A study on clinical manifestations, treatment pattern and outcome in systemic lupus erythematosus patients in tertiary care hospital

Introduction: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder. Its expression is greatly influenced by the combined effect of genetic, environmental, demographic and geographical factors. The treatment is highly individualized depending on the development of clinical features. Objective: To study the treatment pattern and disease progression using appropriate disease activity indices. Material and Methods: A retrospective observational study was conducted in a tertiary care teaching hospital of South India. As per the study criteria, data was collected from 2010 to 2012. SLEDAI and ECLAM scores were calculated at the first and last admission for comparing the treatment given with the disease progression. Data analysis was done using SPSS 20.0. Wilcoxon non parametric test was used to compare scores at the first admission and last admission. Results: A total of 93 patients were included in the study. The mean age of onset was 29.3±8.5 years with female to male ratio of 15:1.9. Most common clinical features were arthritis (74.3%), fever (71.4%) and malar rash (52.9%). Involvement of cardiovascular and respiratory system was found to be less common. During the treatment period and last follow up steroids, hydroxychloroquine and immunosuppressants were given in different combinations. Out of which, a combination of steroids, hydroxychloroquine and immunosuppressant’s (44.1%) was the most highly prescribed. The most commonly used drugs were methyl prednisolone (89.2%), hydroxychloroquine (69.9%) and cyclophosphamide (38.7%). A statistical significance was observed (at p=0.0001) in the disease activity indexes of last admission when compared to first admission. Conclusion: There was a statistically significant improvement (at p=0.0001) in the SLEDAI and ECLAM disease activity scores from first admission to the last follow up with the treatment given in our hospital which included steroids, hydroxychloroquine and immunosuppressant’s in single or combinations of two or more.