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Background: Clinical features of systemic lupus erythematosus may differ significantly in various regions and are frequently associated with the ethnicity of patients.
Objectives: The aim of this study was to compare clinical features and treatment of patients with systemic lupus erythematosus in the Russian Federation (RF), Kirgizstan and Kazakhstan in real clinical practice.
Methods: 1102 SLE pts who fulfilled SLICC 2012 criteria were enrolled into the study. Disease activity was evaluated by the SLEDAI-2K, and chronic damage by the Systemic Lupus International Collaborating Clinics Damage Index score (SDI).
Results: 400/600/102 Lupus pts from RF, Kirgizstan and Kazakhstan respectively were studied. Pts were predominantly female (91%/93%/98%) with a mean±SD age of 34,2±11,5/35,07±12,2/33,8±10,5 years (p=0,36; p=0,96) respectively. The mean disease duration (Мe) in RF/ Kazakhstan was 6 [3;12]/ 5[2;9] years (p=0,15), in Kirgizstan- 2[0,6; 7] years(p≤0,05). Kazakh pts (p=0,00) have higher disease activity (SLEDAI 2K) 17,6±8,8 than Kirghiz pts 15,1±8,3 and Russian pts 9,4±8,1. The higher SLICC damage index 2,39±1,61was in Kazakh pts (p=0,00) as compared to the Russian. Clinical features of 1102 patients with systemic lupus erythematosus in the Russian Federation (RF), Kirgizstan and Kazakhstan are shown in
Russian/Kirghiz/ Kazakh pts received corticosteroids per os with duration (Me) 48[18; 106] /24[7,2; 84]/ 37[13; 84] months. The mean±SD dosage was 17,8±12,0/23,2± 19,9/12,33±9,8 mg per day. Аmong cytostatic drugs, patients in Kirgizstan were prescribed more often cyclophosphamide (64%) and methotrexate (27%). They were prescribed mofetila micofenolate much less frequently (4%) than patients from Russia (20%) and Kazakhstan (46%). Prescription of cyclophosphamide, azathioprine and methotrexate in the Russian and Kazakhstan pts was approximately of the same frequency and ranged from 10 to 23%. Hydroxychloroquine was obtained in 67%/26%/51% Russian/Kirghiz/ Kazakh pts respectively. Disability benefits in RF included payment for biological therapy. Lupus patients in Kirgizstan and Kazakhstan bought biological drugs at their own expense. In RF rituximab was administrated in 34% cases and belimumab -in 10%. In Kirgizstan and Kazakhstan rituximab was administrated in 2% and 6% respectively.
Clinical Features of 1102 Patients with Systemic Lupus Erythematosus in the Russian Federation (RF), Kirgizstan and Kazakhstan
| Clinical features | Russian Federation
| Kyrgyztan
| Kazakhstan
|
| Pyrexia | 52(13%) | 276 (46%) | 15 (15%) |
| Neuropsychiatric | 68 (17%) | 198 (33%) | 34(33%) |
| Mucocutaneus | 176 (44%) | 396 (66%) | 75 (74%) |
| Vasculitis | 40 (10%) | 162 (27%) | 4 (4%) |
| Arthritis | 240 (60%) | 282 (47%) | 81(80%) |
| Myocarditis | 16 (4%) | 78 (13%) | - |
| Serositis | 52 (13%) | 294 (49%) | 12 (12 %) |
| Lupus nephritis | 116 (29%) | 246 (41%) | 24 (24%) |
| Leukopenia≤3х10 9 | 36 (9%) | 96 (16%) | 6 (6%) |
| Trombocytopenia ≤ 100X 10 9 | 12 (3%) | 90(15%) | 5(5%) |
| Anti dsDNA ≥20 Ед\мл | 276 (69%) | 198 (33%) | 80 (80%) |
| Low complement | 200 (50%) | 324 (54%) | 6 (6%) |
Conclusion: Significant differences have been revealed in the Kirghiz patients as compared to those of the RF and Kazakhstan. Disease activity in vital organs was more often revealed in the Kirghiz patients: neuropsychiatric disorders, vasculitis, serositis and lupus nephritis. As a result, they received a higher mean corticosteroids dose and cyclophosphamide was administered more often. Prescription of biological therapy was limited by a high cost of such sort of drugs. In spite of this fact, the highest SLICC damage index was demonstrated by the Kazakh cohort (2,38 score, while the lowest of merely 0,79) was in the Kirghiz cohort.
Disclosure of Interests: None declared