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Demographic, clinical and immunological features of 134 Malaysian patients with systemic lupus erythematosus

Azizah MR, Ainol SS, Kong NCT, Normaznah Y, Rahim MN

International Medical Journal (Tokyo), 2001;8(1):45-50.

Objective: SLE is an autoimmune disease which affects multiple organ system. Clinical and immunological expression of the disease have been widely studied and variations occur in different ethnic groups. Here in this study, we have analyzed the clinical manifestations and immunological features of Malaysian patients with Systemic lupus erythematosus (SLE) and compared them with SLE population from some of the Asian countries. Study design: A total of 134 Malaysian patients attending the SLE Clinic of The National University Hospital of Malaysia, Kuala Lumpur and who satisfy the revised ACR (American College of Rheumatology) criteria for the classification of SLE were enrolled into the study. Data on the demography, clinical and immunological features were obtained from medical records. Materials and Methods: The female to male ratio in the study cohort was 10:1 and consisted of the Malay, Chinese and Indian races. Past clinical and immunological features were entered into a prepared questionnaire. At study entry patients were seen by a rheumatologist for assessment of present clinical condition and blood obtained for immunological tests (Antinuclear, antids DNA, antiSm, antiU1RNP, antiSSA(Ro), antiSSB(La), anticardiolipin (IgG and IgM) antibodies and complements C3 and C4). Chi-square, Fisher's exact test and Mann Whitney U Test were used to analyze data. Results: Clinical features expressed at disease presentation in order of frequency was mucocutaneous (72%), followed by musculoskeletal (58%) and renal involvement (45%) which was also similar during the course of the disease (90%, 72% and 64% respectively). A high prevalence of antiSSB (La) antibodies was found (48%). Conclusion: This study provides the literature on the clinical and immunological features of Malaysian SLE patients and further shows the different spectrum of disease profile when compared to other ethnic groups. The roles of racial and genetic factors are suggested.

Matched MeSH terms: Lupus Erythematosus, Systemic*
Lack of correlation between Apo-1/Fas promoter polymorphism and susceptibility to systemic lupus erythematosus

Radzi AM, Hun KS, Kong N, Yahaya N

International Medical Journal (Tokyo), 2008;15(4):257-259.

Background: Systemic lupus erythematosus (SLE) is a complex autoimmune disease exhibiting extensive clinical heterogeneity. Genetic factors and immune dysregulation play important roles in its development. Apoptosis is a physiologic process that regulates normal homeostasis. It is likely to contribute to the pathogenesis of autoimmune diseases by impairing elimination of autoreactive T and B cells. Apo-1/Fas which is a transmembrane protein mediates apoptosis and is a member of the tumour necrosis factor/nerve growth factor receptor family. It transduces the apoptotic signal into susceptible target cells. Recent studies have focused on the apoptosis mediated by these proteins in the causation of several autoimmune disorders including SLE. Aim: To determine the frequency of Apo-1/Fas promoter gene polymorphism in patients with systemic lupus erythematosus and healthy controls and to investigate its role in the susceptibility of SLE in a cohort of Malaysian Chinese SLE patients Materials and methods: 107 Chinese patients and 60 matched controls were genotyped using polymerase chain reaction (PCR) amplification followed by MvaI restriction enzyme digestion. The MvaI RFLP is located at the -670 position from the transcription starting site and results from an A→G substitution which alters the MvaI restriction site. Results: G/G genotype was found in 25% of patients and controls while the A/A genotype in 23% and 31.6% of patients and controls respectively. Heterozygous form was noted in 43% of the normal population compared to 51% in SLE patients. There was also no significant difference in the allele frequencies of G and A in both groups studied. Conclusion: We suggest that polymorphism of the Apo-1/Fas promoter gene does not play a role in disease susceptibility in Chinese patients with SLE. © 2008 Japan International Cultural Exchange Foundation.

Matched MeSH terms: Lupus Erythematosus, Systemic*
Lack of IL-1RA gene polymorphism association in malay and chinese patients with systemic lupus erythematosus

Azizah MR, Kuak SH, Ainol SS, Kong NCT, Rahim MN, Normaznah Y

International Medical Journal (Tokyo), 2004;11(1):9-12.

