ANEMIA AS A PREDICTOR OF DISEASE ACTIVITY IN SYSTEMIC LUPUS ERYTHEMATOSUS

Abstract

Systemic Lupus Erythematosus is a multifactorial autoimmune disease, in which genetic and environmental factors interact to determine susceptibility and phenotype. A wide range of autoantibodies and clinical manifestations, with a remitting/relapsing course, characterizes SLE. Hematological abnormalities are common in SLE. The most common forms of anemia in SLE are: anemia of chronic disease, iron deficiency anemia and autoimmune hemolytic anemia. This study aimed to investigate the type and severity of anemia and their association with disease activity and organ damage in SLE patients. Our study was conducted on fifty Egyptian SLE patients; they were diagnosed according to the SLICC criteria for diagnosis of SLE.Patients were evaluated at study entry where full history, clinical examination and laboratory investigations were done. Assessment of anemia and categorization into the three main groups commonly found in SLE was done: o Iron deficiency anemia (IDA): group (1). o Anemia of chronic disease (ACD): group (2). o Autoimmune hemolytic anemia (AIHA): group (3).

Laboratory investigations included (CBC, ANA, Anti-ds DNA C3, C4, 24-hours urinary protein, creatinine, ESR, Iron study, Retics,Coomb's test and LDH). Lupus disease activity was determined using the SLAM score.As well, Assessment of organ damage was done using the SLICC/ACR Damage Index. Anemia of chronic disease (ACD) was the most prevalent in our study groups representing 46% of our SLE patients. Followed by IDA in 40% then AIHA in only 14% of cases. There was a highly significant positive correlation between Hb level and each of C3 and C4, while a highly significant negative correlation was found between Hb level in one hand and SLAM activity score and24-Hrs urinary protein in the other hand representing that: The more the activity and severity of the SLE, the more profound is the degree of the anemia. SLICC/ACR damage score showed highly significant negative correlation with Hb levelpointing to the clear observation that anemia is a marker for ongoing SLE damage. The conclusion is that anemia (independently of its cause) may act as a prognostic factor for the short (disease activity) and long-term (damage accrual) disease outcome of SLE.