Abstract
Objective: To study the clinical spectrum of systemic lupus patients and outcome at King Abdul Aziz Specialists Hospital, Taif.
Methodology: This retrospective study was conducted at Department of Nephrology, King Abdul Aziz Specialists Hospital, Taif. It included 110 patients with age limit of 14 to 60 years of both genders. Patients diagnosed with SLE either initial presentation or during follow up were reviewed.
Results: Out of 110 patients, 101 were female and 9 males (F:M::9:1), with majority between 14 to 40 years of age. Only 25% of patients were diagnosed with SLE at initial presentation and another 25% within one year. In 50%, the time period from initial presentation to diagnosis varied between 1 to 20 years. Presenting clinical features were rheumatological (joint/skin) in 70 (63%), renal in 56(51%), hematological in 36(33%) mucocutaneous in 26 (24%), neuropsychiatric in 14 (13%) and cardiovascular in 18(16%) patients. On follow up, 75% patients had involvements of another organ not present initially. Common affection was renal in 20, pulmonary hemorrhage in 6, seizures in 8, and serositis in 8 patients. Renal presentation comprised of nephrotic syndrome in 18, rapidly progressive glomerulonephritis (RPGN) in 12, proteinuria in 8, end stage renal disease in 8, and acute nephritic syndrome in 6 patients. On follow up, another 20 patients had renal involvement i.e. nephrotic syndrome in 14, RPGN in 4 and proteinuria in two. Treatment comprised of steroids (oral +/- pulse) in 52, mycophenolate mofetil in 25, hydroxychloroquine in 15, cyclophosphamide pulses in 10, and other in 6 patients in different combinations. At the time of conclusion of study, 38 patients were in remission and 10 on dialysis. Causes of mortality in 10 patients were severe disease in 3, pulmonary hemorrhage in 5 and severe thrombocytopenia one and sepsis one each.
Conclusion: Diagnosis of SLE was delayed in significant number of patients. Clinical renal involvement during follow up approached 70%. Pulmonary hemorrhage and severe disease was cause of mortality. Management was still not uniform.