PREVALENCE OF PHOTOSENSITIVITY IN CUTANEOUS SYSTEMIC LUPUS ERYTHEMATOSUS IN PAKISTAN: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Main Article Content
Keywords
Systemic Lupus Erythematosus; Cutaneous Lupus erythematosus; autoimmune disease; photosensitivity; meta-analysis; Pakistan
Abstract
Background: SLE, a complex autoimmune disorder, manifests in diverse organ systems, with cutaneous involvement being particularly debilitating. The purpose of this study is to examine studies concerning the rate of photosensitivity in individuals with CLE living in Pakistan and its associated demographics. Methods: We conducted a thorough assessment of databases including PubMed, Embase, and Google Scholar from 1996 to 2024. We subjected all qualifying data to a random-effect systematic review and meta-analysis. This meta-analysis encompassed 18 studies, totaling 2761 individuals diagnosed with photosensitivity. The analysis was performed through R-software (version 4.4.1). Results: The pooled photosensitivity prevalence was 34.2% (95 % CI: 20.5-49.5, I2 = 98 %, 12 studies). Based on geographic location, KP had the highest pooled prevalence estimate (62.8%; 95% CI: 58.9–66.4%) of photosensitivity in SLE patients. The prevalence rates were lower in Punjab (49.3%; 95% CI: 30.4%–68.3%) and Sindh (12.9%; 95 CI: 3.6%–26.5%). A time-based subgroup meta-analysis revealed an increase in the reported prevalence of cutaneous photosensitivity among SLE patients after 2010, with rates rising to 45.8% (95% CI: 27.0%–65.1%) compared to 17.9% (95% CI: 3.6%–39.5%) before 2010. Conclusion: This meta-analysis demonstrates the high and increasing prevalence of photosensitive patients, as well as regional variations, which correspond to an expanding burden of photosensitivity among SLE patients throughout Pakistan. The disease's growing trend, especially since 2010, underscores the need for greater clinical awareness and more targeted methods in studying the population health issue. Guidelines for managing lupus in a nation, particularly one with a high prevalence of the condition, such as Khyber Pakhtunkhwa, must include early detection and proactive management of photosensitivity. Policymakers and healthcare providers must enhance screening, education, and access to care for the communities they serve.
References
2. Gill JM, Quisel AM, Rocca PV, Walters DT. Diagnosis of systemic lupus erythematosus. American family physician. 2003 Dec 1;68(11):2179-87.
3. Uva L, Miguel D, Pinheiro C, Freitas JP, Marques Gomes M, Filipe P. Cutaneous manifestations of systemic lupus erythematosus. Autoimmune diseases. 2012;2012(1):834291.
4. Khan MI, Qureshi H, Akhtar S, Bae SJ, Hassan F. Prevalence of neuropsychiatric disorders in patients with systemic lupus erythematosus in Pakistan: A systematic review and meta-analysis. Frontiers in Psychiatry. 2023 Feb 2;14:1098734.
5. Rider V, Abdou NI, Kimler BF, Lu N, Brown S, Fridley BL. Gender bias in human systemic lupus erythematosus: a problem of steroid receptor action?. Frontiers in immunology. 2018 Mar 28;9:611.
6. Millard TP, Hawk JL, McGregor JM. Photosensitivity in lupus. Lupus. 2000 Jan;9(1):3-10.
7. Klein B, Kunz M. Current concepts of photosensitivity in cutaneous lupus erythematosus. Frontiers in Medicine. 2022 Aug 25;9:939594.
8. Manzoor MS, Mumtaz S, Maqbool F, Samar D, Adil MH, Malik J. Varied Presentations Of Patients With Systemic Lupus Erythematosus–What Makes Pakistani Lupus Patients Different. Journal of Rawalpindi Medical College. 2024 Mar 16;28(1).
9. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. bmj. 2021 Mar 29;372.
10. Freeman MF, Tukey JW. Transformations related to the angular and the square root. The annals of mathematical statistics. 1950 Dec 1:607-11.
11. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta‐analysis. Statistics in medicine. 2002 Jun 15;21(11):1539-58.
12. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994 Dec 1:1088-101.
13. Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1998;316(7129):469-71.
14. Wallace BC, Schmid CH, Lau J, Trikalinos TA. Meta-Analyst: software for meta-analysis of binary, continuous and diagnostic data. BMC medical research methodology. 2009 Dec 4;9(1):80.
15. Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic. Fam med. 2005 May 1;37(5):360-3.
16. Aringer M, Johnson SR. Classifying and diagnosing systemic lupus erythematosus in the 21st century. Rheumatology. 2020 Dec;59(Supplement_5):v4-11.