Background: Systemic lupus erythematosus (SLE) is a chronic disease of autoimmune nature. Genetic pre-disposition has been known to play a role. With a number of genes already named, the IL-RA is no exception. Polymorphism in the human cytokine gene, an uncommon allele of a variable repeat polymorphism in intron 2 of the IL1-RA gene has been found to be associated with SLE. Objective: The aim of this present study was to study the polymorphism of the IL-1RA gene in Malay and Chinese SLE patients and to investigate the possible contribution of the IL-RA gene polymorphism in disease susceptibility. Materials and Methods: We thus investigated the allele frequencies of the IL-RA gene polymorphism in 87 Malay and 100 Chinese SLE population at the Hospital of National University of Malaysia, Kuala Lumpur by PCR and direct analysis by electrophoresis on agarose gel. Unrelated healthy ethnically-matched individuals were taken as controls. Results: Allelic frequencies of the IL1-RN*4 were most dominant in all groups (patients and controls) but there was no significant differences among them. We found an increased allelic frequency and carriage rate of the IL1-RN*2 repeat in both the Malay and Chinese SLE cases compared to controls. However they were not statistically significant. Conclusion: Thus from this finding we postulate that the polymorphism of the IL-1RA gene (both alleles 2 and 4) does not influence susceptibility to SLE.

Matched MeSH terms: Lupus Erythematosus, Systemic*
Hyperthyroidism in systemic lupus erythematosus

Cheah JS, Chia BL, Tay HH, Tan BY

Med J Aust, 1970 Nov 28;2(22):1029-30.
PMID: 5494951
Matched MeSH terms: Lupus Erythematosus, Systemic/complications*
Fulltext SMART-SLE: serology monitoring and repeat testing in systemic lupus erythematosus-an analysis of anti-double-stranded DNA monitoring

Yeo AL, Kandane-Rathnayake R, Koelmeyer R, Golder V, Louthrenoo W, Chen YH, et al.

Rheumatology (Oxford), 2024 Feb 01;63(2):525-533.
PMID: 37208196 DOI: 10.1093/rheumatology/kead231

OBJECTIVE: Disease activity monitoring in SLE includes serial measurement of anti-double stranded-DNA (dsDNA) antibodies, but in patients who are persistently anti-dsDNA positive, the utility of repeated measurement is unclear. We investigated the usefulness of serial anti-dsDNA testing in predicting flare in SLE patients who are persistently anti-dsDNA positive.
METHODS: Data were analysed from patients in a multinational longitudinal cohort with known anti-dsDNA results from 2013 to 2021. Patients were categorized based on their anti-dsDNA results as persistently negative, fluctuating or persistently positive. Cox regression models were used to examine longitudinal associations of anti-dsDNA results with flare.
RESULTS: Data from 37 582 visits of 3484 patients were analysed. Of the patients 1029 (29.5%) had persistently positive anti-dsDNA and 1195 (34.3%) had fluctuating results. Anti-dsDNA expressed as a ratio to the normal cut-off was associated with the risk of subsequent flare, including in the persistently positive cohort (adjusted hazard ratio [HR] 1.56; 95% CI: 1.30, 1.87; P 3. Both increases and decreases in anti-dsDNA more than 2-fold compared with the previous visit were associated with increased risk of flare in the fluctuating cohort (adjusted HR 1.33; 95% CI: 1.08, 1.65; P = 0.008) and the persistently positive cohort (adjusted HR 1.36; 95% CI: 1.08, 1.71; P = 0.009).
CONCLUSION: Absolute value and change in anti-dsDNA titres predict flares, including in persistently anti-dsDNA positive patients. This indicates that repeat monitoring of dsDNA has value in routine testing.

