Insights into systemic lupus erythematosus: a retrospective observational study of clinical features, autoantibodies, and gender-related differences.

This study aims to analyze the clinical and immunologic features of SLE in Jordan, while also investigating the impact of age and gender on disease presentation. The study included 275 patients diagnosed with SLE. Data were collected through meticulous patient interviews and thorough examination of patient hospital records. The cohort exhibited a mean age of 36.8 ± 12.9 years, with an average disease duration of 7.0 ± 7.8 years. The mean age at diagnosis was 29.9 ± 12.1 years, and the female to male ratio was 7.8:1. The most frequently observed symptoms were arthralgia (90.2%), fatigue (80.7%), hematologic manifestations (62%), photosensitivity (60.7%), Raynaud's phenomenon (53.5%), and malar rash (50.9%). The frequencies of various autoantibodies were as follows: ANA (96.7%), anti-dsDNA (39.6%), anti-SSA/Ro (32.8%), anti-Sm (21.8%), anti-U1-RNP (20.6%), and anti-SSB/La (15.5%). Male patients tended to receive a diagnosis at a younger age and exhibited a higher likelihood of experiencing severe manifestations compared to females. Additionally, juvenile onset patients demonstrated an increased likelihood of fever, photosensitivity, myositis, and anti-dsDNA autoantibodies, while adult onset patients were more predisposed to having anti-Ro, anti-La, and RF autoantibodies. This study reveals that the most prevalent manifestations of SLE in the Jordanian cohort encompassed arthralgia, fatigue, and hematologic manifestations. The prevalence of alopecia and Raynaud's phenomenon exceeded that observed in other published cohorts, while arthritis and discoid rash were less frequently encountered. The study highlights that males are more susceptible to developing severe manifestations of SLE compared to females.

Therapeutic changes of systemic lupus erythematosus (SLE) patients in pregnancy and feto-maternal outcomes: a retrospective cohort study.

OBJECTIVES: Patients with systemic lupus erythematosus (SLE) frequently show non-compliance with their medication. We evaluated the compliance of patients with SLE in Jordan with their medication and the relationships with fetal and maternal outcomes. METHODS: We performed a retrospective cohort study of patients with SLE who had no co-morbidities or antiphospholipid syndrome; and were taking only prednisolone, hydroxychloroquine, and/or antiplatelet and anticoagulant medication. RESULTS: We studied 173 pregnancies. Prednisolone was administered around pregnancy in 50 (28.9%) of these. The compliance with hydroxychloroquine, prednisolone, and anticoagulant and antiplatelet medication was 87.5%, 91.4%, and 97.3%, respectively. Non-compliance with anticoagulant/antiplatelet therapy was significantly associated with pregnancy-related complications. No complications developed in participants who were non-compliant with prednisolone therapy. The mean pre-pregnancy Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) for the pregnancies was 3.7, indicating low disease activity. Pregnancies with high pre-pregnancy SLEDAI scores tended to be more likely to have preterm deliveries, intrauterine growth restriction, and stillbirth. Postpartum relapse tended to be associated with higher pre-pregnancy SLEDAI. CONCLUSIONS: In patients with pre-conceptional low SLE activity, changes in therapeutic compliance during pregnancy are not associated with adverse outcomes. In addition, post-partum relapse is not associated with pre-pregnancy SLEDAI score in therapeutically compliant patients.

In-hospital mortality in patients with systemic lupus erythematosus: a study from Jordan 2002-2017.

We aimed to study the mortality among hospitalized patients with systemic lupus erythematosus (SLE). We performed a retrospective cross-sectional study and identified patients with SLE who were hospitalized at Jordan University Hospital (JUH) between 2002 and 2017.There were 990 admissions among which 283 were SLE patients. The mean age at disease onset was 34 ± 12.5 years and the female to male ratio was 8.4:1. Forty patients died during the 15-year period. In-hospital case fatality was 14% over 15 years. For the deceased patients, the female to male ratio was 3.4:1, mean age at disease onset was 27.8 ± 11.5 years, mean age at death was 35.1 ± 12 years, and mean disease duration was 7.5 ± 6.9 years. Twenty patients had disease duration ≤ 5 years. Infection and SLE-related complication contributed equally to mortality in hospitalized SLE patients (42.5% [CI 27.5%-59%] and 40% [95% CI 25%-56.5%], respectively). Infection related mortality compared to SLE-related mortality was associated with younger age and shorter disease duration (29.5 years versus 38.3 years and 6.4 versus 8.7 years, respectively). CRP was higher in infection related mortality compared to SLE-related mortality (131.4 mg/dl versus 87.6 mg/dl, respectively). Most SLE-related deaths were secondary to pulmonary disease. Renal disease did not contribute directly to mortality. No fatalities were attributed to cardiovascular disease (CVD) or cancer. Infection and active SLE accounted for the majority of deaths at a young age. Significant pulmonary related deaths may indicate a change in trends in SLE mortality, as renal related mortality is expected to decline due to proper management.

Unusual manifestations and unusual mimics of adult onset Still's disease.

[No Abstract Available].

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome and the Rheumatologist.

PURPOSE OF THE REVIEW: The purpose of the review is to summarise the various drugs used in rheumatology practice implicated in the causation of DRESS syndrome. RECENT FINDINGS: The most commonly reported drugs are allopurinol, sulfasalazine and minocycline, which pose a very high risk for DRESS syndrome development, followed by strontium ranelate and dapsone. Other, less commonly reported, drugs include leflunomide, hydroxychloroquine, non-steroidal anti-inflammatory drugs, febuxostat, bosentan and solcitinib. Reaction to some drugs is strongly associated with certain HLA alleles, which may be used to screen patients at risk of serious toxicity. DRESS syndrome is a serious reaction to many drugs used in rheumatic diseases, with a potentially fatal outcome and needs to be considered in any patient started on these medications who presents with a rash, fever and eosinophilia, sometimes with internal organ involvement.

Voriconazole-induced periostitis: a new rheumatic disorder.

Over the past few years, several reports of periostitis affecting patients treated with voriconazole appeared in the literature. As rheumatologists are likely to be called to see such patients, a review of the reported cases was undertaken. A systematic search of Pubmed and Google scholar for case reports, case series and observational studies was undertaken. Twenty-six articles including 23 case reports/case series (total 40 patients), a prospective study and two retrospective studies of 58 cases were included. Age ranged from 3 months to 77 years. Eleven cases (27.5 %) were male and 29 cases (72.5 %) were female. The duration of treatment varied from 6 weeks to 8 years (mean 53.6, SD 77.4 weeks). Most cases presented with diffuse skeletal pain affecting various sites in association with elevated alkaline phosphatase. Periostitis is increasingly reported and should be considered in patients taking voriconazole who present with bone pain and/or alkaline phosphatase elevation.

An update on drug-induced arthritis.

A large and heterogeneous group of drugs can cause drug-induced arthritis. No single pathogenetic mechanism or drug class unifies these diverse culprits. Recognizing that joint symptoms may, in fact, be drug-related not only saves time and unnecessary investigations but can also prevent needless suffering and morbidity due to late recognition of a drug-induced arthritic condition. The extent of drug-induced arthritis is variable and ranges from minor short-lived and reversible arthralgia to a prolonged and occasionally destructive arthritis. The onset of arthritis due to various medications in relation to the timing of drug initiation is also variable and may range from a few days to several months.