Abstract
Background and aims Variable evolution of manifestations and reliance on serology for definitive SLE classification in early systemic lupus erythematosus (SLE) can challenge shared patient-physician management decisions and strain limited resources. This study aimed to determine which clinical manifestation/s require additional serology to formally classify early SLE patients.
Methods Clinical and serologic manifestations of patients with early SLE diagnosed <1 year from symptom onset at Lupus Clinics of University of Santo Tomas (UST) Hospital, Manila, Philippines from January 2014 to December 2015 were analysed. Minimum laboratory tests included complete blood count (CBC), urinalysis and anti-nuclear antibody (ANA). Clinical manifestations were based on the 2012 SLICC criteria.
Results 79 patients (78 females) had mean age at SLE diagnosis of 31.95+10.5 years (range 18–53), mean disease duration 5.66+5.41 months (range 0.23–12), all patients were ANA positive. Most common clinical manifestations were alopecia, acute cutaneous lupus rash (malar and photosensitive rash), arthritis and nephritis. Sixty-five patients (82.3%) fulfilled at least 3 clinical criteria for SLE. Fourteen patients required additional serology to complete classification criteria: 12 patients had only 2 clinical criteria including mucocutaneous (n=11), arthritis (n=6) and nephritis (n=4); the other 2 patients had only 1 clinical criterion each as thrombocytopenia or nephritis.
Conclusions In this early SLE cohort, mucocutaneous and musculoskeletal were the most common presenting manifestations. Additional serology was more often required in those with “asymptomatic” features of nephritis and thrombocytopenia when other clinical features are absent – reinforcing the value of CBC and urinalysis in early SLE.