Matched MeSH terms: Lupus Erythematosus, Systemic*
Fulltext The usefulness of endothelial cell adhesion molecules and anti-C1q antibody in monitoring systemic lupus erythematosus disease activity

Mahayidin H, Yahya NK, Wan Ghazali WS, Mohd Ismail A, Wan Ab Hamid WZ

Int Sch Res Notices, 2014;2014:275194.
PMID: 27355017 DOI: 10.1155/2014/275194

Objectives. The study was conducted to determine the correlation of ICAM-1, VCAM-1, and anti-C1q antibody levels with SLE disease activity index (SLEDAI) and standard SLE disease activity immunological markers (anti-dsDNA and sera C3 and C4). Study Design. This was a cross-sectional study. Materials and Methods. Blood samples were obtained from 95 SLE patients (45 active SLE and 50 nonactive SLE) and 50 controls. The subjects were assessed using SLEDAI and score of more than five is determined as having active SLE. The sera were tested for serum ICAM-1, VCAM-1, and anti-C1q (ELISA), anti-dsDNA (CLIFT), serum C3, and serum C4 (immunonephelometry). Results. Anti-dsDNA and anti-C1q antibody showed good positive correlations with SLEDAI (r = 0.529, P < 0.001 and r = 0.559, P < 0.001, resp.). VCAM-1 and sera C3 and C4 showed fair correlation with SLEDAI (r = 0.294, P = 0.004; r = -0.312, P = 0.002; and r = -0.382, P < 0.001, resp.). ICAM-1 level showed no significant correlation with SLEDAI (P = 0.062). There were significant correlations of VCAM-1 and anti-C1q antibody with anti-dsDNA (r = 0.226, P = 0.006 and r = 0.511, P < 0.001, resp.). VCAM-1 showed poor inverse correlation with serum C3 (r = -0.183, P = 0.028) and fair inverse correlation with serum C4 (r = -0.251, P = 0.002). Anti-C1q antibody demonstrated fair inverse correlation with both sera C3 and C4 (r = -0.420, P ≤ 0.001 and r = -0.398, P < 0.001, resp.). However, ICAM-1 showed no significant correlation with anti-dsDNA and sera C3 and C4 (P = 0.259, P = 0.626 and P = 0.338, resp.). Conclusions. The serum levels of anti-C1q antibody in SLE patients showed the best correlation with the SLEDAI and standard immunological tests for SLE disease activity. These data support that anti-C1q antibody is a useful marker for monitoring SLE global disease activity. The potential of VCAM-1 needs further confirmation.
Study site: Hospital Universiti Sains Malaysia (HUSM), Kubang Kerian, and Hospital Raja Perempuan Zainab II (HRPZ II), Kota Bharu, Kelantan, Malaysia

Matched MeSH terms: Lupus Erythematosus, Systemic*
Clinical and electrophysiological characteristics of symmetric polyneuropathy in a cohort of systemic lupus erythematosus patients

Jasmin R, Sockalingam S, Ramanaidu LP, Goh KJ

Lupus, 2015 Mar;24(3):248-55.
PMID: 25253567 DOI: 10.1177/0961203314552115

OBJECTIVE: Peripheral neuropathy in systemic lupus erythematosus (SLE) is heterogeneous and its commonest pattern is symmetrical polyneuropathy. The aim of this study was to describe the prevalence, clinical and electrophysiological features, disease associations and effects on function and quality of life of polyneuropathy in SLE patients, defined using combined clinical and electrophysiological diagnostic criteria.
METHODS: Consecutive SLE patients seen at the University of Malaya Medical Centre were included. Patients with medication and other disorders known to cause neuropathy were excluded. Demographic, clinical and laboratory data were obtained using a pre-defined questionnaire. Function and health-related quality of life was assessed using the modified Rankin scale and the SF-36 scores. Nerve conduction studies (NCS) were carried out in both upper and lower limbs. Polyneuropathy was defined as the presence of bilateral clinical symptoms and/or signs and bilateral abnormal NCS parameters.
RESULTS: Of 150 patients, 23 (15.3%) had polyneuropathy. SLE-related polyneuropathy was mainly characterized by sensory symptoms of numbness/tingling and pain with mild signs of absent ankle reflexes and reduced pain sensation. Function was minimally affected and there were no differences in quality of life scores. NCS abnormalities suggested mild length-dependent axonal neuropathy, primarily in the distal lower limbs. Compared to those without polyneuropathy, SLE-related polyneuropathy patients were significantly older but had no other significant demographic or disease associations.
CONCLUSIONS: SLE-related polyneuropathy is a chronic, axonal and predominantly sensory neuropathy, associated with older age. Its underlying pathogenetic mechanisms are unknown, although a possibility could be an increased susceptibility of peripheral nerves in SLE patients to effects of aging.

