The aim of this study was to present the epidemiology, clinical manifestations and treatment pattern of systemic lupus erythematosus (SLE) in Egyptian patients over the country and compare the findings to large cohorts worldwide. Objectives were extended to focus on the age at onset and gender driven influence on the disease characteristics.
Patients and method
This population-based, multicenter, cross-sectional study included 3661 adult SLE patients from Egyptian rheumatology departments across the nation. Demographic, clinical, and therapeutic data were assessed for all patients.
Results
The study included 3661 patients; 3296 females and 365 males (9.03:1) and the median age was 30 years (17–79 years), disease duration 4 years (0–75 years) while the median age at disease onset was 25 years (4–75 years). The overall estimated prevalence of adult SLE in Egypt was 6.1/100,000 population (1.2/100,000 males and 11.3/100,000 females).There were 316 (8.6%) juvenile-onset (Jo-SLE) and 3345 adult-onset (Ao-SLE). Age at onset was highest in South and lowest in Cairo (p < 0.0001).
Conclusion
SLE in Egypt had a wide variety of clinical and immunological manifestations, with some similarities with that in other nations and differences within the same country. The clinical characteristics, autoantibodies and comorbidities are comparable between Ao-SLE and Jo-SLE. The frequency of various clinical and immunological manifestations varied between gender. Additional studies are needed to determine the underlying factors contributing to gender and age of onset differences.
SimardJFCostanbaderKH.Epidemiology and classification of systemic lupus erythematosus. In: HochbergMCSilmanAJSmolenJSWeinblattMEWeismanMH (eds) Rheumatology. 6th ed.
Philadelphia:
Elsevier, 2015, pp.1021–1025.
2.
JamesJA.Preclinical features of lupus. In: HochbergMCSilmanAJSmolenJSWeinblattMEWeismanMH (eds) Rheumatology. 6th ed.
Philadelphia:
Elsevier, 2015, pp.1026–1031.
3.
DvorkinaOGinzlerEM.Clinical features of systemic lupus erythematosus. In: HochbergMCSilmanAJSmolenJSWeinblattMEWeismanMH (eds) Rheumatology. 6th ed.
Philadelphia:
Elsevier, 2015, pp.1032–1044.
4.
CrowMK.Etiology and pathogenesis of systemic lupus erythematosus. In: FiresteinGSBuddRCGabrielSEMcInnesIBO'DellJR (eds) Kelley and Firestein's textbook of rheumatology. 10th ed.
Philadelphia:
Elsevier, 2017, pp.1329–1344.
5.
AkbarianMFaeziSTGharibdoostF, et al.
Systemic lupus erythematosus in Iran: a study of 2280 patients over 33 years. Int J Rheum Dis2010;
13: 374–379.
6.
CarterEEBarrSGClarkeAE.The global burden of SLE: prevalence, health disparities and socioeconomic impact. Nat Rev Rheumatol2016;
12: 605–620.
7.
MokCCLeeKWHoCTLauCSWongRW.A prospective study of survival and prognostic indicators of systemic lupus erythematosus in a Southern Chinese population. Rheumatology (Oxford)2000;
39: 399–406.
8.
ZakyMRShaatRMEl-BassionySRAbdel RazekAAFaragSM.Magnetic resonance imaging (MRI) brain abnormalities of neuropsychiatric systemic lupus erythematosus patients in mansoura city: relation to disease activity. Egypt Rheumatol2015;
37: S7–S11.
9.
El-HewalaANageebGSEl-ShahawyEE, et al.
Anti-C1q and anti-dsDNA antibodies in systemic lupus erythematosus: relationship with disease activity and renal involvement in Sharkia Governorate, Egypt. Egypt Rheumatol2011;
33: 203–208.
10.
El-HadidiKT.Systemic lupus erythematosus in Egypt: clinical and serological features in 521 patients. Egypt Rheumatol1998;
20: 215–229.
11.
PetriMOrbaiAMAlarcónGS, et al.
Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum2012;
64: 2677–2686.
12.
Egypt 2018. Statistical abstract. Central Agency for Public Mobilization and Statistics (CAPMAS). 2018 June. Available at: https://www.capmas.gov.eg/HomePage.aspx#
13.
BombardierCGladmanDDUrowitz MB, CaronDChangCH.Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE. Arthritis Rheum1992;
35: 630–640.
14.
GladmanDDUrowitzMBGoldsmithCH, et al.
The reliability of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index in patients with systemic lupus erythematosus. Arthritis Rheum1997;
40: 809–813.
