Clinical and immunological profile of SLE patients: Experience from a Chennai- based tertiary care centre (revisited)

Introduction SLE is the typical autoimmune disease with varied clinical manifestations involving multiple organs. Inadequate data on clinicoepidemiological manifestations and lack of disease registries from India pose major barrier to further understand patient/disease characteristics and to build a comprehensive knowledge base on SLE. In contrast to the Chennai-based study conducted in 1983, our recent study has indicated an increase in neuropsychiatric manifestations of SLE.1 In view of these findings, the present study has focused on re-evaluating the clinical and immunological features of patients presenting with SLE to our centre. Materials and methodology The cross-sectional study was conducted on 100 newly detected SLE patients admitted in Department of Rheumatology, Madras Medical College & Rajiv Gandhi Government General Hospital, Chennai. The duration of study was from January 2012 to December 2013. The ethical committee approval and informed consent in patients own language were obtained before starting the study.


Introduction
SLE is the typical autoimmune disease with varied clinical manifestations involving multiple organs. Inadequate data on clinicoepidemiological manifestations and lack of disease registries from India pose major barrier to further understand patient/disease characteristics and to build a comprehensive knowledge base on SLE. In contrast to the Chennai-based study conducted in 1983, our recent study has indicated an increase in neuropsychiatric manifestations of SLE. 1 In view of these findings, the present study has focused on re-evaluating the clinical and immunological features of patients presenting with SLE to our centre.

Materials and methodology
The cross-sectional study was conducted on 100 newly detected SLE patients admitted in Department of Rheumatology, Madras Medical College & Rajiv Gandhi Government General Hospital, Chennai. The duration of study was from January 2012 to December 2013. The ethical committee approval and informed consent in patients own language were obtained before starting the study.
was performed. Patients were subjected to baseline blood investigations, immunological investigations, and relevant radiological investigations. ANA was done by either ELISA or indirect immunofluorescence (IIF) by Hep-2 method, ds DNA, anticardiolipin antibody by ELISA, and complements by nephelometry. ANA profile 3 was done by EUROIMMUN Line Immunoassay (Immunoblot). Patient's generalized disease activity was calculated using SLE Disease Activity Index (SLEDAI). Patients with features of overlap syndrome were excluded from the study.

Results and analysis
The study group had 59% of the patients (48% females and 11% males) in the age group of 21-30 years and 24% (22% females and 2% males) belonging to the age group of 17-20 years. So the maximum number of patients was from 2nd and 3rd decades. Among the subjects, 86% of the patients were females and 14% were males. Around 81% of the subjects had fever and constitutional symptoms followed by arthritis, and cutaneous, neuropsychiatry and renal involvement (Fig. 1). Seizure was the common neuropsychiatric manifestations observed, followed by psychosis, stroke etc. (Table 1). In our study group, class IV lupus nephritis was common, followed by class III and class V ( Table 2). ANA was positive in 100%, ds DNA in 45%, and low complements in 73%. Anti-Sm was found  in 49%, followed by anti Ro, anti-dsDNA, and anti-U1RNP (Fig. 2). High disease activity was noted in 84% of the patients.

Discussion
In the present study, the majority of patients were in their 2 nd and 3 rd decades with a mean age of 25.45 years. The female to male ratio in our study was 6:1.

Conclusion
The present study has reported higher prevalence of constitutional symptoms, followed by joint and skin manifestations. Around 84% of the patients demonstrated high disease activity. The incidence of renal and neuropsychiatric manifestations was similar, but the rate of incidence of neuropsychiatric and cardiovascular manifestations was more compared to other Indian studies.