Clusters of clinical and immunologic features in systemic lupus erythematosus: analysis of 600 patients from a single center

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Abstract

Objective

To analyze the prevalence and characteristics of the main clinical, hematologic, and immunologic manifestations of systemic lupus erythematosus (SLE) in a cohort of 600 consecutive patients from a single center, and to determine the specific characteristics of organ involvement in a homogeneous SLE population.

Methods

Patients were consecutively seen in our department either as inpatients or outpatients between 1980 and 2001. All had documented medical histories and underwent a medical interview as well as a routine general physical examination. Clinical and serologic characteristics of all patients were consecutively collected in a protocol form.

Results

The final cohort (survival cohort) consisted of 533 (89%) women and 67 (11%) men (female to male ratio, 8:1), with an average of 29 new patients per year. Mean age at onset of symptoms attributable to the disease was 31 years (range, 5 to 84 years) and mean age at the time of diagnosis of SLE was 33 years (range, 6 to 85 years). The most frequent SLE involvement was articular involvement, found in 498 patients (83%), followed by hematologic involvement in 451 patients (75%), specific SLE cutaneous involvement in 354 patients (59%), constitutional features in 252 patients (42%), and nephropathy in 203 patients (34%). Patients enrolled in the protocol before 1991 had a higher frequency of central nervous system (CNS) involvement (27% vs 10%, P < .001), thrombotic events (17% vs 9%, P = .003), and abnormal hematologic parameters (85% vs 66%, P < .01), but a lower frequency of articular involvement (79% vs 86%, P = .038) than those enrolled after 1991. The following were observed associations: specific SLE cutaneous involvement was associated with anti-Sm antibodies; renal involvement with hemolytic anemia and anti-double-sranded DNA antibodies; CNS involvement with thrombocytopenia and immunoglobulin G-anticardiolipin; thrombotic events with low total hemolytic complement, immunoglobulin G-anticardiolipin, and lupus anticoagulant; and myositis with anemia and anti-ribonucleoprotein antibodies.

Conclusion

This large study, performed in a single center, has shown cluster associations between certain clinical, hematologic, and immunologic features of SLE, reflecting specific patterns of disease expression. The accurate evaluation of clinical features and laboratory markers at disease diagnosis and during evolution may improve the clinical treatment of SLE patients.

Section snippets

Patient selection

Patients were consecutively seen in our unit either as inpatients or outpatients between 1980 and 2001. All had documented medical histories and underwent a medical interview as well as a general physical examination. Clinical and serologic characteristics of all patients were consecutively collected in a protocol form. Salient features included were 1) age at onset of the disease, defined as the initial manifestation clearly attributable to SLE; 2) age at diagnosis, defined as the age when the

General characteristics

The final cohort (survival cohort) consisted of 533 (89%) women and 67 (11%) men (female to male ratio, 8:1) enrolled in a 22-year period (average, 29 new patients per year). Mean age at onset of symptoms attributable to the disease was 31.1 ± 0.6 years (range, 5 to 84 years); mean age at the time of diagnosis of SLE was 32.7 ± 0.6 years (range, 6 to 85 years). Mean age at protocol entry was 37.2 ± 0.6 years (range, 8 to 85 years). Evolution of the disease from the onset of symptoms to protocol

Discussion

This study analyzed the prevalence and characteristics of clinical and immunologic features in a large cohort of SLE patients from a single center that follows all the cases diagnosed within its referral area. Patients were derived from a variety of specialists, mainly internists, rheumatologists, nephrologists, and dermatologists. Only patients with 4 or more of the 1997 American College of Rheumatology criteria for SLE classification (7) were included in our survivor cohort, thus avoiding

Acknowledgements

The authors thank Josep Vivancos, Albert Bové, Alfons López-Soto, Lucio Pallarés, Margarita Navarro, Carles Miret, Francisco José Muñoz, Gerard Espinosa, Sonia Jiménez, and Pilar Brito for their contribution to this article. They also thank David Buss for his editorial assistance.

Josep Font, MD, PhD: Consultant, Department of Autoimmune Diseases, IDIBAPS, Hospital Clı́nic, School of Medicine, University of Barcelona, Barcelona, Catalonia, Spain

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  • Cited by (0)

    Josep Font, MD, PhD: Consultant, Department of Autoimmune Diseases, IDIBAPS, Hospital Clı́nic, School of Medicine, University of Barcelona, Barcelona, Catalonia, Spain

    Ricard Cervera, MD, PhD: Consultant, Department of Autoimmune Diseases, IDIBAPS, Hospital Clı́nic, School of Medicine, University of Barcelona, Barcelona, Catalonia, Spain

    Manuel Ramos-Casals, MD, PhD: Specialist Physician, Department of Autoimmune Diseases, IDIBAPS, Hospital Clı́nic, School of Medicine, University of Barcelona, Barcelona, Spain

    Mario Garcı́a-Carrasco, MD, PhD: Research Fellow, Department of Autoimmune Diseases, IDIBAPS, Hospital Clı́nic, Barcelona, Spain, and Professor of Rheumatology, Rheumatology Unit, School of Medicine, Benemérita Universidad Autónoma de Puebla, Puebla, México

    Juan Sentı́s, MD, PhD: Specialist Physician, Statistic Unit, Department of Public Health, School of Medicine, University of Barcelona, Barcelona, Spain

    Carme Herrero, MD, PhD: Consultant, Department of Dermatology, IDIBAPS, Hospital Clı́nic, School of Medicine, University of Barcelona, Barcelona, Catalonia, Spain

    José Antonio del Olmo, MD: Specialist Physician, Department of Rheumatology, Hospital Clı́nic, Barcelona, Catalonia, Spain

    Alexandre Darnell, MD, PhD: Senior Consultant, Department of Nephrology, IDIBAPS, Hospital Clı́nic, School of Medicine, University of Barcelona, Barcelona, Catalonia, Spain

    Miguel Ingelmo MD, PhD: Professor of Medicine, Department of Autoimmune Diseases, IDIBAPS, Hospital Clı́nic, School of Medicine, University of Barcelona, Barcelona, Catalonia, Spain.

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