A Study of Clinical Features and Associated Factors in Photosensitive Patients with Systemic Lupus Erythematosus

A Study of Clinical Features and Associated Factors in Photosensitive Patients with Systemic Lupus Erythematosus | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article A Study of Clinical Features and Associated Factors in Photosensitive Patients with Systemic Lupus Erythematosus Jia-huan He, Zhi-qi Song, Hui Li, Yi-jing Kang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6637050/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract OBJECTIVE: Some patients with systemic lupus erythematosus (SLE) exhibit atypical clinical manifestations, leading to misdiagnosis or missed diagnosis. Photosensitivity is one of the common initial symptoms in SLE, which is often overlooked in early stage due to the absence of other symptoms. This study provides evidence for a regular screening and follow-up system for photosensitive patients by comparing the clinical features of photosensitive and non-photosensitive patients and by analyzing their different clinical manifestations and factors associated with photosensitivity. It is expected that the system will facilitate early identification and warning of SLE-predisposed patients through regular follow-up and screening targeting photosensitive patients, thereby achieving early treatment and improving prognosis. METHODS: A retrospective analysis was conducted on clinical data of SLE patients hospitalized at our hospital between October 2016 and October 2024. All diagnoses were made according to the SLE classification and evaluation criteria recommended by the American College of Rheumatology (ACR) in 1997. General characteristics, clinical data and immunological indicators were collected. The patients were divided into photosensitive and non-photosensitive groups for comparing the differences in epidemiological and clinical features and analyzing the factors associated with photosensitivity. Analysis was performed with statistical software SPSS 24.0. RESULTS: An epidemiological analysis was performed on sex, age and accuracy rate of initial diagnosis. A total of 276 SLE patients were included, comprising 28 males (10.14%) and 248 females (89.86%). The patients were divided into a photosensitive group (n=101, 36.59%) and a non-photosensitive group (n=175, 63.41%). The photosensitive group consisted of 96 female patients (95.05%) and 5 male patients (4.95%), and the non-photosensitive group consisted of 152 female patients (86.86%) and 23 male patients (13.14%). A significantly higher prevalence of photosensitivity was found in female SLE patients than in males (P<0.05). In the photosensitive group, 80 patients (79.21%) were <50 years old and 21 (20.79%) were ≥50 years old. In contrast, the non-photosensitive group included 106 patients <50 years old (60.57%) and 69 patients ≥50 years old (39.43%). Accordingly, SLE patients <50 years old had a significantly higher incidence of photosensitivity than those ≥50 years old (P<0.05). Regarding accuracy rate of initial diagnosis, 56 patients (55.45%) in the photosensitive group were correctly diagnosed with SLE at initial diagnosis, while 45 (44.56%) were undiagnosed or misdiagnosed. In the non-photosensitive group, 62 patients (35.43%) were correctly diagnosed with SLE at initial diagnosis, while 130 (64.57%) were undiagnosed or misdiagnosed. The non-photosensitive group had significantly lower diagnostic accuracy or higher misdiagnosis rates (P<0.05). In terms of clinical manifestations, the photosensitive group showed significantly higher percentages compared to the non-photosensitive group in rash (100, 99.01% vs. 89, 50.86%), alopecia (62, 61.39% vs. 65, 37.14%), arthritis (72, 71.29% vs. 100, 57.14%), and Raynaud syndrome (21, 20.79% vs. 17, 9.71%) (all P<0.05). Conversely, the non-photosensitive group had significantly higher percentages compared to the photosensitive group in terms of sjogren (76, 43.43% vs. 31, 30.69%), fever (82, 46.86% vs. 31, 30.69%), and hematological damage (104, 59.43% vs. 44, 43.56%) (all P0.05). As for immunological indicators, the photosensitive group exhibited significantly higher percentages than the non-photosensitive group in terms of positive results for anti-SSA antibody (73, 72.28% vs. 99, 56.57%), anti-Sm antibody (41, 40.59% vs. 49, 28.00%), and anti-SSB antibody (31, 30.69% vs. 26, 11.43%) (all P<0.05). The number of patients with decreased C3, decreased C4, and RF positive in the photosensitive group was 82 (81.19%), 59 (58.42%), and 31 (30.69%) respectively, representing significantly higher percentages than those in the non-photosensitive group (121, 69.14%; 76, 43.43%; 24, 13.71%) (all P<0.05). ANA positive rate approached 100% in both groups. Multivariate logistic regression analysis revealed that rash, alopecia, arthritis, Raynaud syndrome, anti-Sm antibody, anti-SSA antibody, anti-SSB antibody, decreased C3, decreased C4 and RF positive were the main factors associated with photosensitivity. CONCLUSION: 1. Photosensitivity was significantly more prevalent in female SLE patients and those aged <50 years old compared to male patients and other age groups. Photosensitive SLE patients had significantly higher rates of rash, alopecia, arthritis and Raynaud syndrome. Additionally, these patients showed significantly higher positive rates of anti-Sm antibody, anti-SSA antibody, anti-SSB antibody, RF, as well as lower C3 and C4 compared to non-photosensitive SLE patients. 2. Multivariate analysis revealed significant positive correlations between photosensitivity and physical symptoms (e.g., rash, alopecia, arthritis, and Raynaud syndrome) as well as abnormal indicators (e.g., anti-Sm antibody, anti-SSA antibody, anti-SSB antibody, RF positive, decreased C3, and decreased C4. 3. For photosensitive patients with no other sings of SLE, routine screening of these physical signs and laboratory indicators may facilitate the identification of individuals with SLE predisposition or in their early onset. Health sciences/Health care Health sciences/Rheumatology systemic lupus erythematosus clinical feature photosensitivity associated factor Figures Figure 1 Introduction Systemic lupus erythematosus (SLE) with elusive pathogenesis has brought a heavy burden to patients, their families and the society due to its various complications and high fatality rates [ 1 ] . In China, the high incidence of organ involvement in SLE patients may correlate with delayed diagnosis and treatment due to the lack of awareness of its early symptoms [ 2 ] . Consequently, it is a pressing challenge in SLE diagnosis and treatment to enhance the public attention to SLE, achieve early diagnosis and prevention, and then improve the patient outcome [ 3 ] . Photosensitivity is a common manifestation of SLE due to skin damage caused by hypersensitivity of the skin to ultraviolet (UV) radiation [ 4 ] . Additionally, it has been recognized as an important indicator in the classification criteria for SLE developed by the American College of Rheumatology (ACR) in 1982 [ 5 ] and 1997 [ 6 ] . UV is not only associated with photosensitive skin lesions, but also induces system and organ-specific lesions in SLE patients, resulting in systemic diseases. The mechanism of action involves UV-induced immune system disorder and autoantibody production, characterized by high levels of autoantibodies in circulation and inflammatory damage in kidneys and other organs [ 7 ] . Hence, methods to reduce UV exposure, such as sun protection, protective clothing and effective UV-proof sunscreen cream, will help prevent SLE from being induced in the healthy population and alleviate characteristic skin lesions in SLE patients [ 8 ] . According to previous reports, SLE patients may initially exhibit only one or some of the clinical symptoms or immunologic disorders that will progress to SLE, which cannot meet the ACR classification criteria. However, about 10–55% of these patients will progress to SLE that meets the ACR classification criteria over time [ 9 ] . Although photosensitivity is one of the common initial symptoms of SLE, it is often overlooked in early stage. To this end, a routine screening system for SLE in photosensitive patients should be established based on ACR classification criteria. The system will facilitate identification of individuals with SLE predisposition who do not meet the ACR classification criteria. Early diagnosis and prevention which therefore becomes possible may shift the therapeutic window forward and improve prognosis. We conducted a retrospective study on 276 hospitalized SLE patients regarding clinical symptoms, auxiliary examinations, and immunologic disorders. By comparing the difference in clinical features between photosensitive and non-photosensitive patients, we aimed to analyzed the associated factors between clinical manifestations and photosensitivity, and provide a basis for routine screening and follow-up system of SLE in photosensitive patients, with a view to early detection and early warning of patients with SLE predisposition. Materials and Methods 1. Subjects and Content 1.1 Subjects and Grouping The subjects were hospitalized patients diagnosed with SLE at our hospital from October 2016 to October 2024. Based on patient history interviews and clinical physician observations, photosensitivity was defined. Patients were then divided into a photosensitive group and a non-photosensitive group according to the presence or absence of photosensitivity manifestations. 1.2 Diagnostic Criteria and Systemic Manifestation Assessment Basis 1.2.1 Diagnostic criteria We adopted the ACR classification criteria revised in 1997 [6] . The clinical manifestations and autoantibody evaluation criteria for SLE patients included in the study are as follows: (1) Malar rash: Fixed erythema over the cheeks, exceeding the zygomatic ridge (usually not involving skin near the nasolabial folds), flat or elevated, with the most common prominent area on the zygomatic region bilaterally. (2) Discoid rash: Scattered or elevated erythema in patches over lesions, with localized scaling or follicular plugging; atrophic scarring or raised plaques, which can be seen in old lesions, possibly accompanied by keratinized scales or follicular plugging. (3) Photosensitivity: Patient-reported photosensitivity symptoms or clinician-observed skin reactions that can cause rash. (4) Oral ulcer: Painless oral or nasal ulcers, usually observed by a physician. (5) Arthritis: Non-erosive arthritis involving two or more peripheral joints, characterized by tenderness, swelling, or effusion. (6) Serositis: Including pleuritis and pericarditis. (7) Renal damage: Including proteinuria, cylindruria, and elevated creatinine, with criteria as follows: ① Persistent proteinuria, urine protein >3+ in qualitative test or >0.5g/24h in quantitative test; ② Cellular casts (red cell cast, granular cast, hemoglobin cast, or mixed cast); ③ Serum creatinine >75μmol/L, unexplained elevation of creatinine. (8) Neurological involvement: Mainly involving central nervous system (CNS). ① Seizures: Excluding those induced by drug and metabolic disorders (e.g., electrolyte imbalance, ketoacidosis, and uremia); ② Mental symptoms: Excluding mental disorders induced by drug and mental symptoms caused by metabolic disorders (e.g., electrolyte imbalance, ketoacidosis, and uremia). (9) Hematology disorder: Including anaemia, decreased granulocyte or decreased platelet (PLT). Specific criteria are as follows: ① Hemolytic anemia accompanied by reticulocytosis; ② Decreased granulocyte, white blood cell (WBC) <4,000/mm³ and lymphocyte <1,500/mm³ in two or more tests; ③ Decreased PLT: PLT <100,000/mm³ (excluding medication effects on bone marrow and PLT). (10) Immunologic disorders: Manifested as abnormal positivity of a variety of autoantibodies, including ① serum anti-ds DNA antibody positive; ② serum anti-Sm antibody positive in qualitative test or increase in quantitative test; ③ serum antiphospholipid antibody positive in qualitative test or increase in quantitative test (a. serum anticardiolipin antibody IgG or IgM abnormality; b. LE anticoagulant factor positive in standard test; c. serum syphilis test false-positive for 6 months or more confirmed by treponema pallidum immobilization (TPI) or fluorescent treponemal antibody absorption. (any one of the three). (11) ANA positive in qualitative test or increase in quantitative test: An increased titer of antinuclear antibody (ANA) should be detected by immunofluorescence or other equivalent tests at any random time, excluding the effects of drug metabolism. A patient is classified as having SLE if he or she meets 4 or more of the 11 items above, based on clinical features and auxiliary examination. 1.2.2 Inclusion and Exclusion Criteria Inclusion criteria: (1) Patients definitively diagnosed with SLE; (2) Patients aged between 13 and 80 years; (3) Patients without severe systemic diseases (e.g., malignancies, severe cardiovascular or cerebrovascular diseases) or other autoimmune diseases. Exclusion criteria: (1) Patients with severe systemic diseases (e.g., malignancies, severe cardiovascular or cerebrovascular diseases); (2) Patients with other autoimmune diseases; (3) Patients with incomplete clinical data. 1.2.3 Ethical consideration We received approval from the Medical Ethics Commit tee of the China Rongtong Medical & Healthcare Group Tai’an 88 Hospital for undertaking this study. The study was designed to be secure and fair to patients while mini mizing risk of harm to participants. The included participants provided written informed voluntary consent. Par ticipants had the right to withdraw from the study at any time. 1.2.4 SLE Disease Activity The disease activity of SLE patients in this study was assessed using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2000) developed by Gladman et al. [10] (Table 1). Specifically, the standardized SLEDAI-2000 scores of 276 patients were calculated to evaluate SLE disease activity. This allowed for a comparative analysis of clinical phenotypic differences between the photosensitive and non-photosensitive groups. Table 1 clinical SLEDAI score Score Clinical manifestations 8 Seizure: recent onset, exclude metabolic, infectious, or drug causes. 8 Psychosis: Altered ability to function in normal activity due to severe disturbance in the perception of reality (include hallucinations, incoherence, marked loose associations, impoverished thought content, marked illogical thinking, and bizarre, disorganized, or catatonic behavior); exclude uremia and drug causes. 8 Organic brain syndrome Altered mental function with impaired orientation, memory, or other intellectual function (with rapid onset and fluctuating clinical features), inability to sustain attention to environment, and ≥2 of the following: perceptual disturbance, incoherent speech, insomnia or daytime drowsiness, and increased or decreased psychomotor activity; exclude uremia, metabolic, CNS infectious, or drug causes. 8 Visual disturbance: Retinal changes of SLE (include retinal hemorrhages, serous exudates, and optic neuritis); exclude hypertensive, infectious, or drug causes. 8 Cranial nerve disorder: New onset, extensive involvement, include cranial, sensory or motor neuropathy. 8 Lupus headache: Severe, persistent headache; may be migrainous, but must be nonresponsive to narcotic analgesia. 8 CVA: New onset of cerebrovascular accident(s); exclude arteriosclerosis. 8 Vasculitis: Ulceration, gangrene, or periungual infarction, and tender finger nodules, or biopsy or angiogram proof of vasculitis. 4 Arthritis: ≥2 joints with pain and signs of inflammation (i.e., tenderness, swelling or effusion). 4 Myositis: Proximal muscle aching/weakness, associated with elevated creatine phosphokinase/aldolase or electromyogram changes or a biopsy showing myositis. 4 Urinary casts: New or recent onset, include red cell, granular or hemoglobin casts. 4 Hematuria: New or recent onset, >5/HP urine red blood cells; exclude stone, infection or other cause. 4 Proteinuria: New or recent onset, >0.5g/d in quantitative test. 4 Pyuria: New or recent onset, WBC > 5/HP; exclude infection. 