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Clinical and evolutive interrelation and the medical-social impact of systemic lupus erythematosus

Author: Mazur-Nicorici Lucia
Degree:doctor habilitat of medicine
Speciality: 14.00.06 - Cardiology and Reumatology
Scientific consultants: Ninel Revenco
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Oleg Lozan
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova


The thesis was presented on the 7 February, 2019
Approved by NCAA on the 15 March, 2019


Adobe PDF document5.48 Mb / in romanian


CZU 616.5-002.525.2 – 08: 614.2

Adobe PDF document 7.05 Mb / in romanian
255 pages


systemic lupus erythematosus, social support, direct and indirect costs, social status, flares, burden of disease, pediatric lupus, treatment compliance, patient education


Structure of the thesis. The thesis contains 194 pages of main text divided into: introduction, 5 chapters of original researches, conclusions and recommendations, bibliography of 211 sources, 63 figures, 42 tables, 19 appendeces. The results of the research were presented in 47 publications.

Domain of research: Rheumatology Aim of the study: To study the particularities of the clinical-immunological manifestations in dynamics in patients with juvenile and adult onset and the medical and social consequences for improving the individual, community and public health level of patients with systemic lupus erythematosus. Study objectives: Evaluation of clinical expression in relation to activity, organ damage and duration of disease in SLE patients at child and adult onset; Level of biomarkers, subtypes, exacerbations and correlation with precipitating factors in systemic lupus erythematosus; Researching the socioeconomic status and establishing correlation with disability, quality of life and matrimonial status according to the age of the patients at the onset; Reliability of tools to assess adherence to treatment, satisfaction and general wellbeing in systemic lupus erythematosus; Determining the costs of patients with lupus and predictive factors for increasing expenditure; Estimation of the consequences of the disease in relation to the number of exacerbations, co-morbidities, addresses and hospitalizations in the evolution of the disease; Effects of patient surveillance and training of SLE through patient school in the accomplished study.

Scientific novelty and originality: In premiere for the Republic of Moldova, lupus patients were plural approach in a transversal and prospective study and is remarcable through estimated the impact of the disease and its burden on the patient by using modern methods of clinical, immunological and immunophenotyping of lymphocytes. A new vision of approaching immunopathological mechanisms of SLE stress was proposed. For the first time, the development of childhood and adult onset lupus and the subtypes of the disease were compared. An investigative initiative was also the assessment of the social support, welfare and satisfaction of the patient with lupus by self-administered questionnaires. The direct direct costs of the disease from the patient's perspective and the indirect ones were calculated - through loss of work productivity, the installation of disability, absenteeism and the presence of the person affected in everyday activities. There were highlighted the factors of the accrual and hospitalization risk that increase the care costs of the patient with systemic lupus erythematosus.

The scientific problem solved in the thesis. A personalized management model has been developed and identified a unique prototype of individual, clinical, social and economic management of the SLE patient, effectively improving patient monitoring and contribute to optimize the behavior of these patients for use in clinical practice.

Theoretical significance. The results of the research elucidated contemporary aspects in the clinical, immunological and social significance of the disease, and the quantification of the costs associated with systemic lupus erythematosus with onset in adult and childhood, delineated differences specifying the subgroups of disease evolution. The results of the research contributed to the contouring of the pathogenetic link by lymphocyte immunophenotyping which conjugate CD with autoimmune inflammation.

Applicative value of the study. The results of the study have created a new direction for improving the socio-economic status of patients with systemic lupus erythematosus by argumentation the validity and information of the clinical tools for their application in the clinical practice.

Results implementation: The results of the study were included in the statement of National Clinical Protocol "Systemic lupus erythematosus", applied in the didactic process of the Department of Internal Medicine, in the clinical practice of the IV Department of the Cardiology Institute and the Primary Care Clinic SUMPh ”Nicolae Testemițanu”.