Estudo clínico e imunológico comparativo do acometimento inicial e desfecho de pacientes com lúpus eritematoso sistêmico juvenil e adulto

Abstract

Introduction: Systemic Lupus Erythematosus (SLE) is an autoimmune rheumatic disease, with a chronic character and large clinical spectrum. It results from complex abnormalities of the immune system, with the predominance of antinuclear antibodies that affect several organs and systems. It affects both genders, at any age, however, has a higher incidence in women in reproductive age, with a peak at 30 years. In some cases, it can manifest in the juvenile age group (JSLE). However, considering the diagnosis and the different prevalent clinical manifestations from SLE and JSLE, articles on this subject are still not common, making it difficult to create a profile that comprises the higher severity of symptoms manifested before the age of eighteen in comparison with LES. Objectives: to identify differences in the clinical, epidemiological, and immunological profile of patients that fulfilled the criteria for classification of Systemic Lupus Erythematosus and Juvenile Systemic Lupus Erythematosus, under follow-up at the Pediatric Rheumatology and Rheumatology ambulatory of the Cesupa Medical Specialties Center (CEMEC). Method: a retrospective, descriptive and observational longitudinal study of the historical cohort type was carried out, with a qualitative and quantitative approach. The study was carried out at the Medical Specialties Center (CEMEC) of the Centro Universitário do Pará (CESUPA), located in Belém-PA. Results: both groups had a predominance of females composing the sample. The most frequent clinical manifestations in JSLE were fever, asthenia, acute skin manifestations, arthralgia, vasculitis, pericardial effusion, proteinuria, hematic cylinders, lupus nephritis, lymphopenia, thrombocytopenia and hypocomplementenemia. Adult group patients hadat the beginning and follow-up, predominance of increased values in inflammatory tests, weight loss, papulosquamous cutaneous lupus, scarring and nonscarring alopecia, oral ulcers, arthritis, pericarditis, pleural effusion, transverse myelitis, neuritis and psychosis, hemolytic anemia autoimmune, leukopenia and neutropenia. The juvenile group had a higher index of activity at the beginning of the disease, however, it had a more favorable development when compared to the adult group, since its SLEDAI-2K index decreased more effectively than the group of adult onset. Conclusion: JSLE patients had slightly higher prevalence in males, anti-dsDNA antibody positivity, hypocomplementenemia, higher frequency of acute skin manifestations, renal involvement and higher disease activity index at the beginning, but with better progress in its course. SLE obtained female prevalence, laboratory manifestations of autoimmune hemolytic anemia and leucopenia, in addition to higher inflammatory activity and joint symptoms.