Background/Purpose:

Epidemiological studies in systemic lupus erythematosus (SLE) have been reported in the literature in many countries and ethnic groups. Although SLE in Jamaica has been described in the past, there has not been a detailed evaluation of SLE patients in urban Jamaica a largely Afro-Caribbean population. The goal of this study was to describe the clinical features particularly disease activity, damage index and immunological features of 150 SLE subjects.

Methods:

150 adult patients (≥ 18 years) followed in rheumatology clinic at a tertiary rheumatology hospital center (1 of 2 of the major public referral centers in Jamaica) and the private rheumatology offices in urban Jamaica who fulfilled four or more SLICC criteria were included. Data was collected by retrospective chart review, detailed clinical interview and examination and laboratory investigations. Hence demographics, SLICC criteria, immunological profile, SLEDAI-2K and SLICC/American College of Rheumatology (ACR) damage index (SDI) were documented.

Results:

: Of the 150 patients 145 were female and 5 were male (F: M=29:1); the mean age at SLE onset was 33.2 ± 10.9. Mean disease duration was 11.3 ±8.6 years. The most prevalent clinical SLICC criteria was musculoskeletal with 94% of subjects experiencing arthralgia/arthritis followed by mucocutaneous manifestations of alopecia (68.7%) and malar rash (46%). The most common laboratory SLICC criteria were positive ANA (90.6%) followed by anti-dsDNA (63.3%) and low complement (C3) levels (25.3%). 27% of patients met SLICC diagnostic criteria with only a positive ANA/ds-DNA and lupus nephritis on renal biopsy. The lowest SLICC score of 3 occurred in 2 patients in whom there was a positive ANA and biopsy proven lupus nephritis. 42 patients (28%) presented with lupus nephritis and 37 patients (24.7%) had neuropsychiatric manifestations. Mean SLEDAI score was 6.9 ± 5.1 with a range of 0-32. The most frequent manifestations of active SLE was found in the immunological laboratory variables of the disease namely increased ds-DNA binding (81.3%) and low complement levels (26.7%) and the clinical variable of arthritis in 27.3%. Organ damage occurred in 129 patients (86%); Mean SDI was 2.4 ± 1.8, range of 0-9. Every single organ system was affected by damage. The most frequent organ system involved in damage was the peripheral vascular system (75 patients, 50%), neurological (47 patients, 31.3%), skin (38 patients, 25.3%), ocular (29 patients, 19.3%), diabetes (28 patients, 18.67%), cardiovascular (18 patients, 12%) and renal (15 patients, 10%).

Conclusion: These results are similar to the clinical manifestations reported in other Afro-Caribbean populations; however distinct differences exist with respect to organ involvement and damage particularly with respect to renal involvement which appears to be reduced in this cohort. These differences support the need that further studies are required among similar groups of African descent to determine the spectrum of SLE that exists within this group.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-and-immunological-characteristics-of-150-systemic-lupus-erythematosus-patients-in-urban-jamaica/