title: Pattern of initial clinical manifestations of systemic lupus erythematosus in a tertiary care hospital.
abstract: OBJECTIVE
  To determine the pattern of initial clinical manifestations of Systemic Lupus Erythematosus (SLE) and to compare these features with those recorded elsewhere in Pakistan.
  
  
  METHODS
  This cross-sectional, descriptive study was performed in the Department of Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan, from November 2015 to January 2016. Sixty one patients of SLE diagnosed as per ACR (American College of Rheumatology) 1982 revised criteria, were enrolled. The patients were evaluated for the initial clinical manifestations of SLE. The information was collected on a specially designed proforma and analyzed by using SPSS version 17.
  
  
  RESULTS
  Out of 61 patients, 49 (80.3%) were females and 12 (19.7%) males, showing a female to male ratio of 4:1. The mean age of patients was 26.2 ± 7.9 years. Fatigue was the most common presenting feature in 56 (91.8%) patients, followed by joint pains in 55 (90.2%) and fever in 54 (88.5%). Renal involvement was found in 46 (75.4%). Comparison of these presenting features was made with other studies carried out in Northern Pakistan (Islamabad) and in central Punjab (Pakistan). There were statistically significant differences in fever, fatigue and arthritis between our patients and the other two above mentioned study groups. However, comparison of renal manifestations showed significant difference only with Islamabad study, and not with previous study from central Punjab.
  
  
  CONCLUSIONS
  In this study, majority of patients presented with combination of fatigue, fever, rash and arthritis. Almost three-fourth of patients had renal manifestations at initial presentation. Therefore, it is important for clinicians to have high index of suspicion for SLE, when patients present with above symptoms.
authors.affiliation: Dr. Shabnam Batool, FCPS Medicine. Department of Rheumatology, Fatima Memorial Hospital Lahore, Pakistan.
authors.forename: Shabnam
authors.initials: S
authors.lastname: Batool
authors.affiliation: Prof. Nighat Mir Ahmad, MD, FACP, FACR. Department of Rheumatology, Fatima Memorial Hospital Lahore, Pakistan.
authors.forename: Nighat Mir
authors.initials: NM
authors.lastname: Ahmad
authors.affiliation: Dr. Muhammad Ahmed Saeed, FCPS Medicine, FCPS Rheumatology. Department of Rheumatology, Fatima Memorial Hospital Lahore, Pakistan.
authors.forename: Muhammad Ahmed
authors.initials: MA
authors.lastname: Saeed
authors.affiliation: Dr. Sumaira Farman, MBBS, FRCP, FACP, FACR. Department of Rheumatology, Fatima Memorial Hospital Lahore, Pakistan.
authors.forename: Sumaira
authors.initials: S
authors.lastname: Farman
keywords: Clinical manifestations; Pattern; Systemic Lupus Erythematosus