Systemic lupus erythematosus children in Egypt: Homeland spectrum amid the global situation

Nahla N Eesa¹, Hend Abdel Nabi², Rasha El Owaidy³, Iman Khalifa⁴, Ahmed R Radwan⁵, Abeer M NourEl-Din⁶, Marwa A Amer⁷, Rawhya R ElShereef⁸, Eman Hassan⁹, Faten Ismail⁸, Iman I El-Gazzar¹, Noha M Khalil¹⁰, Abdel Hafeez Moshrif¹¹, Esam Abualfadl^{4

12}, Samar Tharwat¹³, Hanan M Fathi¹⁴, Mervat I Abd Elazeem¹⁵, Emad El-Shebini¹⁶, Nermeen Samy¹⁷, Nermeen Noshy¹⁷, Amany S El-Bahnasawy¹⁸, Ahmed M Abdalla¹⁹, Osama S Abousehly⁵, Eman F Mohamed²⁰, Samah I Nasef²¹, Ahmed M Elsaman⁵, Marwa ElKhalifa⁹, Mohamed N Salem²², Nouran M Abaza²³, Hanan M Fathy²⁴, Nancy Abdel Salam²⁴, Hanan M El-Saadany²⁵, Amany R El-Najjar²⁶, Dina H El-Hammady²⁷, Nevin Hammam^{28

29}, Reem Ha Mohammed¹, Tamer A Gheita¹; Egyptian College of Rheumatology (ECR) SLE Study Group

Affiliations

¹ Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
² Pediatrics Department, Rheumatology and Nephrology Unit, 68782Tanta University, Gharbia, Egypt.
³ Pediatrics Department, Rheumatology Unit, 68792Ain Shams University, Cairo, Egypt.
⁴ Pediatrics Department, Rheumatology and Nephrology Unit, 68900Helwan University, Cairo, Egypt.
⁵ Rheumatology Department, Faculty of Medicine, 68889Sohag University, Sohag, Egypt.
⁶ Pediatrics Department, 68787National Research Centre (NRC), Cairo, Egypt.
⁷ Rheumatology Department, Faculty of Medicine, 68789Alexandria University, Alexandria, Egypt.
⁸ Rheumatology Department, Faculty of Medicine, 68877Minia University, Minia, Egypt.
⁹ Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, 68789Alexandria University, Egypt.
¹⁰ Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, 63527Cairo University, Cairo, Egypt.
¹¹ Rheumatology Department, Faculty of Medicine, 68820Al-Azhar University, Assuit, Egypt.
¹² Qena/Luxor hospitals, Qena, Egypt.
¹³ Internal Medicine, Rheumatology Unit, 68780Mansoura University, Dakahlia, Egypt.
¹⁴ Rheumatology Department, Faculty of Medicine, 158405Fayoum University, Fayoum, Egypt.
¹⁵ Rheumatology Department, Faculty of Medicine, 158411Beni-Suef University, Beni-Suef, Egypt.
¹⁶ Internal Medicine Department, Rheumatology Unit, 68872Menoufiya University, Menoufiya, Egypt.
¹⁷ Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, 68792Ain-Shams University, Cairo, Egypt.
¹⁸ Rheumatology Department, Faculty of Medicine, 68780Mansoura University, Dakahlia, Egypt.
¹⁹ Rheumatology Department, Faculty of Medicine, 435387Aswan University, Aswan, Egypt.
²⁰ Internal Medicine Department, Rheumatology Unit, Faculty of Medicine (Girls), 68820Al-Azhar University, Cairo, Egypt.
²¹ Rheumatology Department, Faculty of Medicine, Suez-Canal University, Ismailia, Egypt.
²² Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, 158411Beni-Suef University, Beni-Suef, Egypt.
²³ Rheumatology Department, Faculty of Medicine, 68792Ain Shams University, Cairo, Egypt.
²⁴ Pediatrics Department, Rheumatology and Nephrology Unit, 68789Alexandria University, Alexandria, Egypt.
²⁵ Rheumatology Department, 68782Tanta University, Gharbia, Egypt.
²⁶ Rheumatology Department, Faculty of Medicine, 68799Zagazig University, Sharkia, Egypt.
²⁷ Rheumatology Department, Faculty of Medicine, 68900Helwan University, Cairo, Egypt.
²⁸ Rheumatology Department, Faculty of Medicine, 68797Assuit University, Assuit, Egypt.
²⁹ Rheumatology Department, 8785University of California San Francisco (UCSF), San Francisco, CA, USA.

PMID: 34528835
DOI: 10.1177/09612033211043010

Multicenter Study

Systemic lupus erythematosus children in Egypt: Homeland spectrum amid the global situation

Nahla N Eesa et al. Lupus. 2021 Nov.

. 2021 Nov;30(13):2135-2143.

doi: 10.1177/09612033211043010. Epub 2021 Sep 16.