2 Alopecia: New onset or relapse, patchy or diffuse loss of hair. 2 Rash: New onset or relapse, inflammatory type rash. 2 Mucosal ulcers: New onset or relapse, oral or nasal ulcerations. 2 Pleurisy: Pleuritic chest pain with pleural rub or effusion on auscultation, or pleural thickening on auxillary examination. 2 Pericarditis: Pericardial pain with rub or effusion. 2 Low complement Decrease in CH50, C3, or C4 below the lower limit of normal for testing laboratory. 2 Increased ds-DNA antibody: Above normal range for testing laboratory or >25% by Farr assay. 1 Fever: ≥38℃; exclude infectious or other cause. 1 Decreased PLT: PLT below the lower limit of normal for testing laboratory. 1 Decreased WBC: WBC<3×10 9 /L; exclude drug cause. Note: ≥15 for severe activity; 5-14 for mild to moderate activity; 0-4 for essentially no activity. 1.2.5 Assessment Criteria for Organ Damage Renal Damage: Based on confirmed SLE diagnosis, the presence of clinical features (glomerular or tubular dysfunction) or laboratory abnormalities including persistent/recurrent proteinuria (urine protein >3+ in qualitative test or >0.5g/L/24h in quantitative test), casts (hemoglobin, granular, red cell, or mixed casts), or abnormal renal biopsy findings. Neurological Damage: Based on confirmed SLE diagnosis, the presence of CNS manifestations (e.g., vertigo, headache, blurred vision) accompanied by abnormal result in ≥1 item among cerebrospinal fluid analysis, EEG, cranial MRI, or CT, excluding infections, uremic encephalopathy, electrolyte imbalance, hypertensive encephalopathy, psychiatric disorders, hepatic encephalopathy, or hormonotherapy-induced mental disorders. Hematological Damage: Based on confirmed SLE diagnosis, the presence of abnormalities in ≥1 system: WBC <4.0×10 9 /L, hemoglobin <110g/L, or PLT <100×10 9 /L. 2. Research Content 2.1 Clinical Data Collection (1) Demographics and family history We established a patient database by collecting general demographic information of SLE patients through the hospital's inpatient case management system and supplementing clinical data from telephone follow-up. The database recorded general information such as patient's name, sex, ethnicity, age, date of birth, weight, height, living environment, marital status and occupation. (2) Disease onset and treatment The information includes whether it is the first onset, course of disease, initial symptoms, major clinical manifestations and signs (e.g., photosensitivity, rash (malar rash, discoid rash, or other SLE-specific rashes), renal damage, arthritis, alopecia, hematological damage, oral ulcer, Raynaud syndrome, sjogren, fever, CNS diseases, serositis, cardiac damage), and whether misdiagnosis occurred during treatment. 2.2 Key Laboratory Tests and Auxiliary Examinations Laboratory tests include blood routines (focusing on WBC, RBC, hemoglobin, and PLT), urine routines (including urinary WBC, RBC, and casts), 24-hour quantitative urinary protein, and serological tests for ANA, anti-dsDNA antibody, anti-Sm antibody, anti-SSB antibody, anti-SSA antibody, anti-RNP antibody, immunoglobulin (Ig), C3, C4, erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), and C-reactive protein (CRP). Auxiliary examinations include cardiac and abdominal ultrasound, ECG, head CT or MRI, chest X-ray or CT, and renal biopsy. 3. Statistical Analysis Statistical analysis was performed using SPSS 24.0. Measurement data are presented as mean ± standard deviation ( ±s) and statistically compared by t-tests. Enumeration data are described as frequencies and percentages, with group comparisons conducted via chi-square (χ 2 ) tests. Multivariate analysis was performed by logistic regression to identify clinical manifestations and immunological indicators associated with photosensitivity. The significant level was 0.05. Results 1. General Data 1.1 Age The mean age at diagnosis for 276 SLE patients was 42.22±16.27 years. Among these patients, 186 (67.39%) were <50 years old, and 90 (32.61%) were ≥50 years old. They were divided into the photosensitive group (n=101, 36.59%) and the non-photosensitive group (n=175, 63.41%). The mean age was 40.11±15.71 years for the 101 patients in the photosensitive group, including 80 patients (79.21%) <50 years old and 21 patients (20.79%) ≥50 years old. In the photosensitive group of 175 patients with a mean age of 43.78±16.79 years, 106 (60.57%) were <50 years old and 69 (39.43%) were ≥50 years old. Therefore, photosensitivity was significantly more prevalent in SLE patients <50 years old compared to those ≥50 years old (χ² = 10.121, P<0.05) (Table 2). Table 2 age at diagnosis of SLE patients Age Number of cases Percentage (%) Photosensitive group Non-photosensitive group Number of cases Percentage (%) Number of cases Percentage (%) <50 years old 186 67.39 80 79.21 106 60.57 ≥50 years old 90 32.61 21 20.79 69 39.43 Total 276 100.00 101 100.00 175 100.00 Note: χ 2 =10.121, P=0.001 1.2 Sex Among the 276 SLE patients, the male-female ratio was approximately 1:8.86, with 28 male patients (10.14%) and 248 female patients (89.86%). The ratio aligns with most studies at home and abroad. The photosensitive group (n=101) comprised 5 male patients (4.95%) and 96 female patients (95.05%), resulting in a male-female ratio of approximately 1:19.20. In contrast, the non-photosensitive group (n=175) had a male-female ratio of approximately 1:6.60, including 23 male patients (13.14%) and 152 female patients (86.86%). Hence, photosensitivity was significantly more pronounced in female SLE patients compared to males (χ²=4.715, P<0.05) (Table 3). Table 3 sex characteristics of SLE patients Sex Number of cases Percentage (%) Photosensitive group Non-photosensitive group Number of cases Percentage (%) Number of cases Percentage (%) Female 248 89.86 96 95.05 152 86.86 Male 28 10.14 5 4.95 23 13.14 Total 276 100.00 101 100.00 175 100.00 Note: χ 2 =4.715, P=0.030 2. Accuracy rate of initial diagnosis Of the 276 SLE patients, 118 (42.75%) were correctly diagnosed with SLE at initial diagnosis, while 158 (57.25%) were undiagnosed or misdiagnosed. Of the misdiagnosed cases, 47 (17.03%) were misdiagnosed as infectious disease, and the rest were misdiagnosed as arthritis (22, 7.97%), skin disease (30, 10.87%), hematological disease (22, 7.97%), other connective tissue disease excluding SLE (11, 3.99%), renal disease (19, 7.61%), Raynaud syndrome (2, 0.72%), hypothyroidism (2, 0.72%), digestive system disease (2, 0.72%), and recurrent oral ulcer (1, 0.36%). In the photosensitive group (n=101), 56 patients (55.45%) were correctly diagnosed with SLE at initial diagnosis, while 45 patients (44.56%) were undiagnosed or misdiagnosed. In the non-photosensitive group (n=175), 62 patients (35.43%) were accurately diagnosed with SLE at initial diagnosis, while 130 patients (64.57%) were undiagnosed or misdiagnosed. Therefore, photosensitive SLE patients were significantly more likely to receive an accurate initial diagnosis, while non-photosensitive SLE patients were more prone to missed diagnosis or misdiagnosis (χ² = 10.484, P<0.05). No significant difference was found between the two groups in the proportion of patients misdiagnosed as arthritis, infectious disease, other connective tissue disease (except SLE), hematological disease, and other systemic disease (e.g., Raynaud syndrome, hypothyroidism) (P>0.05). However, SLE patients in the non-photosensitive group had significantly higher misdiagnosis rates for skin disease excluding SLE and renal disease (χ²= 7.849, 5.976, P<0.05) (Table 4 and Figure 1). Table 4 clinical analysis at initial diagnosis for SLE patients Disease diagnosed at initial diagnosis Number of cases Percentage (%) Photosensitive group Non-photosensitive group χ 2 P Number of cases Percentage (%) Number of cases Percentage (%) SLE 118 42.75 56 55.45 62 35.43 10.484 0.001 Infectious disease 47 17.03 12 11.88 35 20.00 2.988 0.084 Arthritis 22 7.91 10 9.90 12 6.86 0.809 0.368 Skin disease 30 10.87 4 3.96 26 14.86 7.849 0.005 Hematological disease 22 7.97 6 5.94 16 9.14 0.895 0.344 Other CTD 11 3.99 7 6.93 4 2.29 3.611 0.057 Renal disease 19 6.88 2 1.98 17 9.71 5.976 0.015 Other systemic disease 7 2.53 4 3.96 3 1.71 1.307 0.253 Total 276 100.00 101 100.00 175 100.00 - - 3. Initial symptoms Among the 276 SLE patients, rash (malar rash, discoid rash, or other SLE-specific rash) was found in 77 patients (27.90%), making it the most common initial symptom, followed by fever (56, 20.29%), arthritis (48, 17.39%), renal damage (44, 15.94%), hematological damage (25, 9.06%), fatigue (14, 5.07%), Raynaud syndrome (6, 2.17%), other symptoms including alopecia (1, 0.36%), digestive tract symptom (1, 0.36%), sjogren (1, 0.36%), chest pain and distress (1, 0.36%), oral ulcer (1, 0.36%), and myalgia (1, 0.36%). In the photosensitive group (n=101), rash was the most common initial symptom in 44 patients (43.56%), followed by fever (20, 19.80%), arthritis (18, 17.82%), renal damage (7, 6.93%), Raynaud syndrome (5, 4.95%), hematological damage (3, 2.97%), fatigue (2, 1.98%), other symptoms including alopecia (1, 0.99%), and sjogren (1, 0.99%). However, in the non-photosensitive group (n=175), renal damage was the most common initial symptom, found in 37 patients (21.14%), followed by fever (36, 20.57%), rash (33, 18.86%), arthritis (30, 17.14%), hematological damage (22, 12.51%), fatigue (12, 6.86%), Raynaud syndrome (1, 0.57%), other symptoms including digestive tract symptom (1, 0.57%), chest pain and distress (1, 0.57%), oral ulcer (1, 0.57%), and myalgia (1, 0.57%). No significant difference was found between the two groups in the percentage of patients with arthritis, fever or fatigue as their initial symptom. However, the photosensitive group had significantly more cases with rash or Raynaud syndrome as initial symptom (χ² = 19.434, 5.775, P<0.05); but the non-photosensitive group had significantly larger percentages of cases with renal damage or hematological damage as initial symptom (χ² =9.653, 7.166, P<0.05) (Table 5). Table 5 analysis of initial symptoms in 276 SLE patients Photosensitive group Non-photosensitive group Symptom Number of cases Percentage (%) Number of cases Percentage (%) Number of cases Percentage (%) χ 2 P Rash 77 27.90 44 43.56 33 18.86 19.434 <0.001 Arthritis 48 17.39 18 17.82 30 17.14 0.021 0.886 Fever 56 20.29 20 19.80 36 20.57 0.023 0.878 Renal damage 44 15.94 7 6.93 37 21.14 9.653 0.002 Hematological damage 25 9.06 3 2.97 22 12.57 7.166 0.007 Fatigue 14 5.07 2 1.98 12 6.86 3.163 0.075 Raynaud syndrome 6 2.17 5 4.95 1 0.57 5.775 0.016 Other 6 2.17 2 1.98 4 2.29 0.028 0.867 Total 276 100.00 101 100.00 175 100.00 - - 4. Clinical manifestations for diagnosing SLE The most common clinical manifestations in the 276 SLE patients were rash (189, 68.48%), arthritis (172, 62.30%), hematological damage (148, 53.62%), alopecia (127, 46.01%), fever (113, 40.94%), myositis (110, 39.86%), and renal damage (107, 38.77%). Other less common manifestations included Raynaud syndrome, recurrent oral and nasal ulcer, and neuropsychiatric damage. Specifically, rashes included malar rash and discoid rash; hematological damage primarily included decreased WBC, decreased RBC or hemoglobin, decreased PLT, and decreased lymphocyte; renal damage included proteinuria and/or hematuria, pathological cast, impaired renal function, and renal biopsy lesions; and CNS manifestations included headache, CVA, seizure, coma, and psychiatric disorders. No significant difference was found between the two groups in the distribution of oral ulcer, myositis, renal damage, neurological damage, and serositis (P>0.05). However, the photosensitive group had significantly higher percentages of patients with rash, alopecia, arthritis, and Raynaud syndrome(χ² =68.791, 15.152, 5.456, 6.619, P<0.05); while the non-photosensitive group had significantly higher percentages of patients who developed sjogren, fever, and hematological damage (χ²= 4.376, 6.920, 6.481, P<0.05) (Table 6). Table 6 analysis of clinical manifestations for diagnosing SLE in SLE patients Symptom Number of cases Percentage (%) Photosensitive group Non-photosensitive group χ 2 P Number of cases Percentage (%) Number of cases Percentage (%) Rash 189 68.48 100 99.01 89 50.86 68.791 <0.001 Alopecia 127 46.01 62 61.39 65 37.14 15.152 <0.001 Oral ulcer 41 14.86 17 16.83 24 13.71 1.798 0.483 Sjogren 107 38.77 31 30.69 76 43.43 4.376 0.036 Myositis 110 39.86 35 34.65 75 42.86 1.798 0.180 Fever 113 40.94 31 30.69 82 46.86 6.920 0.009 Arthritis 172 62.32 72 71.29 100 57.14 5.456 0.020 Raynaud syndrome 38 13.77 21 20.79 17 9.71 6.619 0.010 Renal damage 107 38.77 38 37.62 69 39.43 0.088 0.767 Hematological damage 148 53.62 44 43.56 104 59.43 6.481 0.011 Neuropsychiatric damage 35 12.68 13 12.87 22 12.57 0.005 0.943 Serositis 58 21.01 17 16.83 41 23.43 1.679 0.195 Total 276 100.00 101 100.00 175 100.00 - - 5. SLEDAI score The mean SLEDAI score for the 276 SLE patients was 19.32±8.39, and no significant difference was found between the photosensitive group (18.54±9.85) and the non-photosensitive group (21.87±8.82) (P>0.05). Among the 276 patients, SLEDAI indicated severe activity in 111 patients (40.22%), moderate activity in 79 patients (28.62%), mild activity in 81 patients (29.35%), and essentially no activity in 5 patients (1.81%). No significant difference was found between the two groups in terms of severe activity (40, 39.60% vs. 71, 40.57%), moderate activity (29, 28.71% vs. 50, 28.57%), mild activity (30, 29.70% vs. 51, 29.14%), or essentially no activity (all P>0.05) (Table 7). Table 7 SLEDAI score of SLE patients SLEDAI score Number of cases Percentage (%) Photosensitive group Non-photosensitive group χ 2 P Number of cases Percentage (%) Number of cases Percentage (%) Essentially no activity 5 1.81 2 1.98 3 1.71 0.025 0.873 Mild activity 81 29.35 30 29.70 51 29.14 0.010 0.922 Moderate activity 79 28.62 29 28.71 50 28.57 0.001 0.980 Severe activity 111 40.22 40 39.60 71 40.57 0.025 0.875 Total 276 100.00 101 100.00 175 100.00 - - 6. Immunological indicators 6.1 Autoantibody Among the 276 SLE patients, 275 (99.64%) were ANA positive, 90 (32.61%) were anti-Sm antibody positive, 148 (53.62%) were anti-dsDNA antibody positive, 172 (62.32%) were anti-SSA antibody positive, 51 (18.48%) were anti-SSB antibody positive, and 93 (33.70%) were anti-RNP antibody positive. No significant difference was found between the photosensitive group and the non-photosensitive group in ANA positive patients (101, 100.00% vs. 174, 99.43%), anti-dsDNA antibody positive patients (55, 54.46% vs. 93, 53.14%), or anti-RNP antibody positive patients (41, 40.59% vs. 52, 29.71%) (all P>0.05). The photosensitive group had 41 anti-Sm antibody positive patients (40.59%), 73 anti-SSA antibody positive patients (72.28%) and 31 anti-SSB antibody positive patients (30.69%), representing significantly higher percentages than the non-photosensitive group (49, 28.00%; 99, 56.57%; 20, 11.43%) (χ²= 4.622, 6.727, 15.777; all P<0.05). (Table 8). Table 8 analysis of autoantibody in 276 SLE patients Item Number of cases Percentage (%) Photosensitive group Non-photosensitive group χ 2 P Number of cases Percentage (%) Number of cases Percentage (%) ANA positive 275 99.64 101 100 174 99.43 0.579 0.447 Anti-RNP antibody 93 33.70 41 40.59 52 29.71 3.393 0.065 Anti-dsDNA antibody 148 53.62 55 54.46 93 53.14 0.044 0.833 Anti-Sm antibody 90 32.61 41 40.59 49 28.00 4.622 0.032 Anti-SSA antibody 172 62.32 73 72.28 99 56.57 6.727 0.009 Anti-SSB antibody 51 18.48 31 30.69 20 11.43 15.777 <0.001 Total 276 100.00 101 100.00 175 100.00 - - 6.2 Immunoglobulin and complement Among the 276 SLE patients, there were 158 patients (57.25%) with elevated immunoglobulin G (IgG), 48 patients (17.39%) with elevated immunoglobulin M (IgM), 47 patients (17.03%) with elevated immunoglobulin A (IgA), and 203 patients (73.55%) with decreased C3. No significant difference was found between the photosensitive group and the non-photosensitive group in terms of patients with elevated IgG (62, 61.39% vs. 96, 54.86%), patients with