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Abstract
Objectives 1) Compare the clinical manifestations in SLE patients at diagnosis and after treatment. 2) Stratifying SLE patients on (flare and remission) based on different immunosuppressants (CYC, HCQ and MMF) with optimal therapeutic approach.
Methods The prospective and longitudinal study was performed in the Department of Medicine, Rheumatology, Biochemistry and Nephrology in KMC Manipal and AIIMS New Delhi from Oct 2022 to Oct 2023.
42 lupus patients evaluated with clinical manifestations at diagnosis and after treatment with Cyclophosphamide, Hydroxychloroquine and Mycophenolate. BILAG scoring was done to evaluate the organ involved with disease activity. Blood plasma profiling for molecular stratification of patients at different stages of the disease and genomic DNA was isolated for SNPs non-responding to the above drugs apart from clinical study. Ethics approval from both institutions have been taken for the study and patients gave their informed consent.
Results Out of 42 adult patients, our cohort includes 37 females (88%) and 5 males (11.9%).
The mean patient age range is 31.5. The female to male ratio of 7.5:1 in our cohort. The youngest patient was 18 year and 62-year-old female with maximum age. The youngest developed the disease at the age six. Arthralgia (83.3%) most common symptoms followed by fever and photosensitivity (64.28%) (table 1) Lupus headache, depression and anxiety were common in our cohort with progression of disease. Renal involvement in 46% with majority in class IV (41.1%) class III (35.2%) lupus nephritis (LN)and one patient with chronic kidney disease (CKD). Musculoskeletal, mucocutaneous, haematological, and immunological dominates in our population (35%). HCQ the drug of choice in adults (50%) in comparison to MMF and CYC (table 2).
In our cohort, maximum patient was in remission with the response to drugs (HCQ- 72%, MMF-68% and Cyclo- 66%.
Conclusions Our study revealed Seizures, Depression, Chronic Kidney Disease and End stage Lupus Nephritis is major concern. Lupus panniculitis, and Pityriasis lichenoid chronic are distinctive features seen in adult SLE.HCQ seems to be optimal therapeutic immunosuppressant as maintenance therapy in both flare and remission. Stratification of patients based on drug response and disease activity using clinical, molecular, and genomic tool will resolve complexity of the lupus and help in development of biomarker in lupus flare.
Acknowledgements Authors did not receive any funding for the study.
The graph explains the clinical features in percentage at the time of diagnosis and after treatment treatment
Graph depicts percentage of patients with different immunosuppressive drugs at flare and remission
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