الفهرس 
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Abstract
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder with a broad spectrum of clinical presentations (Tsokos. 2011). There is a peak age of onset among young women between the late teens and early 40’s and a female to male ratio of 9:1. Ethnic groups such as those with African or Asian ancestry are more at risk of developing the disorder and it may be more severe compared to Caucasian patients.
Red blood cell distribution width (RDW) is a parameter routinely tested to describe the heterogeneity of red blood cells. During the past decades, it has been regarded as a useful index to differential diagnosis between thalassemia andmegaloblastic anemia, aswell as iron deficiency anemia (Salvagno et al. 2015).
Autoimmune diseases as SLE usually consist of inflammatory components. The chronic inflammatory process, which is triggered by auto-antigen and maintained by both environmental and genetic factors, is a common characteristic for all autoimmune diseases (Goodnow. 2007). Therefore, inflammatory indexes, such as CRP and ESR, may be useful to assess the activity of autoimmune diseases as well. As a novel index for inflammation, RDW may be also useful to estimate the activity of autoimmune diseases. Previous studies have shown that RDW was associated with the severity of inflammatory bowel disease (IBD), SLE (Song et al. 2012, Cakal et al. 2009) and rheumatoid arthritis (RA) (Lee and Kim. 2010). A recent study has also shown that RDWwas increased in patients with systemic lupus erythematosus (SLE) (Vaya et al. 2013).
Aim of this study was to assess SLE activity by RDW, and SLEDAI.
In this study, mean RDW was higher in active cases (16.64%±4.7%) compared to other 2 groups (13.16%±2.67%, 12.7%±1.13% respectively) with high significant difference (p value<0.001). Regarding SLEDAI score, its mean was higher in active group (8.43±4.1) than other 2 groups with high significant difference (p value<0.001). Also Gulkesen and Gozel. (2018) found that RDW value was also higher in patients with SLE in comparison with the healthy control group and the elevation in the RDW was statistically significant, this was similar to results of Hu et al. (2013) as they found that RDW increased in SLE patients when compared to healthy individuals. This finding is also consistent with a recent study by Vaya et al. (2013).
When we made correlation between RDW and disease activity indices, we found that RDW positive and high significant correlate with both SLEDAI score and 24 hrs proteins, but it negative and non significant correlate with each of WBCs, HGB, PLTs, C3 and C4.
We found that patients with positive antidsDNA had mean RDW higher than patients with negative antidsDNA with high significant difference (p<0.001). However, in study of Hu et al. (2013), there was no correlation observed between RDW and the above index. This inconsistency may be due to medical intervention, which has a great effect on C3, C4, and anti-dsDNA antibodies (Stohl et al. 2012).
Conclusion
In conclusion ,in our study we found that RDW is higher in actively lupus patient group than in Inactive group, also it positively correlate with SLEDAI score and 24 hour urinary protein,so This study demonstrate that RDW could be a useful index for disease activity assessment for SLE patient, ,as it cheap method and done routinely with CBC, further well-designed studies are needed to validate the clinical value of RDW in SLE patients.