elevated IgM (14, 13.86%; 34, 19.43%), or patients with elevated IgA (19, 18.81% vs. 28, 16.00%) (all P>0.05). The photosensitive group had 82 patients (81.19%) with decreased C3, representing a significantly higher percentage than the non-photosensitive group (121, 69.14%), which indicated that there were significantly more patients with decreased C3 in photosensitive SLE patients (χ² =4.776, P<0.05) (Table 9). The photosensitive group had 59 patients (58.42%) with decreased C4, representing a significantly higher percentage than the non-photosensitive group (76, 43.43%), which indicated that there were significantly more patients with decreased C4 in the photosensitive group (χ² =5.172, P<0.05) (Table 9). Table 9 analysis of abnormal immunoglobulin and complement in 276 SLE patients Photosensitive group Non-photosensitive group Item Number of cases Percentage (%) Number of cases Percentage (%) Number of cases Percentage (%) χ 2 P Elevated IgG 158 57.25 62 61.39 96 54.86 1.115 0.291 Elevated IgA 47 17.03 19 18.81 28 16.00 0.358 0.549 Elevated IgM 48 17.39 14 13.86 34 19.43 1.382 0.240 Decreased C3 203 73.55 82 81.19 121 69.14 4.776 0.029 Decreased C4 135 48.91 59 58.42 76 43.43 5.172 0.023 Total 276 100.00 101 100.00 175 100.00 - - 6.3 ESR, RF, CRP Of the 276 SLE patients, 162 patients (58.70%) exhibited increased ESR, including 55 patients (54.46%) in the photosensitive group and 107 patients (61.14%) in the non-photosensitive group (χ² =1.181, P>0.05); 135 patients (48.91%) had elevated CRP, including 48 patients (47.52%) in the photosensitive group, and 87 patients (49.71%) in the non-photosensitive group (P>0.05). Additionally, there were 55 RF positive patients (19.93%), including 31 patients (30.69%) in the photosensitive group and 24 patients (13.71%) in the non-photosensitive group (χ²= 11.570, P<0.05) (Table 10). Table 10 analysis of abnormal ESR, RF and CRP in 276 SLE patients Item Number of cases Percentage (%) Photosensitive group Non-photosensitive group χ² P Number of cases Percentage (%) Number of cases Percentage (%) Increased ESR 162 58.70 55 54.46 107 61.14 1.181 0.277 RF positive 55 19.93 31 30.69 24 13.71 11.570 0.001 Elevated CRP 135 48.91 48 47.52 87 49.71 0.123 0.726 Total 276 100.00 101 100.00 175 100.00 - - Logistic regression analysis of photosensitivity associated factors Logistic regression analysis was performed with photosensitivity symptoms as dependent variables (y=1) and clinical manifestations and immunological indicators as independent variables. As shown in Table 11, rash, alopecia, arthritis, Raynaud syndrome, anti-Sm antibody, anti-SSA antibody, anti-SSB antibody, decreased C3, decreased C4 and RF positive were the main factors associated with photosensitivity. Table 11 Logistic regression analysis of photosensitivity influencing factors in SLE patients Variable B SE Walds χ² P OR OR 95%CI Correlation Rash 3.045 0.687 19.675 <0.001 21.019 5.473-80.728 Positive Alopecia 1.782 0.651 7.487 0.006 5.940 1.658-21.281 Positive Oral ulcer 0.006 0.513 0.000 0.991 1.006 0.368-2.751 None Sjogren -2.868 0.833 11.841 0.001 0.057 0.011-0.291 Negative Myositis -1.138 1.341 0.721 0.396 0.320 0.023-4.435 None Fever -1.609 0.753 4.563 0.033 0.200 0.046-0.876 Negative Arthritis 0.636 0.302 4.433 0.035 1.889 1.045-3.416 Positive Raynaud syndrome 0.971 0.308 9.921 0.002 2.641 1.443-4.834 Positive Renal damage -0.313 0.452 0.478 0.489 0.731 0.302-1.774 None Hematological damage -0.827 0.317 6.807 0.009 0.438 0.235-0.814 Negative Anti-RNP antibody 0.511 0.660 0.599 0.439 1.667 0.457-5.085 None Anti-dsDNA antibody 0.406 0.549 0.546 0.460 1.500 0.511-4.402 None Anti-Sm antibody 0.342 0.130 6.894 0.009 1.408 1.091-1.818 Positive Anti-SSA antibody 0.849 0.223 14.528 <0.001 2.337 1.510-3.615 Positive Anti-SSB antibody 1.126 0.361 9.717 0.002 3.084 1.519-6.626 Positive Elevated IgG 0.191 0.303 0.397 0.529 1.210 0.668-2.190 None Elevated IgA 0.193 0.415 0.216 0.642 1.213 0.537-2.736 None Elevated IgM -0.394 0.406 0.941 0.332 0.674 0.304-1.495 None Decreased C3 2.661 0.715 13.862 <0.001 14.308 3.526-58.061 Positive Decreased C4 1.232 0.487 6.408 0.011 3.429 1.321-8.904 Positive Increased ESR -0.294 0.173 2.870 0.090 0.745 0.531-1.047 None RF positive 2.365 0.810 8.513 0.004 10.640 2.173-52.093 Positive Elevated CRP 0.465 0.343 1.832 0.176 1.592 0.812-3.119 None Constant -29.906 3403.342 <0.001 0.993 - - - Discussion SLE can progress from mild clinical manifestations such as photosensitivity, rash or Raynaud syndrome, to involvement of multiple vital organs (e.g., renal damage). Early diagnosis and treatment of SLE can be facilitated by recognizing SLE-related early symptoms, detecting predictive biomarkers, identifying immune abnormalities, alerting to SLE occult or premorbid states, and conducting long-term follow-up for patients with suggestive clinical manifestations who do not yet meet the SLE classification criteria. Our findings indicated that SLE patients in the photosensitive group were less likely to be misdiagnosed and more likely to be correctly diagnosed at initial diagnosis, suggesting that photosensitivity may be an important entry point for SLE screening studies. According to previous publications, photosensitivity is found in approximately 11%~94% of SLE patients [ 11 ] , and it is more common in Asian countries (90%) [ 12 ] . Enhancing awareness of SLE among photosensitive individuals and attention of clinicians to photosensitive patients with a predisposition to SLE is important for the early diagnosis and treatment of SLE. Our results demonstrated that clinical manifestations such as rash, alopecia, arthritis, and Raynaud syndrome were significantly more prevalent in photosensitive SLE patients compared to non-photosensitive SLE patients. A correlation analysis revealed that these factors were strongly associated with photosensitivity symptoms, suggesting that rash, alopecia, arthritis, and Raynaud syndrome are closely related to photosensitivity. Given their easy observation and specificity to SLE, these four clinical features can be included as screening indicators in subsequent studies on SLE screening in photosensitive patients. Immunological indicators are highly important in the classification criteria of SLE. Retrospective data from two cohort studies on SLE suggested that autoantibody can be present long before the onset of symptoms [ 13 ] . Different mechanisms of onset are indicated by the difference between photosensitive and non-photosensitive SLE patients in terms of abnormal autoimmune antibody and complement. Therefore, it is important to select targeted treatment scheme along with photoprotection based on the presence or absence of photosensitization. Currently, photoprotection is the major approach to preventing photosensitivity. It has also been found that hydroxychloroquine (HCQ) has a protective effect in patients with incomplete SLE, which can reduce organ damage, delay the progression of SLE-related conditions, and improve quality of life and survival [ 14 ] . Khellaf M et al. [ 15 ] concluded that HCQ is a safe drug by finding that a treatment combining HCQ can achieve favorable effect in patients with reduced PLT and increased ANA titers who could not be diagnosed with SLE. For patients with SLE predisposition or in their early onset, it is advised to enhance photoprotection during follow-up and give them HCQ and other medications when necessary, which is not only beneficial to alleviate UV-induced skin damage, but also helps to control the progression of systemic damage. Our next step is to develop criteria for recruiting photosensitive patients with a focus on young women, screen for SLE-related signs and conduct initial ANA screening; test positive patients for relevant immune markers to identify potential, SLE-predisposed, or early SLE patients; assign these patients into different groups and provide guidance on photoprotection and/or medication; and conduct long-term follow-up and periodic summaries. It is expected that our study will provide a basis for a routine screening system for SLE in photosensitive patients, which will facilitate early identification and warning of patients with a predisposition to SLE and provision of appropriate treatment. Conclusions 1. Photosensitivity was significantly more prevalent in females, young and middle-aged SLE patients <50 years old compared to males and other age groups. Photosensitive SLE patients had significantly higher rates of rash, alopecia, arthritis and Raynaud syndrome. Additionally, these patients showed significantly higher positive rates of anti-Sm antibody, anti-SSA antibody, anti-SSB antibody, RF, as well as lower C3 and C4 compared to non-photosensitive SLE patients. 2. Multivariate analysis revealed significant positive correlations between photosensitivity and physical symptoms (e.g., rash, alopecia, arthritis, and Raynaud syndrome) as well as abnormal indicators (e.g., anti-Sm antibody, anti-SSA antibody, anti-SSB antibody, RF positive, decreased C3, and decreased C4. 3. For photosensitive patients with no other sings of SLE, routine screening of these physical signs and laboratory indicators may facilitate the identification of individuals with SLE predisposition or in their early onset. Declarations Author contributions Jia-huan He and Yi-jing Kang writed the thesis, Zhi-qi Song gathered the data, Hui-Li conducted data analysis.All authors read and approved the final manuscript. Funding No funding available. Data availability No datasets were generated or analysed during the current study. The datasets generated and/or analysed during the current study are not publicly available due, but are available from the corresponding author on reasonable request. Ethics approval and consent to participate The protocol of this study was approved by the Ethics Committee of China Rongtong Medical & Healthcare Group Tai’an 88 Hospital. The study is in line with the World Medical Association Declaration of Helsinki. Before their admission to the study, a signed and dated informed consent was obtained from each patient. They were totally voluntary and could withdraw from the study at any time. We can get information that could identify individual participants during or after data collection. Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Suárez-Avellaneda, A. et al. Systemic lupus erythematosus in the intensive care unit: a systematic review. Lupus 29 (11), 1364–1376 (2020). Zeng Xiaofeng, L. et al. China Systemic Lupus Erythematosus Development Report 2020 (Science and Technology Publishing House, 2021). 15 ~ 40. Sebastiani, G. D. et al. The Importance of an Early Diagnosis in Systemic Lupus Erythematosus. Isr. Med. Assoc. J. 18 (34), 212– (2016). Hochberg, M. C. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 40 (9), 1725 (1997). Tan, E. M. et al. The 1982 revised criteria for the classication of systemic lupus erythematosus. Arthr. Rhuem. 25 (11), 1271– (1982). Hochberg, M. C. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 40 (9), 1725 (1997). Aringer, M. K. et al. 2019 European League against rheumatism American College of Rheumatology classification criteria for systemic lupus erythematosus. Ann. Rheum. Dis. 78 (22), 1151– (2019). Jatwani, K. et al. Tumid Lupus Erythematosus and Systemic Lupus Erythematosus: A Report on Their Rare Coexistence. Cureus 12 (4), e7545 (2020). Lambers, W. M. et al. From incomplete to complete systemic lupus erythematosus; A review of the predictive serological immune markers. Semin Arthritis Rheum. 51 (1), 43– (2021). Gladman, D. D., Ibañez, D. & Urowitz, M. B. Systemic lupus erythematosus disease activity index 2000. J. Rheumatol. 29 (2), 288– (2002). Leuchten, N. et al. Early symptoms of systemic lupus erythematosus (SLE) recalled by 339 SLE patients. Lupus 27 (9), 1431– (2018). Scheinfeld, N. & Deleo, V. A. Photosensitivity in lupus erythematosus. Photodermatol Photoimmunol Photomed. 20 (4), 272– (2004). Eriksson, C. et al. Autoantibodies predate the onset of systemic lupus erythematosus in northern Sweden. Arthritis Res. Ther. 13 (23), 1186– (2011). Olsen, N. J. et al. Study of Anti-Malarials in Incomplete Lupus Erythematosus (SMILE): study protocol for a randomized controlled trial. Trials 19 (1), 694 (2018). Khellaf, M. et al. Hydroxychloroquine is a good second-line treatment for adults with immune thrombocytopenia and positive antinuclear antibodies. Am. J. Hematol. 89 (2), 194– (2014). Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6637050","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":468162532,"identity":"57f48a9a-6b36-4b51-80b2-5e6d5945bed3","order_by":0,"name":"Jia-huan He","email":"","orcid":"","institution":"The Department of Dermatology, The Second Affiliated Hospital Zhejiang University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jia-huan","middleName":"","lastName":"He","suffix":""},{"id":468162533,"identity":"173d2967-161e-422b-8278-94e62ccb61a9","order_by":1,"name":"Zhi-qi Song","email":"","orcid":"","institution":"The Department of Dermatology, The First Affiliated Hospital of Dalian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhi-qi","middleName":"","lastName":"Song","suffix":""},{"id":468162534,"identity":"a05b2532-88aa-46d4-aca8-65abec7a4c3a","order_by":2,"name":"Hui Li","email":"","orcid":"","institution":"The Department of Pediatric, Taian 88 Hospital of China Rongtong Medical Healthcare Group Co.Ltd","correspondingAuthor":false,"prefix":"","firstName":"Hui","middleName":"","lastName":"Li","suffix":""},{"id":468162535,"identity":"cecfd3bb-a218-43cf-add1-91f67972cfc1","order_by":3,"name":"Yi-jing Kang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYBACNmb2g49/GPyTs29vPkCcFj52nmRjhoIDxgY8xxKI0yLHz2AmzfDhQKKBRI4BsQ5jSJAuMLiTYM5z5uONNwx2croNBLUwHjCeYfAsz7K9d7PlHIZkY7MDRNiSwGPAXMxw5uw2aR6GA4nbiNBicACoJbHhRs4zorUYNvMYHE7ccCOHjVgtPMmMMwzSjCV7jhlbzjEgwi/y/ceP//jwx0aOn7354Y03FXZyBLWgAAkeIqMGWQupOkbBKBgFo2BEAADJ9kD5r6yTKQAAAABJRU5ErkJggg==","orcid":"","institution":"The Department of Nephrology，Taian 88 Hospital of China Rongtong Medical Healthcare Group Co.Ltd","correspondingAuthor":true,"prefix":"","firstName":"Yi-jing","middleName":"","lastName":"Kang","suffix":""}],"badges":[],"createdAt":"2025-05-11 00:38:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6637050/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6637050/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84340845,"identity":"ff34ef3b-5d9e-4f4e-9e77-aaa1ee67249f","added_by":"auto","created_at":"2025-06-10 18:26:57","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":39102,"visible":true,"origin":"","legend":"\u003cp\u003eclinical analysis at initial diagnosis for 276 SLE patients\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6637050/v1/3ce1afb3472bc54e7a35e737.png"},{"id":84991149,"identity":"41fecfd6-9f86-46e8-a6aa-742e159f434a","added_by":"auto","created_at":"2025-06-19 15:16:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1061731,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6637050/v1/3182555a-2404-46fe-a957-2ed4303535fc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Study of Clinical Features and Associated Factors in Photosensitive Patients with Systemic Lupus Erythematosus","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSystemic lupus erythematosus (SLE) with elusive pathogenesis has brought a heavy burden to patients, their families and the society due to its various complications and high fatality rates\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. In China, the high incidence of organ involvement in SLE patients may correlate with delayed diagnosis and treatment due to the lack of awareness of its early symptoms\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Consequently, it is a pressing challenge in SLE diagnosis and treatment to enhance the public attention to SLE, achieve early diagnosis and prevention, and then improve the patient outcome\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePhotosensitivity is a common manifestation of SLE due to skin damage caused by hypersensitivity of the skin to ultraviolet (UV) radiation\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Additionally, it has been recognized as an important indicator in the classification criteria for SLE developed by the American College of Rheumatology (ACR) in 1982\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e and 1997\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. UV is not only associated with photosensitive skin lesions, but also induces system and organ-specific lesions in SLE patients, resulting in systemic diseases. The mechanism of action involves UV-induced immune system disorder and autoantibody production, characterized by high levels of autoantibodies in circulation and inflammatory damage in kidneys and other organs\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Hence, methods to reduce UV exposure, such as sun protection, protective clothing and effective UV-proof sunscreen cream, will help prevent SLE from being induced in the healthy population and alleviate characteristic skin lesions in SLE patients\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAccording to previous reports, SLE patients may initially exhibit only one or some of the clinical symptoms or immunologic disorders that will progress to SLE, which cannot meet the ACR classification criteria. However, about 10\u0026ndash;55% of these patients will progress to SLE that meets the ACR classification criteria over time\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Although photosensitivity is one of the common initial symptoms of SLE, it is often overlooked in early stage. To this end, a routine screening system for SLE in photosensitive patients should be established based on ACR classification criteria. The system will facilitate identification of individuals with SLE predisposition who do not meet the ACR classification criteria. Early diagnosis and prevention which therefore becomes possible may shift the therapeutic window forward and improve prognosis.