Discussion
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease, a rheumatic disease with a non-transparent cause caused by autoantibodies and immune complexes that cause systemic damage. There are various reports from different countries of the world regarding the prevalence and characteristics of SLE. In these reports, the influence of genetic and environmental factors on the manifestations of SLE is discussed. In the present study, clinical and paraclinical characteristics (ANA Profilling panel) of 110 patients (14 Male and 96 female) with Iranian SLE have been studied. gnificant correlation was observed. an, as a country located in the Middle East and with the same race as the people of European countries, is a good candidate to study the effect of environmental and genetic factors on various manifestations of SLE. This disease is more common in women and in the present study 87.3% of female patients And 12.3% of the patients studied were men. The ratio of women to men was 8.8 to 1.2. The higher prevalence of the disease in women was reported in all studies, including the present study and studies in the region and European countries. In the region, the lowest ratio of women to men was reported in Lebanon (1.6 to 1) (21) and the highest in Kuwait (10 to 1) (22). In a study conducted by the Rheumatology Research Center of Tehran University of Medical Sciences from 1977 to 2011 on 2280 men and women with lupus, a male to female ratio of 9 to 1 was reported, which is consistent with our research (23). In our study, the mean age of all patients was 38.63 years with a standard deviation of 10.15 years. The mean age of men and women was 36.14 years with a standard deviation of 7.84 years and 38.99 years with a standard deviation of 10.43 years, respectively, and no statistically significant difference (Mann-Whitney test) was observed between the two groups (P = 0.317). The mean age of onset of the disease in the studied patients was 32.57 years with a standard deviation of 10.92 years. It should be noted that the mean duration of the disease was 6.05 years with a standard deviation of 4.82 years. The mean age of onset of disease in men and women was 27.43 years with a standard deviation of 10.87 years and 33.32 years with a standard deviation of 10.78 years, respectively, and no statistically significant difference (Mann-Whitney test) was observed between the two groups. P = 0.054). Compared to other studies, the age of onset was almost consistent. However, in the study of the Rheumatology Research Center of the University of Tehran, the mean age of onset was 24.4 ± 10.4, which is due to the increase in age of onset and alignment with European countries and the region. Better health care that has happened over a period of more than two decades (21, 22, 24, 25 and 26).
n this study, the highest clinical manifestations were related to arthritis in which 80 patients (72.7%) had this symptom. Malar rash with 60.9%, oral ulcer with 31.8%, renal involvement with 13.6 and the least observed symptoms were related to discoid. In which there were 5 patients (4.5%) in terms of the severity of clinical manifestations according to the research of Rheumatology Research Center of Tehran University of Medical Sciences in which renal disorders with 65.4% most and then arthritis with 51.9, malar rash with 60, oral ulcers With 38.5, and the lowest percentage with discoid was 14.6. This is somewhat consistent with our study, except for renal impairment, which had the highest percentage in more than two decades ago, unlike our study, where arthritis was the most common complaint. The reason for this discrepancy may be the faster and more accurate diagnosis of lupus patients and more advanced treatments (23). A study by Cervera et al. In 2002 and 2006 on European populations found that arthritis had the highest at 48.1 percent, followed by maral rush at 31.3, renal impairment at 27.9, Olar ulcer at 12.5, and the lowest at 7.8 percent with discoid. . In similar studies conducted in several countries in the region, the percentage of skin manifestations (malar rash and discoid) in the countries of the region was in line with our research and doubled in European countries, since Iran is in a lower geographical orbit with ultraviolet rays. These results can be explained by the role of ultraviolet light in exacerbating skin manifestations (22, 24, 25, 26). In our view, the cumulative prevalence of ANA panel antibodies in SLE is limited to six more features searched. Anti-SmAnti Ds-DNA, Anti U1RNP / Sm, SSA Ro 60 Anti and La / SSB Anti, RO-52 recombinant were detectable in a recent study. Some research has been done to investigate the prevalence of these antibodies and clinical communication with very sensitive methods. In our study, based on immunoblotting, a relatively insensitive but highly specific method was used that allows you to identify antibodies to the ANA panel found in sera, Anti-Sm, Anti Ds-DNA, anti-U1RNP / Sm and Anti-La / SSB were frequent features in our group. They examined the clinical manifestations of confirmation of previous reports, and most of these associations continued after logistical analysis for all variables. No association was found between the symptoms of the disease including malaria, discoid, oral ulcer, nephritis and arthritis with ANA panel tests except for Anti Ds-DNA which is significantly associated with the clinical symptoms of oral ulcer and maral rash.in 2004 study by Forger et al. In the Department of Rheumatology at the University of Montserrat, Germany, on the clinical significance of anti-ds DNA isotypes in lupus nephritis showed a significant association with IgM isotypes and skin involvement and IgG isotypes. Nephritis has lupus erythematosus. And IgG / IgM ratio as a significant parameter for the diagnosis of lupus nephritis, which is consistent with our research (27) This was the first comprehensive report on the serum level of ANA panel antibodies in Iranian men and women with SLE. According to valid anti-SM reference values, it is found in only 30% of patients with lupus. However, due to its rarity in other rheumatic diseases such as rheumatoid arthritis, etc., it has significant diagnostic value. In the ACR classification criterion for SLE, it is considered as a pathway and has a value equivalent to Anti-dsDNA (28). In this study, Anti-SM with 17.3% was less than the reference value, which is probably due to the small sample size. In another study conducted in 2018 by Dr. Mir Amir Aghdashi et al. In the Rheumatology Department of Urmia University of Medical Sciences on 72 female patients with SLE on the level of Anti-SM antibody and clinical signs due to the small sample No significant relationship was found between clinical manifestations and Anti-SM antibody that is consistent with our study (29). We could not find an explanation for the significant age of onset of the disease on SSA-Ro 60 (60kDa) (SSA) and Anti-Ds DNA tests.