Matched MeSH terms: Lupus Erythematosus, Systemic/complications*; Lupus Erythematosus, Systemic/epidemiology; Lupus Erythematosus, Systemic/physiopathology
Fulltext Kikuchi disease in a connective tissue disorder

Bachi R

Med J Malaysia, 2002 Sep;57(3):357-60.
PMID: 12440277

A 27-year old woman presented with fever, weight loss, arthralgia, macular skin rash and bilateral axillary lymphadenopathy. The histology of an excised lymph node showed evidence suggestive of Kikuchi disease. Subsequent laboratory tests showed evidence of Systemic Lupus Erythematosus, underscoring the importance of considering other diagnoses in a nodal histological diagnosis of Kikuchi disease, a benign condition of unknown aetiology.

Matched MeSH terms: Lupus Erythematosus, Systemic/complications*; Lupus Erythematosus, Systemic/diagnosis*; Lupus Erythematosus, Systemic/therapy
Fulltext Optic neuritis and retinal vasculitis as primary manifestations of systemic lupus erythematosus

Barkeh HJ, Muhaya M

Med J Malaysia, 2002 Dec;57(4):490-2.
PMID: 12733176

Systemic lupus erythematosus (SLE) is a common multisystem disorder. However, retinal vasculitis as a primary manifestation of SLE is uncommon, accounting for only 4% of causes of retinal vasculitis. The postulated mechanism appeared to be vaso-occlusion of the retinal arterioles by thrombosis, with resultant ischaemia. Optic neuropathy in SLE is also rare, with a prevalence of 1%. This is a case report of a young lady who presented to us with retinal vasculitis as her initial presentation of SLE. Interestingly, the pathologic mechanism appeared to be inflammatory and not vaso-occlusive.

Matched MeSH terms: Lupus Erythematosus, Systemic/complications*; Lupus Erythematosus, Systemic/diagnosis*; Lupus Erythematosus, Systemic/therapy
Fulltext Late-onset systemic lupus erythematosus: clinical and immunological characteristics

Shaikh SK, Wang F

Med J Malaysia, 1995 Mar;50(1):25-31.
PMID: 7752972

Between January 1976 and December 1992, 17 patients on follow-up at Systemic Erythematosus (SLE) Clinic in the University Hospital, Kuala Lumpur had onset of the disease after the age of 50 years. This constituted about 4% of our total SLE patients. They formed a distinct subgroup of the lupus population with an insidious onset and have a benign course compared to the younger SLE patients. Arthritis and skin rashes were the commonest initial manifestations. Renal and central nervous system manifestations were uncommon but pulmonary involvement was frequent compared to young SLE patients. The prevalence of positive autoantibodies and hypocomplementaemia were lower. Disease activity showed no correlation with erythrocyte sendimentation rate, autoantibodies or complement levels. Overall prognosis in these late-onset patients was favourable with a good response to steroids and less frequent relapses.
Study site: SLE clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Matched MeSH terms: Lupus Erythematosus, Systemic/immunology; Lupus Erythematosus, Systemic/epidemiology*; Lupus Erythematosus, Systemic/physiopathology*
The lack of relationship between acetylator phenotype and idiopathic systemic lupus erythematosus in a South-east Asian population: a study of Indians, Malays and Malaysian Chinese

Ong ML, Mant TG, Veerapen K, Fitzgerald D, Wang F, Manivasagar M, et al.

Br J Rheumatol, 1990 Dec;29(6):462-4.
PMID: 2257457

An association of idiopathic systemic lupus erythematosus (ISLE) with genetically determined N-acetylation polymorphism has been suspected from previous studies, mainly on Caucasian populations in which there is an approximate incidence of 50% of slow and rapid acetylators. The present study is of the incidence of ISLE and acetylator status in a mixed population of Malaysia. The results did not support an association between ISLE and acetylator status: the frequencies of slow acetylators in the ISLE patients who were Malaysian Chinese and Malay were 13 and 38% respectively. This did not differ significantly from the respective healthy groups (20 and 29%). The small number of Indians in the survey did not allow a valid comparison, but the figures did suggest a lack of association between ISLE and acetylator status.