17. Lythgoe H, Morgan T, Heaf E, Lloyd O, Al-Abadi E, Armon K, Bailey K, Davidson J, Friswell M, Gardner-Medwin J, Haslam K. Evaluation of the ACR and SLICC classification criteria in juvenile-onset systemic lupus erythematosus: a longitudinal analysis. Lupus. 2017 Oct;26(12):1285-90.
18. Siddique M, Ahmed NM, Raja SF, Saeed MA, Sarwar S. Spectrum of initial clinical presentations in Pakistani patients with systemic lupus erythematosus in the Arthritis Care Foundation lupus cohort. Lupus. 2024 Feb;33(2):187-91.
19. Khan ZA, Mushtaq S, Samreen S, Salim B, Ahmed SN, Zahid PM, Gul H. Clinico-Immunological Profile of Systemic Lupus Erythematosus Patients of Pakistan and Their Correlation. Pakistan Armed Forces Medical Journal. 2022 Aug 31;72(4):1181-5.
20. Khan A, Haroon M, Lashari N, Khan S, Khanum A, Asif S. Inflammatory arthritis and younger age of lupus onset are associated with the development of neuropsychiatric lupus: experience from a single centre in Pakistan. Acta Rheumatol. 2021;8:1-7.
21. Shamim R, Farman S, Batool S, Khan SE, Raja MK. Association of systemic lupus erythematosus disease activity index score with clinical and laboratory parameters in pediatric onset systemic lupus erythematosus. Pakistan Journal of Medical Sciences. 2020 Mar;36(3):467.
22. Ahmed S, Ali SR, Karim F, Ishaque S, Qaiser I, Nayani K, Ahmed A. Childhood-Onset Systemic lupus erythematosus: A cohort study. Journal of the College of Physicians and Surgeons Pakistan: JCPSP. 2018;28(5):365.
23. Khan A, Shah MH, Nauman M, Hakim I, Shahid G, Niaz P, Sethi H, Aziz S, Arabdin M. Clinical manifestations of patients with systemic lupus erythematosus (SLE) in Khyber Pakhtunkhwa. J Pak Med Assoc. 2017 Aug 1;67(8):1180-5.
24. Batool S, Ahmad NM, Saeed MA, Farman S. Pattern of initial clinical manifestations of systemic lupus erythematosus in a tertiary care hospital. Pakistan Journal of Medical Sciences. 2016 Sep;32(5):1066.
25. Naheed A, Shaheen JA, Khalid M. Cutaneous manifestations of systemic lupus erythematosus –An experience from Bahawal-Victoria Hospital, Bahawalpur.
26. Ishaq M, Nazir L, Riaz A, Kidwai SS, Haroon W, Siddiqi S. Lupus, still a mystery: a comparison of clinical features of Pakistani population living in suburbs of Karachi with other Asian countries. JPMA. 2013 Jul 1;63(869).
27. Raza MA, Khan MI. Systemic lupus erythematosus: disease manifestations in patients from Central Punjab (Pakistan). International Journal of Clinical Rheumatology. 2012 Dec 1;7(6):607.
28. Rabbani MA, Habib HB, Islam M, Ahmad B, Majid S, Saeed W, Shah SM, Ahmad A. Survival analysis and prognostic indicators of systemic lupus erythematosus in Pakistani patients. Lupus. 2009 Aug;18(9):848-55.
29. Rabbani MA, Siddiqui BK, Tahir MH, Ahmad B, Shamim A, Majid S, et al. Do clinical manifestations of Systemic Lupus Erythematosus in Pakistan correlate with rest of Asia? J Pak Med Assoc. 2006 May;56(5):222–7.
30. Rabbani MA, Tahir MH, Siddiqui BK, Ahmad B, Shamim A, Shah SM, Ahmad A. Renal involvement in systemic lupus erythematosus in Pakistan. Journal of Pakistan Medical Association. 2005;55(8):328..
31. Rabbani MA, Siddiqui BK, Tahir MH, Ahmad B, Shamim A, Shah SM, Ahmad A. Systemic lupus erythematosus in Pakistan. Lupus. 2004 Oct;13(10):820-5.x.
32. Rabbani MA, Shah SM, Ahmed A. Cutaneous manifestations of systemic lupus erythematosus in Pakistani patients. Journal of Pakistan Medical Association. 2003;53(11):539..
33. Ahmed TA, Ikram N, Hussain T, Farooqui A, Haleem A, Bashir M, Moin S, Karamat KA. Clinical and laboratory features of systemic lupus erythematosus (SLE) in Pakistani patients. JPMA. The Journal of the Pakistan Medical Association. 2002 Jan 1;52(1):12-5.
34. Kapadia N, Haroon TS. Cutaneous manifestations of systemic lupus erythematosus: study from Lahore, Pakistan. International journal of dermatology. 1996 Jun;35(6):408-9.