\u003c/p\u003e \u003cp\u003eWe conducted a retrospective study on 276 hospitalized SLE patients regarding clinical symptoms, auxiliary examinations, and immunologic disorders. By comparing the difference in clinical features between photosensitive and non-photosensitive patients, we aimed to analyzed the associated factors between clinical manifestations and photosensitivity, and provide a basis for routine screening and follow-up system of SLE in photosensitive patients, with a view to early detection and early warning of patients with SLE predisposition.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003e1. Subjects and Content\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1.1 Subjects and Grouping\u003c/p\u003e\n\u003cp\u003eThe subjects were hospitalized patients diagnosed with SLE at our hospital from October 2016 to October 2024. Based on patient history interviews and clinical physician observations, photosensitivity was defined. Patients were then divided into a photosensitive group and a non-photosensitive group according to the presence or absence of photosensitivity manifestations.\u003c/p\u003e\n\u003cp\u003e1.2 Diagnostic Criteria and Systemic Manifestation Assessment Basis\u003c/p\u003e\n\u003cp\u003e1.2.1 Diagnostic criteria\u003c/p\u003e\n\u003cp\u003eWe adopted the ACR classification criteria revised in 1997\u003csup\u003e[6]\u003c/sup\u003e. The clinical manifestations and autoantibody evaluation criteria for SLE patients included in the study are as follows:\u003c/p\u003e\n\u003cp\u003e(1) Malar rash: Fixed erythema over the cheeks, exceeding the zygomatic ridge (usually not involving skin near the nasolabial folds), flat or elevated, with the most common prominent area on the zygomatic region bilaterally.\u003c/p\u003e\n\u003cp\u003e(2) Discoid rash: Scattered or elevated erythema in patches over lesions, with localized scaling or follicular plugging; atrophic scarring or raised plaques, which can be seen in old lesions, possibly accompanied by keratinized scales or follicular plugging.\u003c/p\u003e\n\u003cp\u003e(3) Photosensitivity: Patient-reported photosensitivity symptoms or clinician-observed skin reactions that can cause rash.\u003c/p\u003e\n\u003cp\u003e(4) Oral ulcer: Painless oral or nasal ulcers, usually observed by a physician.\u003c/p\u003e\n\u003cp\u003e(5) Arthritis: Non-erosive arthritis involving two or more peripheral joints, characterized by tenderness, swelling, or effusion.\u003c/p\u003e\n\u003cp\u003e(6) Serositis: Including pleuritis and pericarditis.\u003c/p\u003e\n\u003cp\u003e(7) Renal damage: Including proteinuria, cylindruria, and elevated creatinine, with criteria as follows: ① Persistent proteinuria, urine protein \u0026gt;3+ in qualitative test or \u0026gt;0.5g/24h in quantitative test; ② Cellular casts (red cell cast, granular cast, hemoglobin cast, or mixed cast); ③ Serum creatinine \u0026gt;75\u0026mu;mol/L, unexplained elevation of creatinine.\u003c/p\u003e\n\u003cp\u003e(8) Neurological involvement: Mainly involving central nervous system (CNS). ① Seizures: Excluding those induced by drug and metabolic disorders (e.g., electrolyte imbalance, ketoacidosis, and uremia); ② Mental symptoms: Excluding mental disorders induced by drug and mental symptoms caused by metabolic disorders (e.g., electrolyte imbalance, ketoacidosis, and uremia).\u003c/p\u003e\n\u003cp\u003e(9) Hematology disorder: Including anaemia, decreased granulocyte or decreased platelet (PLT). Specific criteria are as follows: ① Hemolytic anemia accompanied by reticulocytosis; ② Decreased granulocyte, white blood cell (WBC) \u0026lt;4,000/mm\u0026sup3; and lymphocyte \u0026lt;1,500/mm\u0026sup3; in two or more tests; ③ Decreased PLT: PLT \u0026lt;100,000/mm\u0026sup3; (excluding medication effects on bone marrow and PLT).\u003c/p\u003e\n\u003cp\u003e(10) Immunologic disorders: Manifested as abnormal positivity of a variety of autoantibodies, including ① serum anti-ds DNA antibody positive; ② serum anti-Sm antibody positive in qualitative test or increase in quantitative test; ③ serum antiphospholipid antibody positive in qualitative test or increase in quantitative test (a. serum anticardiolipin antibody IgG or IgM abnormality; b. LE anticoagulant factor positive in standard test; c. serum syphilis test false-positive for 6 months or more confirmed by treponema pallidum immobilization (TPI) or fluorescent treponemal antibody absorption. (any one of the three).\u003c/p\u003e\n\u003cp\u003e(11) ANA positive in qualitative test or increase in quantitative test: An increased titer of antinuclear antibody (ANA) should be detected by immunofluorescence or other equivalent tests at any random time, excluding the effects of drug metabolism.\u003c/p\u003e\n\u003cp\u003eA patient is classified as having SLE if he or she meets 4 or more of the 11 items above, based on clinical features and auxiliary examination.\u003c/p\u003e\n\u003cp\u003e1.2.2 Inclusion and Exclusion Criteria\u003c/p\u003e\n\u003cp\u003eInclusion criteria: (1) Patients definitively diagnosed with SLE; (2) Patients aged between 13 and 80 years; (3) Patients without severe systemic diseases (e.g., malignancies, severe cardiovascular or cerebrovascular diseases) or other autoimmune diseases.\u003c/p\u003e\n\u003cp\u003eExclusion criteria: (1) Patients with severe systemic diseases (e.g., malignancies, severe cardiovascular or cerebrovascular diseases); (2) Patients with other autoimmune diseases; (3) Patients with incomplete clinical data.\u003c/p\u003e\n\u003cp\u003e1.2.3 Ethical consideration\u003c/p\u003e\n\u003cp\u003eWe received approval from the Medical Ethics Commit tee of the China Rongtong Medical \u0026amp; Healthcare Group Tai\u0026rsquo;an 88 Hospital for undertaking this study. The study was designed to be secure and fair to patients while mini mizing risk of harm to participants. The included participants provided written informed voluntary consent. Par ticipants had the right to withdraw from the study at any time.\u003c/p\u003e\n\u003cp\u003e1.2.4 SLE Disease Activity\u003c/p\u003e\n\u003cp\u003eThe disease activity of SLE patients in this study was assessed using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2000) developed by Gladman et al.\u003csup\u003e[10]\u003c/sup\u003e (Table 1). Specifically, the standardized SLEDAI-2000 scores of 276 patients were calculated to evaluate SLE disease activity. This allowed for a comparative analysis of clinical phenotypic differences between the photosensitive and non-photosensitive groups.\u003c/p\u003e\n\u003cp\u003eTable 1 clinical SLEDAI score\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScore\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 485px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical manifestations\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 485px;\"\u003e\n \u003cp\u003eSeizure: recent onset, exclude metabolic, infectious, or drug causes.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 485px;\"\u003e\n \u003cp\u003ePsychosis: Altered ability to function in normal activity due to severe disturbance in the perception of reality (include hallucinations, incoherence, marked loose associations, impoverished thought content, marked illogical thinking, and bizarre, disorganized, or catatonic behavior); exclude uremia and drug causes.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 485px;\"\u003e\n \u003cp\u003eOrganic brain syndrome Altered mental function with impaired orientation, memory, or other intellectual function (with rapid onset and fluctuating clinical features), inability to sustain attention to environment, and \u0026ge;2 of the following: perceptual disturbance, incoherent speech, insomnia or daytime drowsiness, and increased or decreased psychomotor activity; exclude uremia, metabolic, CNS infectious, or drug causes.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 485px;\"\u003e\n \u003cp\u003eVisual disturbance: Retinal changes of SLE (include retinal hemorrhages, serous exudates, and optic neuritis); exclude hypertensive, infectious, or drug causes.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 485px;\"\u003e\n \u003cp\u003eCranial nerve disorder: New onset, extensive involvement, include cranial, sensory or motor neuropathy.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 485px;\"\u003e\n \u003cp\u003eLupus headache: Severe, persistent headache; may be migrainous, but must be nonresponsive to narcotic analgesia.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 485px;\"\u003e\n \u003cp\u003eCVA: New onset of cerebrovascular accident(s); exclude arteriosclerosis.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 485px;\"\u003e\n \u003cp\u003eVasculitis: Ulceration, gangrene, or periungual infarction, and tender finger nodules, or biopsy or angiogram proof of vasculitis.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 485px;\"\u003e\n \u003cp\u003eArthritis: \u0026ge;2 joints with pain and signs of inflammation (i.e., tenderness, swelling or effusion).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 485px;\"\u003e\n \u003cp\u003eMyositis: Proximal muscle aching/weakness, associated with elevated creatine phosphokinase/aldolase or electromyogram changes or a biopsy showing myositis.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 485px;\"\u003e\n \u003cp\u003eUrinary casts: New or recent onset, include red cell, granular or hemoglobin casts.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 485px;\"\u003e\n \u003cp\u003eHematuria: New or recent onset, \u0026gt;5/HP urine red blood cells; exclude stone, infection or other cause.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 485px;\"\u003e\n \u003cp\u003eProteinuria: New or recent onset, \u0026gt;0.5g/d in quantitative test.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 485px;\"\u003e\n \u003cp\u003ePyuria: New or recent onset, WBC \u0026gt; 5/HP; exclude infection.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 485px;\"\u003e\n \u003cp\u003eAlopecia: New onset or relapse, patchy or diffuse loss of hair.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 485px;\"\u003e\n \u003cp\u003eRash: New onset or relapse, inflammatory type rash.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 485px;\"\u003e\n \u003cp\u003eMucosal ulcers:\u0026nbsp;New onset or relapse, oral or nasal ulcerations.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 485px;\"\u003e\n \u003cp\u003ePleurisy: Pleuritic chest pain with pleural rub or effusion on auscultation, or pleural thickening on auxillary examination.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 485px;\"\u003e\n \u003cp\u003ePericarditis:\u0026nbsp;Pericardial pain with rub or effusion.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 485px;\"\u003e\n \u003cp\u003eLow complement Decrease in CH50, C3, or C4 below the lower limit of normal for testing laboratory.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 485px;\"\u003e\n \u003cp\u003eIncreased ds-DNA antibody: Above normal range for testing laboratory or \u0026gt;25% by Farr assay.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 485px;\"\u003e\n \u003cp\u003eFever: \u0026ge;38℃; exclude infectious or other cause.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 485px;\"\u003e\n \u003cp\u003eDecreased PLT: PLT below the lower limit of normal for testing laboratory.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 485px;\"\u003e\n \u003cp\u003eDecreased WBC: WBC\u0026lt;3\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L; exclude drug cause.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: \u0026ge;15 for severe activity; 5-14 for mild to moderate activity; 0-4 for essentially no activity.\u003c/p\u003e\n\u003cp\u003e1.2.5 Assessment Criteria for Organ Damage\u003c/p\u003e\n\u003cp\u003eRenal Damage: Based on confirmed SLE diagnosis, the presence of clinical features (glomerular or tubular dysfunction) or laboratory abnormalities including persistent/recurrent proteinuria (urine protein \u0026gt;3+ in qualitative test or \u0026gt;0.5g/L/24h in quantitative test), casts (hemoglobin, granular, red cell, or mixed casts), or abnormal renal biopsy findings.\u003c/p\u003e\n\u003cp\u003eNeurological Damage: Based on confirmed SLE diagnosis, the presence of CNS manifestations (e.g., vertigo, headache, blurred vision) accompanied by abnormal result in \u0026ge;1 item among cerebrospinal fluid analysis, EEG, cranial MRI, or CT, excluding infections, uremic encephalopathy, electrolyte imbalance, hypertensive encephalopathy, psychiatric disorders, hepatic encephalopathy, or hormonotherapy-induced mental disorders.\u003c/p\u003e\n\u003cp\u003eHematological Damage: Based on confirmed SLE diagnosis, the presence of abnormalities in \u0026ge;1 system: WBC \u0026lt;4.0\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L, hemoglobin \u0026lt;110g/L, or PLT \u0026lt;100\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Research Content\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e2.1 Clinical Data Collection\u003c/p\u003e\n\u003cp\u003e(1) Demographics and family history\u003c/p\u003e\n\u003cp\u003eWe established a patient database by collecting general demographic information of SLE patients through the hospital\u0026apos;s inpatient case management system and supplementing clinical data from telephone follow-up. The database recorded general information such as patient\u0026apos;s name, sex, ethnicity, age, date of birth, weight, height, living environment, marital status and occupation.\u003c/p\u003e\n\u003cp\u003e(2) Disease onset and treatment\u003c/p\u003e\n\u003cp\u003eThe information includes whether it is the first onset, course of disease, initial symptoms, major clinical manifestations and signs (e.g., photosensitivity, rash (malar rash, discoid rash, or other SLE-specific rashes), renal damage, arthritis, alopecia, hematological damage, oral ulcer, Raynaud syndrome, sjogren, fever, CNS diseases, serositis, cardiac damage), and whether misdiagnosis occurred during treatment.