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Fathollahi A, Gabalou NB, Aslani S. Mesenchymal stem cell transplantation in systemic lupus erythematous, a mesenchymal stem cell disorder. Lupus 2018; 27:1053-1064. [PMID: 29631514 DOI: 10.1177/0961203318768889] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune and inflammatory disorder with involvement of several organs and systems such as the kidney, lung, brain and the hematopoietic system. As the most prevailing organ manifestation, lupus nephritis is the major cause of mortality and morbidity in SLE patients. The most classically and widely administered immunosuppressive medications, namely corticosteroids and cyclophosphamide, have eventuated in a remarkable amelioration in disease complications over the last few years and reduced the progression to end-stage multiorgan failure. Mesenchymal stem cells (MSCs) are considered as non-hematopoietic and multipotential progenitor cells, which are able to differentiate into multiple cell lineages such as chondrocytes, osteoblasts, myoblasts, endothelial cells, adipocytes, neuron-like cells, hepatocytes and cardiomyocytes. MSCs from SLE patients have demonstrated defects such as aberrant cytokine production. Moreover, impaired phenotype, growth and immunomodulatory functions of MSCs from patients with SLE in comparison to healthy controls have been reported. Therefore, it is hypothesized that SLE is potentially an MSC-mediated disease and, as a result, allogeneic rather than autologous MSC transplantation can be argued to be a potentially advantageous therapy for patients with SLE. On the other hand, the MSC senescence phenomenon may meet the current therapeutic approaches with challenges and demand more attention. Here, we discuss MSC transplantations to date in animal models and humans and focus on the MSC senescence complications in SLE patients.
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Affiliation(s)
- A Fathollahi
- 1 Department of Medical Immunology, School of Medicine, 48486 Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - N B Gabalou
- 2 Department of Genetics, 441802 Islamic Azad University, Ahar Branch , Ahar, Iran
| | - S Aslani
- 3 Department of Immunology and Biology, School of Medicine, 48439 Tehran University of Medical Sciences , Tehran, Iran
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Romero-Díaz J, Acosta-Hernández RI, Criales-Vera S, Kimura-Hayama E, Domínguez-Quintana M, Morán-Contla R, Núñez-Alvarez C, Lara-Reyes P, Aguilar-Salinas C, Sánchez-Guerrero J. Asymptomatic Coronary Artery Calcifications in Men with Systemic Lupus Erythematosus. J Rheumatol 2018; 45:663-670. [PMID: 29545452 DOI: 10.3899/jrheum.170330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To determine whether the prevalence and extent of asymptomatic coronary artery atherosclerosis are increased in men with systemic lupus erythematosus (SLE) compared with age- and sex-matched controls, and to define the associated risk factors. METHODS Ninety-five patients with SLE (mean ± SD age, 34.7 ± 10.1 yrs) and 100 control subjects (age 34.8 ± 9.7 yrs) with no history of coronary artery disease were screened for coronary artery calcification using multidetector computed tomography. The extent of calcification was measured using the Agatston score. The frequency of risk factors for calcification was compared between patients and controls, and the relationship between clinical and immunological characteristics and the presence of coronary artery calcification was investigated. RESULTS Coronary artery calcification was more frequent in patients than controls [18% vs 7%, respectively (OR 2.89, 95% CI 1.07-8.65)]. These factors were independently associated with the presence of calcifications: age (OR 1.12, 95% CI 1.04-1.20), SLE diagnosis (OR 3.38, 95% CI 1.07-10.64), diabetes mellitus (OR 6.88, 95% CI 1.50-31.62), Framingham risk score (OR 1.12, 95% CI 1.00-1.23), and glomerular filtration rate (OR 0.98, 95% CI 0.96-1.00). Among patients with SLE, coronary artery calcifications were observed starting at age 32 years, within 2.3 years of diagnosis. Increasing age (OR 1.18, 95% CI 1.06-1.31), Systemic Lupus International Collaborating Clinics score (OR 2.85, 95% CI 1.21-6.73), and cumulative dose of prednisone (OR 1.04, 95% CI 1.01-1.08) were independent risk factors. CONCLUSION Men with SLE are at an increased risk of coronary artery calcifications than age- and sex-matched controls. Among patients with SLE, the increased risk is associated to older age, increasing chronic damage, and cumulative dose of corticosteroids.
