus Patients in the Eastern...

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder with a wide range of clinical and immunological abnormalities. Several studies have been conducted on the clinical and immunological profile of SLE patients from different parts of India; however, similar studies are lacking from the Eastern region of the country.

The primary objective was to study the clinical manifestations of SLE patients and to determine their immunological profile. The secondary objective was to find an association between clinical features and immunological profile.

A retrospective cross-sectional study was conducted at a tertiary care hospital in eastern India, analyzing all data from January 2019 to September 2023, where the diagnosed cases based on Systemic Lupus International Collaborating Clinics (SLICC) criteria were included. Records of 79 patients were evaluated, and their demographic profile, clinical manifestations, biochemical parameters, immunological parameters (antinuclear antibodies (ANA) screening and ANA profile) and treatment details were analysed. Data analysis was performed using IBM SPSS Statistics for Windows, version 20.0 (IBM Corp., Armonk, NY, USA).  Results: Out of 79 patients, there was a female preponderance (6.9:1). The mean age was 29.5 ± 12.8 years. Common clinical manifestations included diffuse non-scarring alopecia 68 (86.1%), joint pain 67 (84.8%), fever 63 (79.7%), and oral ulcers 62 (78.5%). Lupus nephritis (LN) was found in 41 (51.9%) of patients. Anti-nuclear antibodies (ANA) were tested positive among 70 (88.6%) patients. The most commonly detected antibodies were anti-dsDNA 55 (69.6%), anti-U1snRNP 47 (59.5%), anti-Sm 35 (44.3%), anti-Ro 60 35 (44.3%), and anti-Ro52 31 (39.2%). Anti-Sm antibody significantly correlated with lupus nephritis (p=0.002), and anti-dsDNA was associated with maculopapular rash (p=0.012). Our study highlighted the role of rituximab in managing the various disease spectrum of SLE.

This study compares the clinical and immunological profiles of patients from eastern India with those of similar other studies. While analysing, we also found a significant association between anti-dsDNA with maculopapular rash (p-value = 0.012) and anti-Sm antibody (25,60.97%) was the most common antibody among LN patients, with a significant association (p-value = 0.002). Our study also highlighted the management of a few challenging cases, like that of hemophagocytic lymphohistiocytosis (HLH), antiphospholipid antibodies (APLA), and central nervous system (CNS) vasculitis.