Authors

Affiliations

¹ Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
² Pediatrics Department, Rheumatology and Nephrology Unit, 68782Tanta University, Gharbia, Egypt.
³ Pediatrics Department, Rheumatology Unit, 68792Ain Shams University, Cairo, Egypt.
⁴ Pediatrics Department, Rheumatology and Nephrology Unit, 68900Helwan University, Cairo, Egypt.
⁵ Rheumatology Department, Faculty of Medicine, 68889Sohag University, Sohag, Egypt.
⁶ Pediatrics Department, 68787National Research Centre (NRC), Cairo, Egypt.
⁷ Rheumatology Department, Faculty of Medicine, 68789Alexandria University, Alexandria, Egypt.
⁸ Rheumatology Department, Faculty of Medicine, 68877Minia University, Minia, Egypt.
⁹ Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, 68789Alexandria University, Egypt.
¹⁰ Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, 63527Cairo University, Cairo, Egypt.
¹¹ Rheumatology Department, Faculty of Medicine, 68820Al-Azhar University, Assuit, Egypt.
¹² Qena/Luxor hospitals, Qena, Egypt.
¹³ Internal Medicine, Rheumatology Unit, 68780Mansoura University, Dakahlia, Egypt.
¹⁴ Rheumatology Department, Faculty of Medicine, 158405Fayoum University, Fayoum, Egypt.
¹⁵ Rheumatology Department, Faculty of Medicine, 158411Beni-Suef University, Beni-Suef, Egypt.
¹⁶ Internal Medicine Department, Rheumatology Unit, 68872Menoufiya University, Menoufiya, Egypt.
¹⁷ Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, 68792Ain-Shams University, Cairo, Egypt.
¹⁸ Rheumatology Department, Faculty of Medicine, 68780Mansoura University, Dakahlia, Egypt.
¹⁹ Rheumatology Department, Faculty of Medicine, 435387Aswan University, Aswan, Egypt.
²⁰ Internal Medicine Department, Rheumatology Unit, Faculty of Medicine (Girls), 68820Al-Azhar University, Cairo, Egypt.
²¹ Rheumatology Department, Faculty of Medicine, Suez-Canal University, Ismailia, Egypt.
²² Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, 158411Beni-Suef University, Beni-Suef, Egypt.
²³ Rheumatology Department, Faculty of Medicine, 68792Ain Shams University, Cairo, Egypt.
²⁴ Pediatrics Department, Rheumatology and Nephrology Unit, 68789Alexandria University, Alexandria, Egypt.
²⁵ Rheumatology Department, 68782Tanta University, Gharbia, Egypt.
²⁶ Rheumatology Department, Faculty of Medicine, 68799Zagazig University, Sharkia, Egypt.
²⁷ Rheumatology Department, Faculty of Medicine, 68900Helwan University, Cairo, Egypt.
²⁸ Rheumatology Department, Faculty of Medicine, 68797Assuit University, Assuit, Egypt.
²⁹ Rheumatology Department, 8785University of California San Francisco (UCSF), San Francisco, CA, USA.

PMID: 34528835
DOI: 10.1177/09612033211043010

Abstract

Objectives: This study aims to present the manifestations of juvenile systemic lupus erythematosus (JSLE) across Egypt, to focus on age at onset and gender-driven influence on disease characteristics, and to compare findings to other countries.

Methods: The study included 404 Egyptian children with systemic lupus erythematosus (SLE) presenting to one of the specialized rheumatology centers corresponding to 13 major governorates. Juvenile cases age was ≤ 16°years at the time of recruitment. The SLE Disease Activity Index (SLEDAI) and damage index (DI) were assessed.

Results: The mean age was 13.2 ± 2.4°years; 355 females and 49 males (7.2:1), and the disease duration was 2.3 ± 1.6 years, while age at disease onset was 11.1 ± 2.5°years. Their SLEDAI was 13.5 ± 12.3, and DI, 0.36 ± 0.78. The overall estimated prevalence of childhood-SLE patients in the recruited cohort in Egypt was 1/100,000 population (0.24/100000 males and 1.8/100000 females). 7.4% developed pre-pubertal SLE (≤ 7 years); 73.3%, peri-pubertal; and 19.3% during early adolescence. The differences according to age group were equal for gender and clinical manifestations except skin lesions present in 59.3% of pre-pubertal onset, 74.6% of peri-pubertal, and 84.2% of adolescents (p = 0.029), and renal involvement in 73.8% of peripubertal, 62.1% of pre-pubertal and 58.9% of adolescents (p = 0.03). Laboratory investigations, SLEDAI, and DI were similar among age categories. Lupus nephritis was more common in Egypt compared to JSLE from other countries.

Conclusion: Our large multicenter study identified that female gender influenced disease characteristics with more frequent skin involvement. Skin lesions were significantly higher in adolescents, while renal involvement in peri-pubertal children.

Keywords: Egypt; Juvenile; age at onset; gender; prevalence; systemic lupus erythematosus.

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Systemic lupus erythematosus children in Egypt: Homeland spectrum amid the global situation

Affiliations

Systemic lupus erythematosus children in Egypt: Homeland spectrum amid the global situation

Authors

Affiliations

Abstract

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical