AB0546 Age of Onset, Gender and Outcome in a Multi-Ethnic Cohort of Systemic Lupus Erythematosus (SLE) in South Africa
Authors: A. Budhoo, G.M. Mody, N. Patel, T. Dubula, P.G. Mody
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Comparative studies in SLE have shown clinico-serological differences and poorer outcomes in late-onset disease, males and patients of African and Asian descent. <h3>Objectives</h3> To determine if there are any differences in the clinical spectrum and outcome of SLE based on age of onset, gender and ethnicity in our multi-ethnic cohort. <h3>Methods</h3> We reviewed the records of patients with SLE seen in the Departments of Rheumatology and Nephrology from June 2003 to December 2012. We analysed the clinico-serological data and outcome, and compared the findings based on gender, age of onset and ethnicity. <h3>Results</h3> Our 408 patients comprised 237 Indians, 137 Africans, 17 Whites and 17 Coloureds (mixed ethnicity). Patients with early-onset SLE showed a significant increase in the mean number of criteria (6.15±1.63 versus 5.25±1.25, p&lt;0.001), discoid rash (30.2% versus 15.3%, p=0.018), nephritis (43.5% versus 15.3%, p&lt;0.001), neuro-lupus (17.5% versus 3.4%, p=0.006), haematological criteria (76.9% versus 61%, p=0.014) and anti-dsDNA (47.9% versus 30.5%, p=0.009). Interethnic comparison between Indians and Africans showed that Indians had a longer disease duration with a median (IQR) of 75 (37-119.75) versus 42 (22-88.25) months with p&lt;0.001, and more oral ulcers (55.7% versus 38%, p=0.001). Africans displayed a significant increase in serositis (27.7% versus 14.3%, p=0.002), nephritis (46.7% versus 35.9%, p=0.039), haemolytic anaemia (29.2% versus 19.4%, p=0.026), leucopaenia (55.5% versus 37.1%, p=0.001), and anti-dsDNA (53.3% versus 40.9%, p=0.028). Males had a higher frequency of discoid rash (47.2% versus 25.8%, p=0.006) and anti-Sm (52.8% versus 32%, p=0.016). We had 53 deaths (13%), and shorter disease duration with median (IQR) of 28 (6-115) versus 68 (35-115) months (p=0.002), serositis (32.1% versus 17.5%, p=0.038), nephritis (73.6% versus 34.1%, p&lt;0.001), neuro-lupus (34% versus 12.4%, p&lt;0.001), haematological abnormalities (90.6% versus 72.4%, p=0.009) and anti-dsDNA (69.8% versus 41.7%, p&lt;0.001) were more common in the deaths. The independent predictors of death on multivariate analysis were shorter disease duration, nephritis and thrombocytopaenia. The overall 5 year-survival was 90.8% and 10 year survival was 75.1%. Although females had a higher mortality than males, there was no significant difference in the percentage of deaths based on age of onset and Indian or African ethnicity. <h3>Conclusions</h3> Early-onset SLE is associated with more severe disease. Males have higher frequencies of discoid rash and anti-Sm antibodies, but lower mortality. Although a number of clinico-serological differences exist between Indians and Africans, they have a similar percentage of deaths. Shorter disease duration, nephritis and thrombocytopaenia were the independent predictors of death. <h3>References</h3> Wang F, Wang CL, Tan CT, Manivasagar M. Systemic lupus erythematosus in Malaysia: A study of 539 patients and comparison of prevalence and disease expression in different racial and gender groups. Lupus 1997; 6:248–253. Murphy G, Isenberg D. Effect of gender on clinical presentation in systemic lupus erythematosus. Rheumatology 2013; 52:2108-2115. Merola J, Bermas B, Lu B, et al. Clinical manifestations and survival among adults with (SLE) according to age at diagnosis. Lupus 2014; 23:778-784. <h3>Disclosure of Interest</h3> A. Budhoo: None declared, G. Mody Grant/research support from: Aaron Beare Family Chair of Rheumatology Endowment Fund for a research assistant, Consultant for: Vimovo advisory board for Astra Zeneca (South Africa) and Novartis Consumer Health Global Pain Relief Advisory Board, N. Patel Consultant for: Roche, SA; Abbvie, SA; MSD, SA, T. Dubula: None declared, P. Mody: None declared