الفهرس 
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Abstract
Systemic lupus erythematosus (SLE) is a worldwide multisystem autoimmune disease of unknown etiology. It usually affects adults as well as adolescences and affects ten times as many women as men. It is characterized by production of autoantibodies, which result in widespread immunological abnormalities and immune complex formation (Postal et al., 2012).
Our study aimed to evaluate the differences in organ involvement, serological pattern, disease activity and damage indices between juvenile-onset and adult-onset SLE patients at diagnosis and follow-up.
Our study was cross section study, which included 160 SLE patients according to SLICC classification criteria for SLE (Petri et al., 2012).
They were divided to two groups:
group 1: 80 Patients with adult-onset, physician diagnosed SLE who enrolled from adult rheumatology unit, clinic and Internal Medicine department of Ain Shams University Hospital. Adult onset SLE was defined as age of onset above 16 years.
group 2: 80 Patients with juvenile-onset, physician diagnosed SLE who enrolled from pediatric Immunology and rheumatology unit and Pediatrics’ Hospital of Ain Shams University. Juvenile onset SLE was defined as age of onset below 16 years.
All the patients were subjected to: Full history taking with special emphasis on: drugs intake and musculoskeletal affection, thorough clinical examination, the disease activity was assessed by (SLEDAI), (SLICC/ACR) Damage Index, renal BILAG score, different laboratory Investigations including Complete blood count and differential leucocytes, ESR in first hour, CRP level, Kidney function tests, Liver enzymes (ALT, AST), Complete urine analysis, 24 hours urinary proteins, corrected creatinine clearance,Antinuclear antibody (ANA), Anti ds DNA antibody and Serum complement level. Fundus examination and echocardiography were done when necessary.
In our study, the most common clinical presentation among adult SLE was malar rash (75%) followed by articular manifestations (62.5%), while in juvenile SLE we found that the most common clinical presentation among juvenile SLE was articular manifestations (71.2%) followed by nephritis (67.2%). Major organ involvement like kidney and brain were higher in juvenile SLE.
Different hematological abnormalities were higher in juvenile SLE than adult SLE patients including (leucopenia, anemia, lymphopenia, neutropenia and thrombocytopenia). We found also frequency of hemolytic anemia; anemia of chronic illness and microcytic anemia were higher in juvenile than adult SLE patients were.
In our study, frequency of hematuria, proteinuria, urinary cast, pyuria and 24-hour urinary protein (proteinuria) were higher and more frequent in juvenile than adult SLE patients were.
Studying different histopathological types of lupus nephritis according to WHO classification, we found that the most common class of lupus nephritis in juvenile SLE was class II (53.2% vs 20.6%) in adult, but the most common class of lupus nephritis in adult was class IV (37.9% vs 8.5%) in juvenile.
We found that more C3 and C4 consumptions and anti DNA antibodies were higher in juvenile than adult was.
Positive anti cardiolipin antibodies and lupus anticoagulant antibodies were higher in juvenile SLE than adult (28% vs 14%- 24% vs 11%) and antiphospholipid syndrome was more frequent in juvenile.
Disease activity index was higher in adult than that in juvenile while damage was more frequent and index was higher in juvenile.
As regard individual organ damage, we found that neuropsychiatric, cardiovascular, renal damage, pulmonary, skin damage and ocular damage were more frequent in juvenile SLE than adult while musculoskeletal damage, endocrinal damage (diabetes) and peripheral vascular damage were more frequent in adult SLE than juvenile SLE.
As regard treatment, we found that cumulative dose of steroid was higher in adult. There were significantly more frequent patients receiving cyclophosphamide in adult SLE in comparison to juvenile although mycophenolate mofetail was significant more used in juvenile SLE in comparison to adult.
Hydroxychloroquine and azathioprine were more frequent used in adult than juvenile while cyclosporine, IVIG and rituximab were more commonly used in juvenile.
As regard complications, our results revealed that heamophagocytic syndrome and infections were more common in juvenile while hypertension and avascular necrosis were more frequent in adult.
Prolonged duration of disease, lymphopenia, neuropsychiatric manifestations and thrombosis either arterial or venous all were risk factors for damage and increase burden of the disease in adult SLE patients while neuropsychiatric manifestation and thrombosis were risk factors for damage in juvenile SLE patients.