Clinical and laboratory characteristics of patients with articular manifestations of systemic lupus erythematosus

Abstract

Background. Damage of the joints is one of the typical and often the first signs of systemic lupus erythematosus (SLE), however the peculiarities the of clinical and laboratory changes in patients without articular manifestations (AM) remain insufficiently studied. The purpose was to study the frequency of AM in the patients with SLE and to evaluate its interconnection with clinical and laboratory manifestations of the disease. Materials and methods. 376 patients with SLE were examined. 2 groups were formed: I — with AM presented as arthritis and/or arthralgia at the time of application (n=316), II — without AM (n=60). The involvement of various organs and systems, as well as the levels of inflammatory markers and the spectrum of specific autoantibodies, were evaluated. Results. Patients with SLE and AM had erythematous rash on the face in the form of a “butterfly” more often than the patients without AM (34.1vs. 20.0%, p=0.04). Serositis was more often observed in patients with AM (39.6%) compared to the patients without AM (25.4%, p=0.048). Nephritis with nephrotic syndrome was 4 times more frequent in patients without arthritis/arthralgia compared to the subjects with AM (10.2 vs. 2.6%, p=0.04). The frequency of antiphospholipid syndrome was also significantly higher in patients without AM (25.5 vs. 6.0%, p<0.001). The group of the patients with SLE and AM had a higher frequency of Raynaud’s syndrome (27.5 vs. 15.0%, p=0.046), lymphadenopathy (50.5 vs. 35.6%, p=0.048), heart involvement (62.5 vs. 42.4%, p=0.007), weight loss (13.6 vs. 3.8%, p=0.04) and positivity for antibodies to dsDNA (65.0 vs. 45.7%, p=0.03), than the patients without AM. The median value of SLEDAI was significantly higher in the patients with SLE and AM (11 (6–16) points vs. 7.5 (4–14) points, р=0.01). Also they received significantly higher doses of oral glucocorticoids (10 (10–20) mg/d in prednisolone equivalent) compared to the subjects without AM (6.25 (3.75–12.5) mg/d, p=0.01). Conclusions. Rash on the face in the form of a “butterfly”, serositis, heart involvement, lymphadenopathy, Raynaud’s syndrome, weight loss, and anti-dsDNA positivity are significantly more common in SLE patients with AM. Nephritis with nephrotic syndrome and antiphospholipid syndrome occur more often in patients with SLE without AM. Presence of arthritis/arthralgia in patients with SLE is associated with a higher index of disease of activity and the need for higher doses of glucocorticoids.