\u003c/p\u003e\n\u003cp\u003e2.2 Key Laboratory Tests and Auxiliary Examinations\u003c/p\u003e\n\u003cp\u003eLaboratory tests include blood routines (focusing on WBC, RBC, hemoglobin, and PLT), urine routines (including urinary WBC, RBC, and casts), 24-hour quantitative urinary protein, and serological tests for ANA, anti-dsDNA antibody, anti-Sm antibody, anti-SSB antibody, anti-SSA antibody, anti-RNP antibody, immunoglobulin (Ig), C3, C4, erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), and C-reactive protein (CRP).\u003c/p\u003e\n\u003cp\u003eAuxiliary examinations include cardiac and abdominal ultrasound, ECG, head CT or MRI, chest X-ray or CT, and renal biopsy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. Statistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analysis was performed using SPSS 24.0. Measurement data are presented as mean \u0026plusmn; standard deviation (\u003cimg width=\"16\" height=\"16\" src=\"data:image/wmf;base64,R0lGODlhGAAYAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAQABAAOAA4AhQAAAAAAAB0AHR0AAAAAHQAAMwAcSB0zWgAzWgAzWx0zWx4zRx1GbB1IbjMAADVIbjVbbjNbgEczHkk0AFozAFszAFtISFlsRkRqe11/f0huf2xGHW5IHWxGM25bNX9ZSHtqVX9uSG5uRH9/XWpqamaIiIBbMwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwY4QIBwSCwCAsikEmlsOp8AiWDYGRyKAyQCsGE2HQXoMCAWDsqAc3kSfn4ApkDESCk6EB4jmUgwBgEAOw==\" alt=\"image\"\u003e\u0026plusmn;s) and statistically compared by t-tests. Enumeration data are described as frequencies and percentages, with group comparisons conducted via chi-square (\u0026chi;\u003csup\u003e2\u003c/sup\u003e) tests. Multivariate analysis was performed by logistic regression to identify clinical manifestations and immunological indicators associated with photosensitivity. The significant level was 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e1. General Data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1.1 Age\u003c/p\u003e\n\u003cp\u003eThe mean age at diagnosis for 276 SLE patients was 42.22\u0026plusmn;16.27 years. Among these patients, 186 (67.39%) were \u0026lt;50 years old, and 90 (32.61%) were \u0026ge;50 years old. They were divided into the photosensitive group (n=101, 36.59%) and the non-photosensitive group (n=175, 63.41%). The mean age was 40.11\u0026plusmn;15.71 years for the 101 patients in the photosensitive group, including 80 patients (79.21%) \u0026lt;50 years old and 21 patients (20.79%) \u0026ge;50 years old. In the photosensitive group of 175 patients with a mean age of 43.78\u0026plusmn;16.79 years, 106 (60.57%) were \u0026lt;50 years old and 69 (39.43%) were \u0026ge;50 years old. Therefore, photosensitivity was significantly more prevalent in SLE patients \u0026lt;50 years old compared to those \u0026ge;50 years old (\u0026chi;\u0026sup2; = 10.121, P\u0026lt;0.05) (Table 2).\u003c/p\u003e\n\u003cp\u003eTable 2 age at diagnosis of SLE patients\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"95%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003eNumber of cases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 18px;\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 27px;\"\u003e\n \u003cp\u003ePhotosensitive group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 26px;\"\u003e\n \u003cp\u003eNon-photosensitive group\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003eNumber of cases\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eNumber of cases\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003ePercentage (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026lt;50 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e67.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e79.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e60.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026ge;50 years old\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e32.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e20.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e39.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: \u0026chi;\u003csup\u003e2\u003c/sup\u003e=10.121, P=0.001\u003c/p\u003e\n\u003cp\u003e1.2 Sex\u003c/p\u003e\n\u003cp\u003eAmong the 276 SLE patients, the male-female ratio was approximately 1:8.86, \u0026nbsp;with 28 male patients (10.14%) and 248 female patients (89.86%). The ratio aligns with most studies at home and abroad. The photosensitive group (n=101) comprised 5 male patients (4.95%) and 96 female patients (95.05%), resulting in a male-female ratio of approximately 1:19.20. In contrast, the non-photosensitive group (n=175) had a male-female ratio of approximately 1:6.60, including 23 male patients (13.14%) and 152 female patients (86.86%). Hence, photosensitivity was significantly more pronounced in female SLE patients compared to males (\u0026chi;\u0026sup2;=4.715, P\u0026lt;0.05) (Table 3).\u003c/p\u003e\n\u003cp\u003eTable 3 sex characteristics of SLE patients\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"95%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 15px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003eNumber of cases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 18px;\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 28px;\"\u003e\n \u003cp\u003ePhotosensitive group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 27px;\"\u003e\n \u003cp\u003eNon-photosensitive group\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003eNumber of cases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eNumber of cases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e89.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e95.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e86.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e10.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e4.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e13.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: \u0026chi;\u003csup\u003e2\u003c/sup\u003e=4.715, P=0.030\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Accuracy rate of initial diagnosis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the 276 SLE patients, 118 (42.75%) were correctly diagnosed with SLE at initial diagnosis, while 158 (57.25%) were undiagnosed or misdiagnosed. Of the misdiagnosed cases, 47 (17.03%) were misdiagnosed as infectious disease, and the rest were misdiagnosed as arthritis (22, 7.97%), skin disease (30, 10.87%), hematological disease (22, 7.97%), other connective tissue disease excluding SLE (11, 3.99%), renal disease (19, 7.61%), Raynaud syndrome (2, 0.72%), hypothyroidism (2, 0.72%), digestive system disease (2, 0.72%), and recurrent oral ulcer (1, 0.36%).\u003c/p\u003e\n\u003cp\u003eIn the photosensitive group (n=101), 56 patients (55.45%) were correctly diagnosed with SLE at initial diagnosis, while 45 patients (44.56%) were undiagnosed or misdiagnosed. In the non-photosensitive group (n=175), 62 patients (35.43%) were accurately diagnosed with SLE at initial diagnosis, while 130 patients (64.57%) were undiagnosed or misdiagnosed. Therefore, photosensitive SLE patients were significantly more likely to receive an accurate initial diagnosis, while non-photosensitive SLE patients were more prone to missed diagnosis or misdiagnosis (\u0026chi;\u0026sup2; = 10.484, P\u0026lt;0.05). No significant difference was found between the two groups in the proportion of patients misdiagnosed as arthritis, infectious disease, other connective tissue disease (except SLE), hematological disease, and other systemic disease (e.g., Raynaud syndrome, hypothyroidism) (P\u0026gt;0.05). However, SLE patients in the non-photosensitive group had significantly higher misdiagnosis rates for skin disease excluding SLE and renal disease (\u0026chi;\u0026sup2;= 7.849, 5.976, P\u0026lt;0.05) (Table 4 and Figure 1).\u003c/p\u003e\n\u003cp\u003eTable 4 clinical analysis at initial diagnosis for SLE patients\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"98%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 24px;\"\u003e\n \u003cp\u003eDisease diagnosed at initial diagnosis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 6px;\"\u003e\n \u003cp\u003eNumber of cases\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 12px;\"\u003e\n \u003cp\u003ePercentage\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003ePhotosensitive group\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003eNon-photosensitive group\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eNumber of cases\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003ePercentage (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eNumber of cases\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003ePercentage (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eSLE\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e42.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e55.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e35.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e10.484\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eInfectious disease\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e17.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e11.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e20.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e2.988\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0.084\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eArthritis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e7.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e9.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e6.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.809\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0.368\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eSkin disease\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e10.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e3.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e14.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e7.849\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eHematological disease\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e7.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e5.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e9.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.895\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0.344\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eOther CTD\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e3.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e6.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e2.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e3.611\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eRenal disease\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e6.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e9.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e5.976\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eOther systemic disease\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e2.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e3.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e1.307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0.253\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3. Initial symptoms\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 276 SLE patients, rash (malar rash, discoid rash, or other SLE-specific rash) was found in 77 patients (27.90%), making it the most common initial symptom, followed by fever (56, 20.29%), arthritis (48, 17.39%), renal damage (44, 15.94%), hematological damage (25, 9.06%), fatigue (14, 5.07%), Raynaud syndrome (6, 2.17%), other symptoms including alopecia (1, 0.36%), digestive tract symptom (1, 0.36%), sjogren (1, 0.36%), chest pain and distress (1, 0.36%), oral ulcer (1, 0.36%), and myalgia (1, 0.36%). In the photosensitive group (n=101), rash was the most common initial symptom in 44 patients (43.56%), followed by fever (20, 19.80%), arthritis (18, 17.82%), renal damage (7, 6.93%), Raynaud syndrome (5, 4.95%), hematological damage (3, 2.97%), fatigue (2, 1.98%), other symptoms including alopecia (1, 0.99%), and sjogren (1, 0.99%). However, in the non-photosensitive group (n=175), renal damage was the most common initial symptom, found in 37 patients (21.14%), followed by fever (36, 20.57%), rash (33, 18.86%), arthritis (30, 17.14%), hematological damage (22, 12.51%), fatigue (12, 6.86%), Raynaud syndrome (1, 0.57%), other symptoms including digestive tract symptom (1, 0.57%), chest pain and distress (1, 0.57%), oral ulcer (1, 0.57%), and myalgia (1, 0.57%).\u003c/p\u003e\n\u003cp\u003eNo significant difference was found between the two groups in the percentage of patients with arthritis, fever or fatigue as their initial symptom. However, the photosensitive group had significantly more cases with rash or Raynaud syndrome as initial symptom (\u0026chi;\u0026sup2; = 19.434, 5.775, P\u0026lt;0.05); but the non-photosensitive group had significantly larger percentages of cases with renal damage or hematological damage as initial symptom (\u0026chi;\u0026sup2; =9.653, 7.166, P\u0026lt;0.05) (Table 5).\u003c/p\u003e\n\u003cp\u003eTable 5 analysis of initial symptoms in 276 SLE patients\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 310px;\"\u003e\n \u003cp\u003ePhotosensitive group\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 218px;\"\u003e\n \u003cp\u003eNon-photosensitive group\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eSymptom\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003eNumber of cases\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003ePercentage\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eNumber of cases\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003ePercentage\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003eNumber of cases\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003ePercentage\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eRash\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e27.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e43.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e18.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e19.434\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eArthritis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e17.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e17.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e17.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e0.886\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eFever\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e20.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e19.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e20.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e0.878\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eRenal damage\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e15.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e6.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e21.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e9.653\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eHematological damage\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e9.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e2.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e12.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e7.166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eFatigue\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e5.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e1.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e6.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e3.163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eRaynaud syndrome\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e2.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e4.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e5.775\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eOther\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e2.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e1.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e2.