Background
The purpose of this study was to examine the association between anti double-stranded DNA (anti-dsDNA) IgA levels and the severity of systemic lupus erythematosus (SLE) regarding the presence of cutaneous vasculitis.
Method
The cross-sectional study was conducted at the outpatient installation of Wahidin Sudirohusodo Hospital and Hasanuddin University hospital in Makassar from September 2020 to February 2021. Investigation of anti-ds-DNA IgA levels in SLE patients was performed in two groups: group A (SLE patients with cutaneous vasculitis) and group B (SLE patients without cutaneous vasculitis). The diagnosis of cutaneous vasculitis was based on the presence of efflorescence in the form of erythematous macules and papules, petechiae, urticaria, purpura, nodular lesions and ulcerated lesions. To assess the severity of SLE, the Mexican Systemic Lupus Erythematosus Disease Activity Index (MEX-SLEDAI) was employed; the SLE is severe if the value ranges from 11 to 19 and very severe if the value >20. Chi square and Fisher Exact were used in statistical analysis. The results are significant if the p value <0.05.
Result
54 subjects with SLE patients were identified. The mean age of the subjects in group A was 29.6±7.6 years and in group B 29.9±9.5 years where there were more women in both groups. The most skin manifestations of the entire sample were petechiae with 27.6%. In subjects with positive anti-dsDNA IgA, group A was found to be 100% and significantly higher than in group B at 72.0%. Meanwhile, in subjects with moderate, severe and very severe SLE, the percentages of group A were 37.9%, 48.3% and 13.8%, respectively, which were significantly higher than group B with 20.0%, 44.0%. and 0.0%. Furthermore, in moderate, severe and very severe SLE, the percentage of positive anti-dsDNA IgA (31.9%, 51.1% and 8.5%) was significantly higher than the negative (14.3%, 14.3% and 0.0%). Meanwhile, the mild degree was found to be higher in the negative anti-dsDNA IgA (71.4%) than the positive (8.5%) with p value = 0.002.
Conclusion
Anti-dsDNA IgA levels are related to the severity of disease in SLE patients based on cutaneous vasculitis. Therefore, anti-dsDNA IgA levels and the presence of cutaneous vasculitis may be useful as the potential predictors of disease severity in SLE patients.