The effects of double-filtration plasmapheresis on prognosis in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a well defined systemic auto-immune disorder on genetically susceptible people, arising from immune mechanisms on which the environmental factors have an impact and progressing especially on the skin, on the joints and with the cardiac, renal, hematologic and neurological involvement. The prevalence of SLE is 20-150 out of every 100.000 in the population. Lupus nephritis (LN) is the most important complication which related mortality and morbidity of SLE. The treatment of LN is still an important problem currently. No treatments provide a complete cure and exacerbation of the disease can be observed on a patient in remission. The aim of this study is to make a comparison between the respond to the medical treatment and double filtration plasmapheresis (DFPP) of the patients with LN, whom we observe in our centre. The patients older than 18 are included to this study between the years of 2011-2014 in Gaziantep University Department of Internal Medicine Division of Rheumatology. The information related to the patients has been obtained from the patient files, from the anamnesis and the laboratory results registered on the computer system retrospectively. According to the criteria of American Clinic of Rheumatology (ACR), among the patients diagnosed with SLE and the patients diagnosed by LN as a consequence of renal biopsy, 12 patients (1 male/11 female), whose treatment of cyclophosphamide and rituximab has been started, have been included to the study as a control group and 14 patients (1 male/13 female) whose DFPP has been completed, have been included to the study as a DFPP group. The relation between the clinic and demographic features of the patients and the remission has been obtained. The time to stay in remission has been compared between the 2 groups. As a result of the comparison of control and DFPP groups, it has been found out that there is no relation between the age, the sex, C3, C4, creatinine clearance and the remission (p> 0.05). It has been established a statistical difference between the pretreatment/ before processing weight and the level of LDH and proteinuria (p<0.05). The relation of anti-ds DNA with the remission has been determined as a consequence of the comparison the pretreatment/ post treatment and the before processing/ after processing in the two groups( p <0.05). However, as a result of the comparison between each group, it hasn't been determined a significant difference( p>0.05). The time to stay in remission in the posttreatment / after processing has been found as 2 years in the control group, whereas this period has been found as 4 years in DFPP group. There is no significant differences have been established between the two groups (p >0.05). In conclusion, this is the first research in the treatment of LN in Turkey. The DFPP process performed on the patients has increased the time to stay in remission on the patients with lupus nephritis. Although, a complete remission in LN continues being a problem. KEY WORDS: Systemic Lupus Erythematosus, Lupus Nephritis, Double Filtration Plasmapheresis.