Clinical Profile of Systemic Lupus Erythematosus: A Study of 50 cases

Arun Prakas, R (2008) Clinical Profile of Systemic Lupus Erythematosus: A Study of 50 cases. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION: Systemic Lupus Erythematosus is an autoimmune disease in which the cells organs tissues undergo damage by tissue binding antibodies. Annual incidence of Systemic Lupus Erythematosus (SLE) is 2.8 per 1,00,000 in United States and Europe. Estimates of total number with this disease ranges from 20 – 60 per 1,00,000. More than 80% are females. Male to Female ratio is equal in young and old. Highest incidence is between 20 – 50 years of age. The frequency of Systemic Lupus Erythematosus concordance in monozygotic twin is 25% and with 1-2% among dizygotic twins. AIM OF THE STUDY: 1. To analyse the clinical spectrum of manifestations of Systemic Lupus Erythematosus (SLE) patients. 2. To analyse the initial presentation of Systemic Lupus Erythematosus (SLE). 3. To analyse cumulative presentation of SLE. 4. To study various system involvement. 5. To analyse the cause of death of SLE patients. 6. To correlate the clinical and laboratory investigations. 7. To compare my study with western data. MATERIALS AND METHODS: This study way conducted in 50 patients of Systemic Lupus Erythematosus who were attending Rheumatology Department, Medicine Department and Nephrology Department, Stanley Medical College Hospital during the period from June 2006 – July 2007. All the patients of Systemic Lupus Erythematosus who presented with varying signs and symptoms included in this study and were analysed clinically and laboratory wise. A detailed history was taken with particular emphasis on various organ system involvement. Symptoms included: Constitutional - Fever; Malaise; Fatigue; Weight loss. Musculoskeletal - Pain; Swelling of joints. Mucocutaneous - Rash; Photo sensitivity; Pruritus. Cardio vascular - Chest pain; dyspnea; palpitations; syncope. CNS – Seizures ; hallucinations ; Abnormal behavior ; symptoms of peripheral neuropathy. Renal – Hematuria. GIT - Oral Ulcer; acute abdominal pain; abdominal Distension; foetal wastage. This was followed by detailed clinical examination. The following in general examination. • Photo sensitivity; Malar rash; Discoid Lupus Erythematosus (DLE); Purpura; Urticaria; Erythema; Raynaud’s phenomina. • Arthritis; AVN; Osteoporosis. • Pericardial rub; Pleural Rub; Cardiac murmurs. • Anemia; Petechiae; Lymphadenopathy. An elaborate laboratory examination was done which include albumin deposits cellular carsts haemoglobin casts, tubular casts and urine 24 hrs urinary protein more than 500 mg/dl, Serum Creatinine VDRL CRP C3 C4 Antinuclear antibody. X ray chest, ECG, Echo, USG Abdomen, Renal biopsy and skin biopsy in selected patients. For microscopic examination of urine, a clean catch early morning 2nd voided midstream. Urine sample while patient was still fasting were collected and examined in 1 – 3 hrs to avoid lysis of cell and casts and to ensure a reasonably concentrated and acidic urine specimen larger than concentrated volume of urine of about 50 ml. Dysmorphic erythrocyte indicate injlamatory glomerular or tubule interstitial disease while monomorphic RBC’s indicate lower urinary tract bleeding. A telescopic urine sediment contains full range of cell and casts it indicates global nephron involvement. CONCLUSION: Mean Age of SLE is 31 years. • Highest Incidence is found in age group of 29-35 years of age. • The most common clinical presentation in our study is muskuloskeletal involvement seen in 90%. • Next most common presentation is skin lesions seen in 82%. • Neuropsychiatry manifestation seen in 54%. • Renal involvement is seen in 34%. • GIT involvement is seen in 48%. • Most common initial presentation in our study is musculoskeletal involvement similar to the western data. Incidence of renal lesion as initial presentation in western data is more compared to my study. • Normocytic nonmochromic anemias was the most common presentation leucopenia 10% ; thrombocytopenia 8% as far as haematological manfestation are concerned. • ANA was positive in all patients. • Anti ds DNA is seen in 48%. Anti ds DNA is seen in all patients with lupus nephrits compared to vascular lesions. • Renal biopsy revealed active renal disease and evidence of diffuse proliferate glomerulonephrtis seen in 7 patient. Patients with DPGN have nephritic range proteinuria hypertension ds DNA. Membranous nephropathy have nephrotic range proteinuria. • ESR raised in almost all patients with SLE. But significant increase is seen in vasculitis and active lesions. • Death is seen in 3 patients during the course of study. 2 of them died of lupus nephritis and 1 patient died of vascular cause.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Systemic Lupus Erythematosus ; Clinical Profile ; 50 cases study.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 23 Mar 2018 15:56
Last Modified: 23 Mar 2018 15:56

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