title: Clinical and immunological aspects and outcome of a Brazilian cohort of 414 patients with systemic lupus erythematosus (SLE): comparison between childhood-onset, adult-onset, and late-onset SLE.
abstract: The clinical expression of systemic lupus erythematosus (SLE) is influenced by genetic and environmental factors and therefore varies between ethnicities. Information on the epidemiology of SLE in Brazil is scarce and practically limited to studies conducted in socioeconomically developed regions (South and Southeast). The objective of this study was to describe the clinical and immunological aspects and outcome of a cohort of patients with SLE treated at a university hospital in northeastern Brazil and compare patterns related to age at onset: childhood (cSLE), adult (aSLE), and late (lSLE). A random sample of 414 records (women: 93.5%) were reviewed. The mean age at SLE onset and the mean disease duration were 28.9 ± 10.9 years and 10.2 ± 6.6 years, respectively. Most patients had aSLE (n = 338; 81.6%), followed by cSLE (n = 60; 14.5%) and lSLE (n = 16; 3.9%). The female/male ratio was 6.5:1 in cSLE and 16.8:1 in aSLE; in lSLE, all patients were female (p = 0.05). During follow-up, the cSLE group presented higher rates of nephritis (70% vs. 52.9% vs. 12.5%; p = 0.0001) and leuko/lymphopenia (61.7% vs. 43.8% vs. 56.2%; p = 0.02). No significant differences were found for anti-dsDNA, anti-Sm, and antiphospholipid antibodies. Treatment with immunosuppressants was significantly more common, and higher doses of prednisone were used, in cSLE. The prevalence of cardiovascular diseases were more frequent in lSLE (p = 0.03). No significant differences were found between the three groups with regard to mean damage accrual (SDI), remission, and mortality. Although cSLE presented higher rates of nephritis and leuko/lymphopenia, more frequent use of immunosuppressants and higher prednisone doses than aSLE and lSLE, the three groups did not differ significantly with regard to damage accrual, remission, and mortality.
authors.affiliation: Federal University of Ceará, Fortaleza, Brazil mmcmedeiros@hotmail.com.
authors.forename: M M
authors.initials: MM
authors.lastname: das Chagas Medeiros
authors.affiliation: Federal University of Ceará, Fortaleza, Brazil.
authors.forename: M Campos
authors.initials: MC
authors.lastname: Bezerra
authors.affiliation: Federal University of Ceará, Fortaleza, Brazil.
authors.forename: F N Holanda Ferreira
authors.initials: FN
authors.lastname: Braga
authors.affiliation: Federal University of Ceará, Fortaleza, Brazil.
authors.forename: M R Melo
authors.initials: MR
authors.lastname: da Justa Feijão
authors.affiliation: Federal University of Ceará, Fortaleza, Brazil.
authors.forename: A C Rodrigues
authors.initials: AC
authors.lastname: Gois
authors.affiliation: Federal University of Ceará, Fortaleza, Brazil.
authors.forename: V C do Rosário
authors.initials: VC
authors.lastname: Rebouças
authors.affiliation: Federal University of Ceará, Fortaleza, Brazil.
authors.forename: T M Amorim Zaranza
authors.initials: TM
authors.lastname: de Carvalho
authors.affiliation: Federal University of Ceará, Fortaleza, Brazil.
authors.forename: L N Solon
authors.initials: LN
authors.lastname: Carvalho
authors.affiliation: Federal University of Ceará, Fortaleza, Brazil.
authors.forename: Át Mendes
authors.initials: ÁM
authors.lastname: Ribeiro
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000974:Antibodies, Antinuclear / Q000097:blood; D017152:Antibodies, Antiphospholipid / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006785:Hospitals, University; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology* / Q000401:mortality; D008181:Lupus Nephritis / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000974:Antibodies, Antinuclear; D017152:Antibodies, Antiphospholipid; D015415:Biomarkers; D005938:Glucocorticoids; D007166:Immunosuppressive Agents
keywords: Adult-onset SLE; childhood-onset SLE; late-onset SLE; systemic lupus erythematosus