35. Kowalska J, Rok J, Rzepka Z, Wrześniok D. Drug-induced photosensitivity—from light and chemistry to biological reactions and clinical symptoms. Pharmaceuticals. 2021 Jul 26;14(8):723.
36. Di Bartolomeo L, Irrera N, Campo GM, Borgia F, Motolese A, Vaccaro F, Squadrito F, Altavilla D, Condorelli AG, Motolese A, Vaccaro M. Drug-induced photosensitivity: clinical types of phototoxicity and photoallergy and pathogenetic mechanisms. Frontiers in allergy. 2022 Jun 20;3:876695.
37. Desai K, Miteva M. Recent insight on the management of lupus erythematosus alopecia. Clinical, cosmetic and investigational dermatology. 2021 Mar 30:333-47.
38. Hart PH, Norval M, Byrne SN, Rhodes LE. Exposure to ultraviolet radiation in the modulation of human diseases. Annual Review of Pathology: Mechanisms of Disease. 2019 Jan 24;14(1):55-81.
39. Scheinfeld N, Deleo VA. Photosensitivity in lupus erythematosus. Photodermatology, Photoimmunology & Photomedicine. 2004 Oct;20(5):272-9.
40. AlOmair M, AlMalki H, AlShahrani M, Mushait H, Al Qout M, Alshehri T, AlAlyani R, Algarni A, Almaker Y, Madkli E, Alshahrani MA. Clinical manifestations of systemic lupus erythematosus in a tertiary center in Saudi Arabia. Cureus. 2023 Jun 30;15(6).
41. Wysenbeek AJ, Block DA, Fries JF. Prevalence and expression of photosensitivity in systemic lupus erythematosus. Annals of the rheumatic diseases. 1989 Jun 1;48(6):461-3.
42. Battesti G, Felten R, Piga M, Sarmiento-Monroy JC, Ziade N, El Kibbi L, Ugarte-Gil M, Arnaud L, Chasset F. Prevalence and characteristics of, and knowledge related to, photosensitivity in patients with lupus erythematosus: the international PHOTOLUP study. Rheumatology. 2024 Aug;63(8):2170-7.
43. Adwan MH, Qasem U, Atawnah SY, Itmeizeh M, Hanbali R, Alsoofi NA, Jbara MA, AbuHelal A, Alnaimat F. Insights into systemic lupus erythematosus: a retrospective observational study of clinical features, autoantibodies, and gender-related differences. Rheumatology International. 2024 Jul;44(7):1255-63.
44. Foering K, Goreshi R, Klein R, Okawa J, Rose M, Cucchiara A, Werth VP. Prevalence of self-report photosensitivity in cutaneous lupus erythematosus. Journal of the American Academy of Dermatology. 2012 Feb 1;66(2):220-8.
45. AlOmair M, AlMalki H, AlShahrani M, Mushait H, Al Qout M, Alshehri T, AlAlyani R, Algarni A, Almaker Y, Madkli E, Alshahrani MA. Clinical manifestations of systemic lupus erythematosus in a tertiary center in Saudi Arabia. Cureus. 2023 Jun 30;15(6).
46. Wysenbeek AJ, Block DA, Fries JF. Prevalence and expression of photosensitivity in systemic lupus erythematosus. Annals of the rheumatic diseases. 1989 Jun 1;48(6):461-3.
47. Pons-Estel GJ, Alarcón GS, Scofield L, Reinlib L, Cooper GS. Understanding the epidemiology and progression of systemic lupus erythematosus. InSeminars in arthritis and rheumatism 2010 Feb 1 (Vol. 39, No. 4, pp. 257-268). WB Saunders.
48. Estadt SN, Maz MP, Musai J, Kahlenberg JM. Mechanisms of photosensitivity in autoimmunity. Journal of Investigative Dermatology. 2022 Mar 1;142(3):849-56.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Fazal Hassan
Assistant Director ORIC, Iqra National University, Swat Campus, KP, Pakistan.
Taj Farin Khan
Lecturer, CS Department, Iqra National University, Swat Campus, KP, Pakistan.
Waqas Ahmad Khan
Lecturer, MLT Department, Iqra National University, Swat Campus, KP, Pakistan
Ali Irfan Ullah Khan
Lecturer, MLT Department, Iqra National University, Swat Campus, KP, Pakistan
Faiz Ullah
Assistant Director QEC, Iqra National University, Swat Campus, KP, Pakistan.
Mansoor Ahmad
Lecturer / Coordinator, DPT Department, Iqra National University, Swat Campus, KP, Pakistan.
Abdul Samad
Lecturer, CS Department, Iqra National University, Swat Campus, KP, Pakistan.
Sohail Akhtar
Department of Mathematics and Statistics, University of Haripur, Haripur, Pakistan