15.
VerdúRCPego-ReigosaJMSeoane-MatoD, et al.
Prevalence of systemic lupus erythematosus in Spain: higher than previously reported in other countries?Rheumatology2020;
59: 2556–2562.
16.
GheitaTAEesaNN.Rheumatology in Egypt: back to the future. Rheumatol Int2019;
39: 1–12.
17.
ReesFDohertyMGraingeMJLanyonPZhangW.The worldwide incidence and prevalence of systemic lupus erythematosus: a systematic review of epidemiological studies. Rheumatology (Oxford)2017;
56: 1945–1961.
18.
NightingaleALFarmerRDde VriesCS.Incidence of clinically diagnosed systemic lupus erythematosus 1992–1998 using the UK General Practice Research Database. Pharmacoepidemiol Drug Saf2006;
15: 656–661.
19.
KhanfirMSHoumanMHCherifE, et al.
TULUP (TUnisianLUPus): a multicentric study of systemic lupus erythematosus in Tunisia. Int J Rheum Dis2013;
16: 539–546.
20.
GheitaTAFawzySMNour El-DinAMEl-FishawyHS.Juvenile and adult onset systemic lupus erythematosus outcome in Egyptian patients. Egypt Rheumatol2011;
33: 99–105.
21.
LiWGYeZZYinZHZhangK.Clinical and immunological characteristics in 552 systemic lupus erythematosus patients in a Southern Province of China. Int J Rheum Dis2017;
20: 68–75.
22.
MalaviyaANChandrasekaranANKumarAShamarPN.Systemic lupus erythematosus in India. Lupus1997;
6: 690–700.
23.
Al ArfajASKhalilN.Clinical and immunological manifestations in 624 SLE patients in Saudi Arabia. Lupus2009;
18: 465–473.
24.
CerveraRKhamashtaMAFontJ, et al.
Systemic lupus erythematosus: clinical and immunologic patterns of disease expression in a cohort of 1,000 patients. The European Working Party on Systemic Lupus Erythematosus. Medicine (Baltimore)1993;
72: 113–124.
25.
MohamedDFAzizABE-DAHassanSA-MShedidNHEl-OwaidyRHTeamaMAEM.Juvenile lupus: different clinical and serological presentations compared to adult lupus in Egypt. Egypt Rheumatol2018;
40: 55–58.
26.
CooperGSParksCGTreadwellEL, et al.
Differences by race, sex and age in the clinical and immunologic features of recently diagnosed systemic lupus erythematosus patients in the southeastern United States. Lupus2002;
11: 161–167.
27.
AdwanM.Clinical and serologic characteristics of systemic lupus erythematosus in the Arab world: a pooled analysis of 3,273 patients. Arch Rheumatol2018;
33: 455–463.
28.
EssoumaMNkeckJREndombaFTBignaJJSingwe-NgandeuMHachullaE.Systemic lupus erythematosus in native Sub-Saharan Africans: a systematic review and meta-analysis. J Autoimmun2020;
106: 102348.
29.
Pons-EstelBACatoggioLJCardielMH, et al.
The GLADEL multinational Latin American prospective inception cohort of 1,214 patients with systemic lupus erythematosus: ethnic and disease heterogeneity among “Hispanics”. Medicine (Baltimore)2004;
83: 1–17.
30.
TahaSGamalSMNabilM, et al.
Vascular endothelial growth factor G1612A (rs10434) gene polymorphism and neuropsychiatric manifestations in systemic lupus erythematosus patients. Rev Bras Reumatol Engl Ed2017;
57: 149–153.
31.
NazariniaMAGhaffarpasandFShamsdinAKarimiAAAbbasiNAmiriA.Systemic lupus erythematosus in the Fars Province of Iran. Lupus2008;
17: 221–227.
32.
HoumanMHSmiti-KhanfirMBen GhorbellIMiledM.Systemic lupus erythematosus in Tunisia: demo-graphic and clinical analysis of 100 patients. Lupus2004;
13: 204–211.
33.
Al-JarallahKAl-AwadiASiddiquiH, et al.
Systemic lupus erythematosus in Kuwait–hospital based study. Lupus1998;
7: 434–438.
Le SueurHBruceINGeifmanN, on behalf of the Masterplans Consortium.
The challenges in data integration - heterogeneity and complexity in clinical trials and patient registries of systemic lupus erythematosus. BMC Med Res Methodol2020;
20: 164.
