الفهرس 
INTRODUCTION AND AIM OF THE STUDYOnly 14 pages are availabe for public view
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Abstract
SLE is a chronic debilitating disabling disease characterized by increasing incidence and prevalence, it has variable and unpredictable manifestations.
To date, our knowledge about the etiology of SLE is still unclear and limited, genetic and environmental interaction were suggested. Few authors have evaluated the risk of SLE in patients exposed to potential environmental risk factors specifically heavy metals, whose effect on disease development should not be under-estimated.
Epidemiologic evidence suggested that increased risk of SLE is associated with exposure to crystalline silica, cigarette smoking, and sunlight. Less confirmed associations have been reported for exposure to heavy metals, as well as data regarding other environmental risk factors and obesity are inconclusive.
The study was conducted at the Rheumatology outpatient clinic at Alexandria Main University Hospital. Cases were SLE women attending the Rheumatology outpatient clinic, and controls were healthy individuals matched to cases on age and parity. The sample size was 56 subjects: 29 cases and 27 controls. A structured interviewing pre-designed questionnaire was administered to participants and was used to collect data from cases and controls. Data included: personal and socio-demographic data, medical history, lifestyle, dietary habits, indoor and outdoor environmental exposures. Anthropometric measurements were done and a blood sample was drawn from each participant to measure the levels of lead, cadmium, and zinc in blood by flame atomic absorption spectrometry after wet digestion of the blood samples.
Appropriate statistical procedures were then applied to process the data, and the following results were obtained:
• Regarding the educational level, SLE females who were in the primary or preparatory educational level were significantly more likely to be at risk of SLE (OR =14.67, 95%CI =1.16-185.23),and for illiterate SLE females, there was an increased but non significant risk (OR =9, 95%CI =0.75-108.31) compared to controls.
• Living near agricultural areas had 11.67 times more risk to SLE (OR =11.67, 95%CI =2.32-58.6) compared to those not living near these areas which may be due to some environmental exposures such as sunlight and pesticides, in addition to lower socioeconomic status, lower educational level, and poverty.
• By assessing risk due to exposure to some occupational hazards, occupational sun exposure raised risk of SLE significantly by 24 times (95%CI =1.615-356.635) compared to the unexposed.
• Regarding the role of some lifestyle factors and SLE risk: lack of physical activity, exposure to domestic animals, and daily exposure to sunlight showed significant results (OR =12.61, 95%CI =3.05-52.17, OR =3.36, 95%CI =1.11-10.19, OR =13.714, 95%CI =3.768-49.920 respectively).
• With regard to passive smoking, a strong association with SLE risk was found for women who were passively exposed to smoking (OR =3.886, 95%CI =1.273-11.861). Moreover, SLE risk increased with the increase in the number of cigarettes smoked per day (the risk was 2.96 & 10.36 times for light and heavy passive smoking (OR =2.96, 95%CI =0.9-9.75; OR =10.36, 95%CI =1.1-97.69 respectively) depicting a dose-response relationship with SLE, as manifested by the significant trend values (X2 for trend=5.87, p<0.05).
• There was a statistically significant increase in SLE risk with early menopause, menstrual irregularities, use of hormonal therapy, and presence of problems in uterus (OR =31.26, 95%CI =1.7-575.54; OR =7.67, 95%CI =1.3-45.29; OR =4.889, 95%CI = 1.19-20.13; OR =5.625, 95%CI =1.09-29.03 respectively).
• The use of gas cylinders as the fuel usedat home increased SLE risk by 10.95 times (95% CI =3.16-38.01) compared to the natural gas pipes
• The results of lead analysis showed thatthe median blood lead level in the cases group was (0.115±0.165) while that in the controls group was (0.067±0.077), with a significant difference between both groups (U =210, P<0.05). A statistically significant high risk of SLE in relation to blood lead level ≥0.075 was calculated (OR=4.44, 95%CI=1.45-13.65) compared to those with blood lead level <0.075 mg/L.The study showed a dose-response relationship with increasing levels of lead in blood(X2 trend for Odds=7.77, P value for Odds =0.05).
• The median levels of blood cadmium in cases group (0.059±0.102 mg/L) were significantly higher than in the control group (0.017±0.042 mg/L) as U =216, P =0.004.Females with blood cadmium level ≥0.027 mg/L blood revealed significant risk for SLE (OR =8.16, 95% CI =2.36-28.21) compared to those of blood cadmium level <0.027 mg/L blood.The observed increased trend with increasing levels of cadmium in blood was found to be statistically significant (X2 trend for Odds=4.98, p value for Odds = 0.026).
• The observed blood levels of cadmium and lead in both cases and controls in this study were above the permissible range and could be a potential health hazard.
• No statistically significant difference between cases and controls regarding the median levels of zinc in blood.
• By performing a multivariate stepwise logistic regression analysis, five factors appeared to have significant association with SLE, namely living near agricultural areas, passive smoking, blood lead levels ≥ 0.075 mg/L, and exposure to sunlight (OR =58.556, 95% CI =1.897-1807.759, OR =24.116, 95%CI =1.763-329.799, OR =18.981, 95%CI =1.228-293.364, OR =9.549, 95%CI =1.299-70.224 respectively). Whereas walking or doing exercise were significantly protective against SLE (P=0.006).
• No statistical significant difference between cases and controls in terms of the concentration of lead and cadmium analyzed in the lipsticks (P>0.05).
• SLE had a considerable negative impact on the HRQoL of patients and their ability to carry out normal daily activities, resulting in a high prevalence of disability. The HRQoL of patients with SLE was consistently lower than that of matched healthy controls.