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e0.867\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e4. Clinical manifestations for diagnosing SLE\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe most common clinical manifestations in the 276 SLE patients were rash (189, 68.48%), arthritis (172, 62.30%), hematological damage (148, 53.62%), alopecia (127, 46.01%), fever (113, 40.94%), myositis (110, 39.86%), and renal damage (107, 38.77%). Other less common manifestations included Raynaud syndrome, recurrent oral and nasal ulcer, and neuropsychiatric damage. Specifically, rashes included malar rash and discoid rash; hematological damage primarily included decreased WBC, decreased RBC or hemoglobin, decreased PLT, and decreased lymphocyte; renal damage included proteinuria and/or hematuria, pathological cast, impaired renal function, and renal biopsy lesions; and CNS manifestations included headache, CVA, seizure, coma, and psychiatric disorders.\u003c/p\u003e\n\u003cp\u003eNo significant difference was found between the two groups in the distribution of oral ulcer, myositis, renal damage, neurological damage, and serositis (P\u0026gt;0.05). However, the photosensitive group had significantly higher percentages of patients with rash, alopecia, arthritis, and Raynaud syndrome(\u0026chi;\u0026sup2; =68.791, 15.152, 5.456, 6.619, P\u0026lt;0.05); while the non-photosensitive group had significantly higher percentages of patients who developed sjogren, fever, and hematological damage (\u0026chi;\u0026sup2;= 4.376, 6.920, 6.481, P\u0026lt;0.05) (Table 6).\u003c/p\u003e\n\u003cp\u003eTable 6 analysis of clinical manifestations for diagnosing SLE in SLE patients\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 130px;\"\u003e\n \u003cp\u003eSymptom\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 28px;\"\u003e\n \u003cp\u003eNumber of cases\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 40px;\"\u003e\n \u003cp\u003ePercentage\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 118px;\"\u003e\n \u003cp\u003ePhotosensitive group\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 124px;\"\u003e\n \u003cp\u003eNon-photosensitive group\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003eNumber of cases\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003ePercentage\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003eNumber of cases\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003ePercentage\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eRash\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e68.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e99.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e50.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e68.791\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eAlopecia\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e46.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e61.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e37.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e15.152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eOral ulcer\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e14.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e16.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e13.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e1.798\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.483\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eSjogren\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e38.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e30.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e43.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e4.376\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eMyositis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e39.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e34.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e42.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e1.798\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.180\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eFever\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e40.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e30.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e46.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e6.920\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eArthritis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e62.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e71.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e57.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e5.456\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eRaynaud syndrome\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e13.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e20.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e9.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e6.619\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eRenal damage\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e38.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e37.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e39.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.767\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eHematological damage\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e53.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e43.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e59.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e6.481\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eNeuropsychiatric damage\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e12.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e12.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e12.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.943\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eSerositis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e21.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e16.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e23.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e1.679\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.195\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp; 101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e5. SLEDAI score\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean SLEDAI score for the 276 SLE patients was 19.32\u0026plusmn;8.39, and no significant difference was found between the photosensitive group (18.54\u0026plusmn;9.85) and the non-photosensitive group (21.87\u0026plusmn;8.82) (P\u0026gt;0.05). Among the 276 patients, SLEDAI indicated severe activity in 111 patients (40.22%), moderate activity in 79 patients (28.62%), mild activity in 81 patients (29.35%), and essentially no activity in 5 patients (1.81%). No significant difference was found between the two groups in terms of severe activity (40, 39.60% vs. 71, 40.57%), moderate activity (29, 28.71% vs. 50, 28.57%), mild activity (30, 29.70% vs. 51, 29.14%), or essentially no activity (all P\u0026gt;0.05) (Table 7).\u003c/p\u003e\n\u003cp\u003eTable 7 SLEDAI score of SLE patients\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 136px;\"\u003e\n \u003cp\u003eSLEDAI score\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 40px;\"\u003e\n \u003cp\u003eNumber of cases\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 65px;\"\u003e\n \u003cp\u003ePercentage (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 105px;\"\u003e\n \u003cp\u003ePhotosensitive group\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 127px;\"\u003e\n \u003cp\u003eNon-photosensitive group\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003eNumber of cases\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003ePercentage (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eNumber of cases\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003ePercentage\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 136px;\"\u003e\n \u003cp\u003eEssentially no activity\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e1.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e1.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e1.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.873\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003eMild activity\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e29.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e29.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e29.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.922\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003eModerate activity\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e28.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e28.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e28.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.980\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003eSevere activity\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e40.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e39.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e40.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.875\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e6. Immunological indicators\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e6.1 Autoantibody\u003c/p\u003e\n\u003cp\u003eAmong the 276 SLE patients, 275 (99.64%) were ANA positive, 90 (32.61%) were anti-Sm antibody positive, 148 (53.62%) were anti-dsDNA antibody positive, 172 (62.32%) were anti-SSA antibody positive, 51 (18.48%) were anti-SSB antibody positive, and 93 (33.70%) were anti-RNP antibody positive.\u003c/p\u003e\n\u003cp\u003eNo significant difference was found between the photosensitive group and the non-photosensitive group in ANA positive patients (101, 100.00% vs. 174, 99.43%), anti-dsDNA antibody positive patients (55, 54.46% vs. 93, 53.14%), or anti-RNP antibody positive patients (41, 40.59% vs. 52, 29.71%) (all P\u0026gt;0.05).\u003c/p\u003e\n\u003cp\u003eThe photosensitive group had 41 anti-Sm antibody positive patients (40.59%), 73 anti-SSA antibody positive patients (72.28%) and 31 anti-SSB antibody positive patients (30.69%), representing significantly higher percentages than the non-photosensitive group (49, 28.00%; 99, 56.57%; 20, 11.43%) (\u0026chi;\u0026sup2;= 4.622, 6.727, 15.777; all P\u0026lt;0.05). (Table 8).\u003c/p\u003e\n\u003cp\u003eTable 8 analysis of autoantibody in 276 SLE patients\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"564\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 124px;\"\u003e\n \u003cp\u003eItem\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 65px;\"\u003e\n \u003cp\u003eNumber of cases\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 59px;\"\u003e\n \u003cp\u003ePercentage\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 114px;\"\u003e\n \u003cp\u003ePhotosensitive group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 114px;\"\u003e\n \u003cp\u003eNon-photosensitive group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003eNumber of cases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003eNumber of cases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eANA positive\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e275\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e99.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e99.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0.579\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.447\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eAnti-RNP antibody\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e33.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e40.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e29.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e3.393\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eAnti-dsDNA antibody\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e53.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e54.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e53.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.833\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eAnti-Sm antibody\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e32.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e40.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e28.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e4.622\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eAnti-SSA antibody\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e62.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e72.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e56.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e6.727\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eAnti-SSB antibody\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e18.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e30.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e11.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e15.777\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e6.2 Immunoglobulin and complement\u003c/p\u003e\n\u003cp\u003eAmong the 276 SLE patients, there were 158 patients (57.25%) with elevated immunoglobulin G (IgG), 48 patients (17.39%) with elevated immunoglobulin M (IgM), 47 patients (17.03%) with elevated immunoglobulin A (IgA), and 203 patients (73.55%) with decreased C3.\u003c/p\u003e\n\u003cp\u003eNo significant difference was found between the photosensitive group and the non-photosensitive group in terms of patients with elevated IgG (62, 61.39% vs. 96, 54.86%), patients with elevated IgM (14, 13.86%; 34, 19.43%), or patients with elevated IgA (19, 18.81% vs. 28, 16.00%) (all P\u0026gt;0.05).\u003c/p\u003e\n\u003cp\u003eThe photosensitive group had 82 patients (81.19%) with decreased C3, representing a significantly higher percentage than the non-photosensitive group (121, 69.14%), which indicated that there were significantly more patients with decreased C3 in photosensitive SLE patients (\u0026chi;\u0026sup2; =4.776, P\u0026lt;0.05) (Table 9). The photosensitive group had 59 patients (58.42%) with decreased C4, representing a significantly higher percentage than the non-photosensitive group (76, 43.43%), which indicated that there were significantly more patients with decreased C4 in the photosensitive group (\u0026chi;\u0026sup2; =5.172, P\u0026lt;0.05) (Table 9).\u003c/p\u003e\n\u003cp\u003eTable 9 analysis of abnormal immunoglobulin and complement in 276 SLE patients\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 335px;\"\u003e\n \u003cp\u003ePhotosensitive group\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 206px;\"\u003e\n \u003cp\u003eNon-photosensitive group\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eItem\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003eNumber of cases\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003ePercentage (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eNumber of cases\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003ePercentage\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003eNumber of cases\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003ePercentage\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eElevated IgG\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e57.25\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e61.39\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e54.86\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;1.115\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.291\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eElevated IgA\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e17.03\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e18.81\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e16.00\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.358\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.549\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eElevated IgM\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e17.39\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e13.86\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e19.43\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;1.382\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.240\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eDecreased C3\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e203\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e73.55\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e81.19\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e69.14\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;4.776\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.029\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eDecreased C4\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e48.91\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e58.