High-sensitivity C-reactive protein [hs-CRP] in systemic lupus erythematosus patients without cardiac involvement; relation to disease activity, damage and intima-media thickness

To assess the high sensitivity C-reactive protein [hs-CRP level] in systemic lupus erythematosus [SLE] patients without cardiac involvement and find its relation with clinical and laboratory findings, disease activity, damage index and intima-media thickness [IMT]. Forty-five female SLE patients were recruited in the present study without any cardiac involvement. History taking, examination and laboratory investigations were performed for patients. Disease activity was evaluated by the Systemic Lupus Erythematosus Disease Activity Index [SLEDAI] and damage by the Systemic Lupus International Collaborating Clinics [SLICC] index. Thirty age matched female healthy subjects were considered as a control group. hs-CRP was measured quantitatively by microplate immunoenzymometric assay and the IMT measured by ultrasonography. The hs-CRP in the patients was significantly higher [4.84 +/- 3.91 mg/l] compared to the control [1.74 +/- 0.61 mg/l] [p < 0.001]. The IMT in the patients was significantly increased [0.72 +/- 0.37 mm] compared to the control [0.54 +/- 0.15 mm] [p 0.004]. There was no difference in the level of hs-CRP according to the presence or absence of clinical manifestations. However, it was significantly higher in those with positive DNA [5.71 +/- 4.36 mg/L] compared to those with negative results [3.12 +/- 1.97 mg/L] [p 0.009]. There was a significant correlation of the hs-CRP level with the IMT [r 0.49, p 0.001] and SLEDAI [r 0.67, p < 0.001]. These findings suggest that SLE patients without traditional major cardiovascular risk factors may have increased risk of future cardiac events. Measuring hs-CRP may be useful as a marker of disease activity, increased IMT and subclinical atherosclerosis in SLE especially those with positive ds-DNA

Juvenile and adult onset systemic lupus erythematosus outcome in Egyptian patients

The aim was to study the outcome characteristics of systemic lupus erythematosus [SLE] in Egyptians according to the age at disease onset and gender. We studied 239 SLE patients [185 adult and 54 Juvenile onset] with a female to male ratio of 9.39-1 and a mean age of 28.23 +/- 8.91 years and disease duration of 5.45 +/- 4.25 years. Full history taking, thorough clinical examination, laboratory and relevant radiological investigations were performed. Disease activity was assessed using SLEDAI and damage by SLICC. Renal biopsies were done in those with renal involvement. The clinical manifestations, disease activity and damage and laboratory investigations of the SLE patients varied according to the age at disease onset and gender. The prevalence of damage was obviously increased in juvenile patients and higher in males. Growth failure, delayed puberty and fibromyalgia were present more in Juvenile-onset patients. Adult onset SLE patients had a significantly higher secondary Sjogren syndrome especially in females. In the present study, there was a 2.5% mortality and the commonly involved kidneys were an important cause of death. Measuring organ damage in SLE is important with special concern to juvenile-onset patients to allow for designing new treatments that improve control of disease activity and minimize the development of irreversible damage. The kidney appeared to be commonly involved, especially in males, indicating the importance of regular screening for early and appropriate management