Correlation Between Quantitative Anti-dsDNA Levels with Severity of Proteinuria in Systemic Lupus Erythematosus Patients.

OBJECTIVE: To evaluate the correlation of quantitative anti-dsDNA level with proteinuria levels in patients with lupus nephritis in a tertiary care hospital. STUDY DESIGN: In this prospective cross-sectional study, 76 patients of newly diagnosed SLE coming to Fatima Memorial Hospital were included in the study period between January 2020 to June 2020. Demographic data such as age, gender, lupus manifestations such as serositis, arthritis, mucocutaneous disease, and neuropsychiatric manifestations were recorded. Quantitative anti-dsDNA was measured by enzyme-linked immunosorbent assay and proteinuria was estimated by 24h urinary protein collection. Data was analyzed by SPSS 23. Association between categorical variables was assessed using chi-square test. For comparison of categorical independent and continuous dependent variable t-test or Mann-Whitney U test was applied. RESULTS: The median age of the cohort was 29 (with inter quartile range - IQR - of 13) years. The female gender comprised of 68 (89.4%) of the cohort population. The median anti-dsDNA level was 54.9 (183.6 IQR) IU, and baseline proteinuria of the cohort was 520mg/dL (1.49 IQR). There was a significant association of anti-dsDNA level with systemic features such as arthritis (p=<0.01), serositis (p=<0.01) and, Raynaud's phenomenon (p=<0.01). NPSLE and mucocutaneous features did not show statistically significant association (p=0.91 and 0.14 respectively). Baseline anti-dsDNA showed a statistically significant correlation with baseline proteinuria levels (p=<0.01). CONCLUSION: Quantitative anti-dsDNA is directly correlated with nephritis measured as proteinuria, and can be detected even before organ involvement. Hence, it can determine disease course and guide early treatment.

Correlation Between Quantitative Anti-dsDNA Levels with Severity of Proteinuria in Systemic Lupus Erythematosus Patients / Correlación entre los niveles cuantitativos de ADN de anticuerpos con la gravedad de la proteinuria en pacientes con lupus eritematoso sistémico

Objective: To evaluate the correlation of quantitative anti-dsDNA level with proteinuria levels in patients with lupus nephritis in a tertiary care hospital. Study design: In this prospective cross-sectional study, 76 patients of newly diagnosed SLE coming to Fatima Memorial Hospital were included in the study period between January 2020 to June 2020. Demographic data such as age, gender, lupus manifestations such as serositis, arthritis, mucocutaneous disease, and neuropsychiatric manifestations were recorded. Quantitative anti-dsDNA was measured by enzyme-linked immunosorbent assay and proteinuria was estimated by 24h urinary protein collection. Data was analyzed by SPSS 23. Association between categorical variables was assessed using chi-square test. For comparison of categorical independent and continuous dependent variable t-test or Mann–Whitney U test was applied. Results: The median age of the cohort was 29 (with inter quartile range – IQR – of 13) years. The female gender comprised of 68 (89.4%) of the cohort population. The median anti-dsDNA level was 54.9 (183.6 IQR) IU, and baseline proteinuria of the cohort was 520mg/dL (1.49 IQR). There was a significant association of anti-dsDNA level with systemic features such as arthritis (p=<0.01), serositis (p=<0.01) and, Raynaud's phenomenon (p=<0.01). NPSLE and mucocutaneous features did not show statistically significant association (p=0.91 and 0.14 respectively). Baseline anti-dsDNA showed a statistically significant correlation with baseline proteinuria levels (p=<0.01). Conclusion: Quantitative anti-dsDNA is directly correlated with nephritis measured as proteinuria, and can be detected even before organ involvement. Hence, it can determine disease course and guide early treatment.(AU)