Matched MeSH terms: Lupus Erythematosus, Systemic/ethnology; Lupus Erythematosus, Systemic/genetics*; Lupus Erythematosus, Systemic/microbiology
Management of lupus nephritis

Menon SP

Family Physician, 1991;3(2):10-12.

Matched MeSH terms: Lupus Erythematosus, Systemic
Fulltext Tako Tsubo cardiomyopathy in a patient with antiphosholipid syndrome secondary to systemic lupus erythemathosus (SLE)

Lim BA

Med J Malaysia, 2008 Jun;63(2):146-7.
PMID: 18942303 MyJurnal

Tako Tsubo cardiomyopathy is rare, stress related and indistinguishable from acute myocardial infarction clinically. Proper diagnosis is essential to avoid unnecessary thrombolysis and life long management of coronary artery disease.

Matched MeSH terms: Lupus Erythematosus, Systemic/complications*
Fulltext The autoantibody profile and its association with clinical manifestations in Malay SLE patients

Maraina CH, Kamaliah MD, Ishak M

Asian Pac J Allergy Immunol, 2004 Mar;22(1):33-7.
PMID: 15366656

A cross sectional study was conducted to determine the auto-antibody profile of Malay SLE patients in Kelantan, North East Malaysia and to correlate them with clinical presentations. Eighty-two Malay SLE patients who fulfilled the ARA criteria underwent the following tests: ANA, anti-dsDNA antibody, anti-ENA antibody and RF. The results revealed that ANA was positive in 91.5% of the patients, anti-dsDNA antibody in 53.7%, however, anti-ENA antibodies were positive in only 9.8% of the cases at the time of the study and none had a positive RF. The profile of autoantibodies was similar to other studies except for a lower incidence of anti-ENA antibodies. Sixty three percent of patients had lupus nephritis. The pattern of clinical presentations were noted to be more similar to those found among Chinese and Indian SLE populations than compared to the Caucasians. There was a significant association between anti-dsDNA antibody and lupus nephritis and between anti-ENA antibody and thrombocytopenia.

Matched MeSH terms: Lupus Erythematosus, Systemic/immunology*
Fulltext Autoimmune thyroid disease in a cohort of Malaysian SLE patients: frequency, clinical and immunological associations

Ong SG, Choy CH

Lupus, 2016 Jan;25(1):67-74.
PMID: 26113361 DOI: 10.1177/0961203315593164

Autoimmune thyroid disease (ATD) has been associated with other systemic autoimmune diseases. To date, there is limited data on thyroid disorders and autoimmune thyroid disease in Malaysia. The frequency of ATD among 189 systemic lupus erythematosus (SLE) patients was 6.3%, with 2.6% in the hyperthyroid group and 3.7% in the hypothyroid group. Hypothyroidism developed at a much younger mean age (24.3 years), suggesting that SLE might be a predisposing factor for the development of Hashimoto's thyroiditis. There was a higher rate of thyroid peroxidase antibody (TPO) positivity compared with anti-thyroglobulin antibody (Tg) in the hyperthyroid subgroup. This study also demonstrated a greater proportion of ATD patients who demonstrated high titres (≥ 1:6400) of TPO compared with high titres of Tg. Although there was an association between ATD and the presence of anti-Ro/SSA and/or anti-La/SSB antibodies, the absence of sicca symptoms and negative Schirmer's tests suggest a lack of association with secondary Sjogren's syndrome. A novel association between ATD and antiphospholipid syndrome (APS) was detected in our cohort. Hence we propose that patients affected by APS be routinely screened for ATD.

