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.