Objetivo: Evaluar la correlación del nivel cuantitativo de anti-dsDNA con los niveles de proteinuria en pacientes con nefritis lúpica en un hospital de tercer nivel. Diseño del estudio: En este estudio transversal prospectivo se incluyeron 76 pacientes de LES recién diagnosticados que acudieron al Fatima Memorial Hospital en el período de estudio entre enero de 2020 y junio de 2020. Se registraron datos demográficos como edad, sexo, manifestaciones de lupus como serositis, artritis, enfermedad mucocutánea y manifestaciones neuropsiquiátricas. El anti-dsDNA cuantitativo se midió mediante un ensayo inmunoabsorbente ligado a enzimas y la proteinuria se estimó mediante la recogida de proteínas en orina de 24 horas. Los datos fueron analizados por SPSS 23. La asociación entre variables categóricas se evaluó mediante la prueba de χ2. Para la comparación de variable dependiente continua e independiente categórica se aplicó la prueba t o la prueba u de Mann Whitney. Resultados: La mediana de edad de la cohorte fue de 29 años (con rango intercuartil – IQR – de 13). El género femenino comprendía 68 (89,4%) de la población de la cohorte. El nivel medio de anti-dsDNA fue 54,9 (183,6 IQR) UI, y la proteinuria basal de la cohorte fue de 520mg/dL (1,49 IQR). Hubo una asociación significativa del nivel de anti-dsDNA con características sistémicas como artritis (p=<0,01), serositis (p=<0,01) y fenómeno de Raynaud (p=<0,01). El NPSLE y características mucocutáneas no mostraron asociación estadísticamente significativa (p=0,91 y 0,14, respectivamente). El anti-dsDNA basal mostró una correlación estadísticamente significativa con los niveles basales de proteinuria (p=<0,01). Conclusión: El anti-dsDNA cuantitativo se correlaciona directamente con la nefritis medida como proteinuria y puede detectarse incluso antes de la afectación de órganos; por lo tanto, puede determinar el curso de la enfermedad y orientar el tratamiento temprano.(AU)

Spectrum Of Ocular Manifestations Of Rheumatic Autoimmune Diseases: A Tertiary Care Experience In Pakistan.

BACKGROUND: Eye involvement is a common and potentially devastating complication of various immune related rheumatic diseases. We aimed to determine the spectrum, associations and the impact of ocular manifestations among well characterised autoimmune rheumatic disease patients presenting to ophthalmology and rheumatology clinics in a tertiary care hospital in Lahore, Pakistan. METHODS: Descriptive cross-sectional study performed in Rheumatology department of Fatima memorial hospital. Only those rheumatic disease patients were included who have been attending ophthalmology department for their ophthalmic conditions. The patients with ophthalmic symptoms who have not attended an ophthalmologist were not included in this study. Proforma was designed and the studied parameters were recorded prospectively from patient's interview and also by reviewing patient's medical and ophthalmologic medical records. Parameters assessed were demographics, symptoms and the diagnosis of eye disease, unilateral or bilateral presentation, duration of eye symptoms along with the duration of the primary rheumatologic disease, and the complications of the eye disease whether due to the eye diagnosis or its treatment. RESULTS: Eighty-three consecutive patients with mean age 33±11 years, 67.5% being female were recruited. Spondyloarthritis (SpA) comprised 38.6% (n=32) of patients followed by 21.7% (n=18) of Behcet's disease. Majority of patients (68.7%) had bilateral eye symptoms. In our cohort, 70% (n=58) of the patients had uveitis and almost all of these patients had either SpA or Behcet's disease as their primary rheumatologic diagnosis. Scleritis in 15.7% (n=13) patients followed by retinal vasculitis in 9.6% (n=8) patients, while glaucoma and keratopathy were present in 2.4% (n=2) patients each comprised other manifestations. Reassuringly our uveitis patients had no long-term eye related complications either due to the disease or its treatment. CONCLUSIONS: Uveitis represented the most common ophthalmologic manifestation associated with underlying rheumatologic diseases in our cohort, and it was associated with underlying Behcet's disease and SpA. Uveitis associated with connective tissue diseases has good prognosis with low-risk of significant long-term complications. Moreover, uveitis associated with SpA was noted to present much earlier in its disease course.