Systemic Lupus Erythematosus clinical profile and Evaluation of Sub Clinical Atherosclerosis in Children and Adults.

Balameena, S (2006) Systemic Lupus Erythematosus clinical profile and Evaluation of Sub Clinical Atherosclerosis in Children and Adults. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : Systemic lupus Erythematosus (SLE) is an autoimmune inflammatory disorder. It is characterized by multi system involvement and is heterogenous in its presentation. It is associated with numerous antibodies and immune complex formation. It predominantly affects females in their peak reproductive period (F:M=9:1) and in other age groups (3:1). Multiple factors like environmental, genetic and hormones have been implicated in the pathogenesis of this disorder. Under the wider spectrum of molecular biology, using newer immunological techniques, many antibodies along with the epitopes have been discovered which help in further understanding the disease. This disease, which is one of the major differentiated connective tissue disorders, affects all the organs as the disease progresses. The disease activity judged by using various measures is unable to accurately anticipate the morbidity and mortality because of its heterogeneity. It has protean manifestations and encompasses a wide age range from neonates to the elderly. AIMS AND OBJECTIVES : 1. To study the clinical profile of systemic lupus erythematosus in children and adults as it is seen in this part of the country. 2. To study the association of Colour Duplex Doppler of the carotids along with associated traditional risk factors like age, disease duration, smoking, family history of athersclerotic disease and laboratory variables along with SLEDAI, steroid usage and lipid profile in SLE patients. MATERIALS AND METHODS : One hundred consecutive patients who attended the Rheumatic care center, Government General Hospital, Madras Medical College, Chennai and satisfied the revised 1982 ACR criteria for SLE, during 2003 January to 2004 December were selected out of 12,786 adult and 2282 childhood Rheumatic cases. 68 were adults and 32 were children. A detailed history was documented and after clinical examination (Appendix 2) they were subjected to laboratory investigations which included complete blood count, erythrocyte sedimentation rate, (Westegren method) serum creatine, blood urea, urine analysis, muscle enzymes and 24 hrs urine analysis. Immunological tests include tests for ANA by IIF on rat liver substrate, RF & CRP by latex agglutination method by using commercial kits provided by Vital Diagnostics, Chennai. Antibodies to dsDNA, Sm, Ro, La, U1RNP, ACL was done by ELISA using commercial Bindazme company kits. LAC was done by Activated partial thromboplastin method complete test with three step procedure, using commercially obtained APTT substrate. The significant cutoff values for the positivity of the various antinuclear antibodies had already been determined in our lab with respect to healthy controls. C3, C4 were quantitated by single radial immunodiffusion (SRID) using Diffusa plates from Bioscientifica. The cut of values taken were (C3-70 mg/L, C4-20 mg/L). Serological test for syphilis were performed by the VDRL test in the Institute of Sexually transmitted diseases, M.M.C. RESULTS : Among 32 children there were 4 male and 28 female children, M: F 1:7. The mean age in childhood onset SLE was 12.6 years (range 6.5- 16 yrs) and mean disease duration 1.2 years (1 month - 2.6 years). There was no child below 5 years in the study group. The observed sex ratio below 10 years was M:F = 1:4.2 and between 10 to 16 years was 1:10. Among adults there were 4 males and the sex ratio was M:F=1:17. In the adult onset SLE the mean ages was 28 years (17-42 yrs) and the disease duration was 1.18 years (3 months - 3.6 years). CONCLUSION : This was a descriptive study of 32 children and 68 adults with SLE. The clinical profile had been discussed in both age groups. The highlighting feature was the association of lipid profile and the duplex Doppler. The female to male ratio in children was 7:1 and in adults 17:1. The mean age at diagnosis was 12. 6 yrs in children and 28 yrs in adults. The mean disease duration was 1. 2 yrs in children and 1. 18 in adults. The commonest initial manifestation in children were fever and arthritis whereas in adults cutaneous lesion and arthritis was observed. Dyschromia was found more in adults with SLE . ITP and AIHA were found to be commoner in children compared to adults. Pulmonary hypertension, Ischaemic heart disease, shrinking lung syndrome, were seen in lesser percentage in this study compared to other studies. Renal involvement was found to be more in children than adults. Hypertension with renal involvement was seen in 3 children and 10 adults. MRI is the preferential modality for learning NP Lupus. The mean IMT in this study was found among children 0.421 and among adults was 0.428. Duplex Doppler had picked up stenosis and plaque in both children and adults. Plaques were associated with hypertension in children and adults. Older children had greater IMT. Disease duration correlated with the IMT in adults. Smoking did not influence the plaque or the IMT. SLEDAI did not correlate with the plaque and IMT. Renal involvement did not significantly correlate in children and adults with plaque. Steroid usage influenced the development of plaque in children and in adults.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Systemic Lupus Erythematosus Clinical Profile ; Evaluation ; Sub Clinical Atherosclerosis ; Children ; Adults.
Subjects: MEDICAL > Rheumatology
Depositing User: Subramani R
Date Deposited: 16 Aug 2017 00:48
Last Modified: 16 Aug 2017 07:24

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