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e43.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e5.172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e6.3 ESR, RF, CRP\u003c/p\u003e\n\u003cp\u003eOf the 276 SLE patients, 162 patients (58.70%) exhibited increased ESR, including 55 patients (54.46%) in the photosensitive group and 107 patients (61.14%) in the non-photosensitive group (\u0026chi;\u0026sup2; =1.181, P\u0026gt;0.05); 135 patients (48.91%) had elevated CRP, including 48 patients (47.52%) in the photosensitive group, and 87 patients (49.71%) in the non-photosensitive group (P\u0026gt;0.05).\u003c/p\u003e\n\u003cp\u003eAdditionally, there were 55 RF positive patients (19.93%), including 31 patients (30.69%) in the photosensitive group and 24 patients (13.71%) in the non-photosensitive group (\u0026chi;\u0026sup2;= 11.570, P\u0026lt;0.05) (Table 10).\u003c/p\u003e\n\u003cp\u003eTable 10 analysis of abnormal ESR, RF and CRP in 276 SLE patients\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"97%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 6px;\"\u003e\n \u003cp\u003eNumber of cases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 24px;\"\u003e\n \u003cp\u003ePhotosensitive group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 27px;\"\u003e\n \u003cp\u003eNon-photosensitive group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003eNumber of cases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003eNumber of cases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eIncreased ESR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e58.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e54.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e61.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1.181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0.277\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eRF positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e19.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e30.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e13.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e11.570\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eElevated CRP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e48.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;47.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e49.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0.726\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003col start=\"7\"\u003e\n \u003cli\u003e\u003cstrong\u003eLogistic regression analysis of photosensitivity associated factors\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eLogistic regression analysis was performed with photosensitivity symptoms as dependent variables (y=1) and clinical manifestations and immunological indicators as independent variables. As shown in Table 11, rash, alopecia, arthritis, Raynaud syndrome, anti-Sm antibody, anti-SSA antibody, anti-SSB antibody, decreased C3, decreased C4 and RF positive were the main factors associated with photosensitivity.\u003c/p\u003e\n\u003cp\u003eTable 11 Logistic regression analysis of photosensitivity influencing factors in SLE patients\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"555\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eVariable\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003eWalds \u0026chi;\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eOR 95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eCorrelation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eRash\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e3.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.687\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e19.675\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e21.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e5.473-80.728\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003ePositive\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eAlopecia\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e1.782\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.651\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e7.487\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e5.940\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e1.658-21.281\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003ePositive\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eOral ulcer\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.513\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.991\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e1.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.368-2.751\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eNone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eSjogren\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e-2.868\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.833\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e11.841\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.011-0.291\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eNegative\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eMyositis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e-1.138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e1.341\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.721\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.396\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.320\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.023-4.435\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eNone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eFever\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e-1.609\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.753\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e4.563\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.046-0.876\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eNegative\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eArthritis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.636\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.302\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e4.433\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e1.889\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e1.045-3.416\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003ePositive\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eRaynaud syndrome\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.971\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e9.921\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e2.641\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e1.443-4.834\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003ePositive\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eRenal damage\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e-0.313\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.452\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.478\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.489\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.731\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.302-1.774\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eNone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eHematological damage\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e-0.827\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.317\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e6.807\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.438\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.235-0.814\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eNegative\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eAnti-RNP antibody\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.511\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.660\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.599\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.439\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e1.667\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.457-5.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eNone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eAnti-dsDNA antibody\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.406\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.549\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.546\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.460\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e1.500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.511-4.402\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eNone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eAnti-Sm antibody\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.342\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e6.894\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e1.408\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e1.091-1.818\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003ePositive\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eAnti-SSA antibody\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.849\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.223\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e14.528\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e2.337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e1.510-3.615\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003ePositive\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eAnti-SSB antibody\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e1.126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.361\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e9.717\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e3.084\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e1.519-6.626\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003ePositive\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eElevated IgG\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.397\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.529\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e1.210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.668-2.190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eNone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eElevated IgA\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.415\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.642\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e1.213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.537-2.736\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eNone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eElevated IgM\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e-0.394\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.406\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.941\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.332\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.674\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.304-1.495\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eNone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eDecreased C3\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e2.661\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.715\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e13.862\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e14.308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e3.526-58.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003ePositive\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eDecreased C4\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e1.232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.487\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e6.408\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e3.429\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e1.321-8.904\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003ePositive\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eIncreased ESR\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e-0.294\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e2.870\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.745\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.531-1.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eNone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eRF positive\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e2.365\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.810\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e8.513\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e10.640\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e2.173-52.093\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003ePositive\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eElevated CRP\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.465\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.343\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.832\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e1.592\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.812-3.119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eNone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eConstant\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e-29.906\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e3403.342\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.993\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e-\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eSLE can progress from mild clinical manifestations such as photosensitivity, rash or Raynaud syndrome, to involvement of multiple vital organs (e.g., renal damage). Early diagnosis and treatment of SLE can be facilitated by recognizing SLE-related early symptoms, detecting predictive biomarkers, identifying immune abnormalities, alerting to SLE occult or premorbid states, and conducting long-term follow-up for patients with suggestive clinical manifestations who do not yet meet the SLE classification criteria. Our findings indicated that SLE patients in the photosensitive group were less likely to be misdiagnosed and more likely to be correctly diagnosed at initial diagnosis, suggesting that photosensitivity may be an important entry point for SLE screening studies.\u003c/p\u003e \u003cp\u003eAccording to previous publications, photosensitivity is found in approximately 11%~94% of SLE patients\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e, and it is more common in Asian countries (90%)\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Enhancing awareness of SLE among photosensitive individuals and attention of clinicians to photosensitive patients with a predisposition to SLE is important for the early diagnosis and treatment of SLE.\u003c/p\u003e \u003cp\u003eOur results demonstrated that clinical manifestations such as rash, alopecia, arthritis, and Raynaud syndrome were significantly more prevalent in photosensitive SLE patients compared to non-photosensitive SLE patients. A correlation analysis revealed that these factors were strongly associated with photosensitivity symptoms, suggesting that rash, alopecia, arthritis, and Raynaud syndrome are closely related to photosensitivity. Given their easy observation and specificity to SLE, these four clinical features can be included as screening indicators in subsequent studies on SLE screening in photosensitive patients.