Matched MeSH terms: Lupus Erythematosus, Systemic*
Fulltext Mortality in Malaysians with systemic lupus erythematosus

Paton NI, Cheong I, Kong NC, Segasothy M

Med J Malaysia, 1996 Dec;51(4):437-41.
PMID: 10968030

One hundred and two patients attending the systemic lupus erythematosus (SLE) clinic of the Department of Medicine, Universiti Kebangsaan Malaysia, were studied retrospectively to determine their survival rates and causes of death. There were 21 deaths. The 1, 5, and 10 year survival rates were 93%, 86% and 70% respectively. There was a bimodal pattern of mortality with more patients dying in the first 2 years or after 5 years of disease. Infection was the direct cause of death in 52% and contributed to a further 19% of deaths. Patients with lupus nephritis had a higher relative risk (RR) of death (RR = 4.34, p < 0.02) although there was no significant increase in risk with any particular histological type on biopsy. Cerebral lupus (RR = 3.08, p < 0.001) and methylprednisolone treatment (RR = 6.24, p < 0.001) were also associated with increased risk of death. Increased awareness of infection and earlier use of antibiotic therapy may improve survival of patients suffering from SLE.
Study site: SLE clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia

Matched MeSH terms: Lupus Erythematosus, Systemic/mortality*
Fulltext Ethnic distribution of patients with S.L.E. seen in university hospital, Kuala Lumpur 1967--1976

Frank AO

Med J Malaysia, 1980 Mar;34(3):230-7.
PMID: 7412664

Following the opening of the University Hospital of the University of Malaya in 1967, over 126,000 patients (excluding obstetric patients) have been admitted. A retrospective review, run concurrently with a prospective study, of over 200 patients thought to have suffered from systemic lupus erythematosus (SLE) revealed that, up until the 31st December 1975, 175 patients fulfilled the criteria for the diagnosis of SLE. There was a highly significant increase in the diagnosis of SLE over this period among Chinese patients compared to all other races, and no significant differencein the diagnosis of SLE among Indian and Malay patients. A review of the literature revealed that SLE appears to be a worldwide disease, reported frequently from Chinese communities but infrequently from tropical Africa. It is concluded that SLE is more common in the Chinese from Peninsular Malaysia than the other races, and that a careful study of geographical and racial factors in SLE may contribute to further understanding of its pathogenesis.

Matched MeSH terms: Lupus Erythematosus, Systemic/epidemiology*
Solitary paraventricular calcification in cerebral lupus erythematosus: a report of two cases

Daud AB, Nuruddin RN

Neuroradiology, 1988;30(1):84-5.
PMID: 3357575

Paraventricular calcification not previously reported in systemic lupus erythematosus was seen in cranial computed tomograms of two patients with this disorder.

Matched MeSH terms: Lupus Erythematosus, Systemic/complications
Heat inactivation of serum potentiates anti-cardiolipin antibody binding in ELISA

Cheng HM, Ngeow YF, Sam CK

J Immunol Methods, 1989 Nov 30;124(2):235-8.
PMID: 2600427

Heat treatment of sera at 56 degrees C for 30 min results in positive ELISA reactions for anti-cardiolipin antibody (aCL) in sera that had undetectable or low levels of aCL before heat inactivation. The positive, potentiated reactivity of the heated sera in the aCL ELISA could be inhibited with the cardiolipin antigen and was abolished by prior IgG depletion using staphylococcal protein A. The heat-potentiating effect of aCL binding in ELISA was evident in both normal human sera and clinical sera including sera from patients with systemic lupus erythematosus and syphilis.

Matched MeSH terms: Lupus Erythematosus, Systemic/immunology
Fulltext Bilateral optic neuritis in pregnancy

Suraiya MS, Norazlina B, Carmen C, Muhaya M

Med J Malaysia, 2003 Dec;58(5):771-3.
PMID: 15190668

A 25-year old primigravida at 11-weeks period of amenorrhoea presented with bilateral optic neuritis following Varicella Zoster viral (VZV) infection. She was serologically positive for systemic lupus erythematosus but negative for virus. The exact pathogenesis of the patient's severe optic neuritis, adduction and neurological deficit was unknown. The initiation of high dose steroids for optic neuritis was a big clinical dilemma in a pregnant patient with viral infection. The patient was treated with high dose steroids after three days of commencement of antiviral treatment. At 6 months after presentation, her visual acuity in the right eye was 6/36 with perception to light in the left.

Matched MeSH terms: Lupus Erythematosus, Systemic/complications

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