\u003c/p\u003e \u003cp\u003eImmunological indicators are highly important in the classification criteria of SLE. Retrospective data from two cohort studies on SLE suggested that autoantibody can be present long before the onset of symptoms\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. Different mechanisms of onset are indicated by the difference between photosensitive and non-photosensitive SLE patients in terms of abnormal autoimmune antibody and complement. Therefore, it is important to select targeted treatment scheme along with photoprotection based on the presence or absence of photosensitization.\u003c/p\u003e \u003cp\u003eCurrently, photoprotection is the major approach to preventing photosensitivity. It has also been found that hydroxychloroquine (HCQ) has a protective effect in patients with incomplete SLE, which can reduce organ damage, delay the progression of SLE-related conditions, and improve quality of life and survival\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Khellaf M et al.\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e concluded that HCQ is a safe drug by finding that a treatment combining HCQ can achieve favorable effect in patients with reduced PLT and increased ANA titers who could not be diagnosed with SLE. For patients with SLE predisposition or in their early onset, it is advised to enhance photoprotection during follow-up and give them HCQ and other medications when necessary, which is not only beneficial to alleviate UV-induced skin damage, but also helps to control the progression of systemic damage.\u003c/p\u003e \u003cp\u003eOur next step is to develop criteria for recruiting photosensitive patients with a focus on young women, screen for SLE-related signs and conduct initial ANA screening; test positive patients for relevant immune markers to identify potential, SLE-predisposed, or early SLE patients; assign these patients into different groups and provide guidance on photoprotection and/or medication; and conduct long-term follow-up and periodic summaries. It is expected that our study will provide a basis for a routine screening system for SLE in photosensitive patients, which will facilitate early identification and warning of patients with a predisposition to SLE and provision of appropriate treatment.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003e1. Photosensitivity was significantly more prevalent in females, young and middle-aged SLE patients \u0026lt;50 years old compared to males and other age groups. Photosensitive SLE patients had significantly higher rates of rash, alopecia, arthritis and Raynaud syndrome. Additionally, these patients showed significantly higher positive rates of anti-Sm antibody, anti-SSA antibody, anti-SSB antibody, RF, as well as lower C3 and C4 compared to non-photosensitive SLE patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. Multivariate analysis revealed significant positive correlations between photosensitivity and physical symptoms (e.g., rash, alopecia, arthritis, and Raynaud syndrome) as well as abnormal indicators (e.g., anti-Sm antibody, anti-SSA antibody, anti-SSB antibody, RF positive, decreased C3, and decreased C4.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3. For photosensitive patients with no other sings of SLE, routine screening of these physical signs and laboratory indicators may facilitate the identification of individuals with SLE predisposition or in their early onset.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAuthor contributions\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJia-huan He and Yi-jing Kang writed the thesis, Zhi-qi Song gathered the data, Hui-Li conducted data analysis.All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eFunding\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNo funding available.\u003c/p\u003e\n\u003cp\u003eData availability\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNo datasets were generated or analysed during the current study. The datasets generated and/or analysed during the current study are not publicly available due, but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe protocol of this study was approved by the Ethics Committee of China\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRongtong Medical \u0026amp; Healthcare Group Tai\u0026rsquo;an 88 Hospital. The study is in\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eline with the World Medical Association Declaration of Helsinki. Before their\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eadmission to the study, a signed and dated informed consent was obtained\u0026nbsp;\u003c/p\u003e\n\u003cp\u003efrom each patient. They were totally voluntary and could withdraw from\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ethe study at any time. We can get information that could identify individual\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eparticipants during or after data collection.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent for publication\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCompeting interests\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSu\u0026aacute;rez-Avellaneda, A. et al. Systemic lupus erythematosus in the intensive care unit: a systematic review. \u003cem\u003eLupus\u003c/em\u003e \u003cb\u003e29\u003c/b\u003e (11), 1364\u0026ndash;1376 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZeng Xiaofeng, L. et al. \u003cem\u003eChina Systemic Lupus Erythematosus Development Report 2020\u003c/em\u003e (Science and Technology Publishing House, 2021). 15\u0026thinsp;~\u0026thinsp;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSebastiani, G. D. et al. The Importance of an Early Diagnosis in Systemic Lupus Erythematosus. \u003cem\u003eIsr. Med. Assoc. J.\u003c/em\u003e \u003cb\u003e18\u003c/b\u003e (34), 212\u0026ndash; (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHochberg, M. C. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. \u003cem\u003eArthritis Rheum.\u003c/em\u003e \u003cb\u003e40\u003c/b\u003e (9), 1725 (1997).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTan, E. M. et al. The 1982 revised criteria for the classication of systemic lupus erythematosus. \u003cem\u003eArthr. Rhuem.\u003c/em\u003e \u003cb\u003e25\u003c/b\u003e (11), 1271\u0026ndash; (1982).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHochberg, M. C. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. \u003cem\u003eArthritis Rheum.\u003c/em\u003e \u003cb\u003e40\u003c/b\u003e (9), 1725 (1997).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAringer, M. K. et al. 2019 European League against rheumatism American College of Rheumatology classification criteria for systemic lupus erythematosus. \u003cem\u003eAnn. Rheum. Dis.\u003c/em\u003e \u003cb\u003e78\u003c/b\u003e (22), 1151\u0026ndash; (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJatwani, K. et al. Tumid Lupus Erythematosus and Systemic Lupus Erythematosus: A Report on Their Rare Coexistence. \u003cem\u003eCureus\u003c/em\u003e \u003cb\u003e12\u003c/b\u003e (4), e7545 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLambers, W. M. et al. From incomplete to complete systemic lupus erythematosus; A review of the predictive serological immune markers. \u003cem\u003eSemin Arthritis Rheum.\u003c/em\u003e \u003cb\u003e51\u003c/b\u003e (1), 43\u0026ndash; (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGladman, D. D., Iba\u0026ntilde;ez, D. \u0026amp; Urowitz, M. B. Systemic lupus erythematosus disease activity index 2000. \u003cem\u003eJ. Rheumatol.\u003c/em\u003e \u003cb\u003e29\u003c/b\u003e (2), 288\u0026ndash; (2002).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeuchten, N. et al. Early symptoms of systemic lupus erythematosus (SLE) recalled by 339 SLE patients. \u003cem\u003eLupus\u003c/em\u003e \u003cb\u003e27\u003c/b\u003e (9), 1431\u0026ndash; (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScheinfeld, N. \u0026amp; Deleo, V. A. Photosensitivity in lupus erythematosus. \u003cem\u003ePhotodermatol Photoimmunol Photomed.\u003c/em\u003e \u003cb\u003e20\u003c/b\u003e (4), 272\u0026ndash; (2004).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEriksson, C. et al. Autoantibodies predate the onset of systemic lupus erythematosus in northern Sweden. \u003cem\u003eArthritis Res. Ther.\u003c/em\u003e \u003cb\u003e13\u003c/b\u003e (23), 1186\u0026ndash; (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlsen, N. J. et al. Study of Anti-Malarials in Incomplete Lupus Erythematosus (SMILE): study protocol for a randomized controlled trial. \u003cem\u003eTrials\u003c/em\u003e \u003cb\u003e19\u003c/b\u003e (1), 694 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhellaf, M. et al. Hydroxychloroquine is a good second-line treatment for adults with immune thrombocytopenia and positive antinuclear antibodies. \u003cem\u003eAm. J. Hematol.\u003c/em\u003e \u003cb\u003e89\u003c/b\u003e (2), 194\u0026ndash; (2014).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"systemic lupus erythematosus, clinical feature, photosensitivity, associated factor","lastPublishedDoi":"10.21203/rs.3.rs-6637050/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6637050/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eOBJECTIVE:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSome patients with systemic lupus erythematosus (SLE) exhibit atypical clinical manifestations, leading to misdiagnosis or missed diagnosis. Photosensitivity is one of the common initial symptoms in SLE, which is often overlooked in early stage due to the absence of other symptoms. This study provides evidence for a regular screening and follow-up system for photosensitive patients by comparing the clinical features of photosensitive and non-photosensitive patients and by analyzing their different clinical manifestations and factors associated with photosensitivity. It is expected that the system will facilitate early identification and warning of SLE-predisposed patients through regular follow-up and screening targeting photosensitive patients, thereby achieving early treatment and improving prognosis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMETHODS:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA retrospective analysis was conducted on clinical data of SLE patients hospitalized at our hospital between October 2016 and October 2024. All diagnoses were made according to the SLE classification and evaluation criteria recommended by the American College of Rheumatology (ACR) in 1997. General characteristics, clinical data and immunological indicators were collected. The patients were divided into photosensitive and non-photosensitive groups for comparing the differences in epidemiological and clinical features and analyzing the factors associated with photosensitivity. Analysis was performed with statistical software SPSS 24.0.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRESULTS:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn epidemiological analysis was performed on sex, age and accuracy rate of initial diagnosis. A total of 276 SLE patients were included, comprising 28 males (10.14%) and 248 females (89.86%). The patients were divided into a photosensitive group (n=101, 36.59%) and a non-photosensitive group (n=175, 63.41%). The photosensitive group consisted of 96 female patients (95.05%) and 5 male patients (4.95%), and the non-photosensitive group consisted of 152 female patients (86.86%) and 23 male patients (13.14%). A significantly higher prevalence of photosensitivity was found in female SLE patients than in males (P\u0026lt;0.05). In the photosensitive group, 80 patients (79.21%) were \u0026lt;50 years old and 21 (20.79%) were ≥50 years old. In contrast, the non-photosensitive group included 106 patients \u0026lt;50 years old (60.57%) and 69 patients ≥50 years old (39.43%). Accordingly, SLE patients \u0026lt;50 years old had a significantly higher incidence of photosensitivity than those ≥50 years old (P\u0026lt;0.05). Regarding accuracy rate of initial diagnosis, 56 patients (55.45%) in the photosensitive group were correctly diagnosed with SLE at initial diagnosis, while 45 (44.56%) were undiagnosed or misdiagnosed. In the non-photosensitive group, 62 patients (35.43%) were correctly diagnosed with SLE at initial diagnosis, while 130 (64.57%) were undiagnosed or misdiagnosed. The non-photosensitive group had significantly lower diagnostic accuracy or higher misdiagnosis rates (P\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003eIn terms of clinical manifestations, the photosensitive group showed significantly higher percentages compared to the non-photosensitive group in rash (100, 99.01% vs. 89, 50.86%), alopecia (62, 61.39% vs. 65, 37.14%), arthritis (72, 71.29% vs. 100, 57.14%), and Raynaud syndrome (21, 20.79% vs. 17, 9.71%) (all P\u0026lt;0.05). Conversely, the non-photosensitive group had significantly higher percentages compared to the photosensitive group in terms of sjogren (76, 43.43% vs. 31, 30.69%), fever (82, 46.86% vs. 31, 30.69%), and hematological damage (104, 59.43% vs. 44, 43.56%) (all P\u0026lt;0.05). No significant difference was observed in SLEDAI scores between the photosensitive group and the non-photosensitive group (18.54 ± 9.85 vs. 21.87 ± 8.82) (P\u0026gt;0.05).\u003c/p\u003e\n\u003cp\u003eAs for immunological indicators, the photosensitive group exhibited significantly higher percentages than the non-photosensitive group in terms of positive results for anti-SSA antibody (73, 72.28% vs. 99, 56.57%), anti-Sm antibody (41, 40.59% vs. 49, 28.00%), and anti-SSB antibody (31, 30.69% vs. 26, 11.43%) (all P\u0026lt;0.05). The number of patients with decreased C3, decreased C4, and RF positive in the photosensitive group was 82 (81.19%), 59 (58.42%), and 31 (30.69%) respectively, representing significantly higher percentages than those in the non-photosensitive group (121, 69.14%; 76, 43.43%; 24, 13.71%) (all P\u0026lt;0.05). ANA positive rate approached 100% in both groups.\u003c/p\u003e\n\u003cp\u003eMultivariate logistic regression analysis revealed that rash, alopecia, arthritis, Raynaud syndrome, anti-Sm antibody, anti-SSA antibody, anti-SSB antibody, decreased C3, decreased C4 and RF positive were the main factors associated with photosensitivity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONCLUSION:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. Photosensitivity was significantly more prevalent in female SLE patients and those aged \u0026lt;50 years old compared to male patients and other age groups. Photosensitive SLE patients had significantly higher rates of rash, alopecia, arthritis and Raynaud syndrome. Additionally, these patients showed significantly higher positive rates of anti-Sm antibody, anti-SSA antibody, anti-SSB antibody, RF, as well as lower C3 and C4 compared to non-photosensitive SLE patients.\u003c/p\u003e\n\u003cp\u003e2. Multivariate analysis revealed significant positive correlations between photosensitivity and physical symptoms (e.g., rash, alopecia, arthritis, and Raynaud syndrome) as well as abnormal indicators (e.g., anti-Sm antibody, anti-SSA antibody, anti-SSB antibody, RF positive, decreased C3, and decreased C4.\u003c/p\u003e\n\u003cp\u003e3. For photosensitive patients with no other sings of SLE, routine screening of these physical signs and laboratory indicators may facilitate the identification of individuals with SLE predisposition or in their early onset.\u003c/p\u003e","manuscriptTitle":"A Study of Clinical Features and Associated Factors in Photosensitive Patients with Systemic Lupus Erythematosus","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-10 18:26:52","doi":"10.21203/rs.3.rs-6637050/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"40aa0db9-c477-4e59-92b0-5609688166df","owner":[],"postedDate":"June 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":49704527,"name":"Health sciences/Health care"},{"id":49704528,"name":"Health sciences/Rheumatology"}],"tags":[],"updatedAt":"2025-06-19T15:08:43+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-10 18:26:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6637050","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6637050","identity":"rs-6637050","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}