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Affiliation(s)
- Juanita Romero-Díaz
- From the Department of Immunology and Rheumatology, and the Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez, México, DF, México; Division of Rheumatology, Mount Sinai Hospital/Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.,J. Romero-Díaz, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; R.I. Acosta-Hernández, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; S. Criales-Vera, MD, Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez; E. Kimura-Hayama, MD, Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez; M. Domínguez-Quintana, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; R. Morán-Contla, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Núñez-Alvarez, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; P. Lara-Reyes, LICSW, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Aguilar-Salinas, MD, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Sánchez-Guerrero, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, and Division of Rheumatology, Mount Sinai Hospital/Toronto Western Hospital, University of Toronto
| | - Roberto Iván Acosta-Hernández
- From the Department of Immunology and Rheumatology, and the Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez, México, DF, México; Division of Rheumatology, Mount Sinai Hospital/Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.,J. Romero-Díaz, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; R.I. Acosta-Hernández, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; S. Criales-Vera, MD, Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez; E. Kimura-Hayama, MD, Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez; M. Domínguez-Quintana, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; R. Morán-Contla, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Núñez-Alvarez, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; P. Lara-Reyes, LICSW, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Aguilar-Salinas, MD, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Sánchez-Guerrero, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, and Division of Rheumatology, Mount Sinai Hospital/Toronto Western Hospital, University of Toronto
| | - Sergio Criales-Vera
- From the Department of Immunology and Rheumatology, and the Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez, México, DF, México; Division of Rheumatology, Mount Sinai Hospital/Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.,J. Romero-Díaz, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; R.I. Acosta-Hernández, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; S. Criales-Vera, MD, Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez; E. Kimura-Hayama, MD, Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez; M. Domínguez-Quintana, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; R. Morán-Contla, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Núñez-Alvarez, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; P. Lara-Reyes, LICSW, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Aguilar-Salinas, MD, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Sánchez-Guerrero, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, and Division of Rheumatology, Mount Sinai Hospital/Toronto Western Hospital, University of Toronto
| | - Erick Kimura-Hayama
- From the Department of Immunology and Rheumatology, and the Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez, México, DF, México; Division of Rheumatology, Mount Sinai Hospital/Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.,J. Romero-Díaz, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; R.I. Acosta-Hernández, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; S. Criales-Vera, MD, Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez; E. Kimura-Hayama, MD, Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez; M. Domínguez-Quintana, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; R. Morán-Contla, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Núñez-Alvarez, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; P. Lara-Reyes, LICSW, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Aguilar-Salinas, MD, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Sánchez-Guerrero, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, and Division of Rheumatology, Mount Sinai Hospital/Toronto Western Hospital, University of Toronto
| | - Maricruz Domínguez-Quintana
- From the Department of Immunology and Rheumatology, and the Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez, México, DF, México; Division of Rheumatology, Mount Sinai Hospital/Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.,J. Romero-Díaz, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; R.I. Acosta-Hernández, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; S. Criales-Vera, MD, Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez; E. Kimura-Hayama, MD, Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez; M. Domínguez-Quintana, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; R. Morán-Contla, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Núñez-Alvarez, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; P. Lara-Reyes, LICSW, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Aguilar-Salinas, MD, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Sánchez-Guerrero, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, and Division of Rheumatology, Mount Sinai Hospital/Toronto Western Hospital, University of Toronto
| | - Rocío Morán-Contla
- From the Department of Immunology and Rheumatology, and the Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez, México, DF, México; Division of Rheumatology, Mount Sinai Hospital/Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.,J. Romero-Díaz, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; R.I. Acosta-Hernández, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; S. Criales-Vera, MD, Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez; E. Kimura-Hayama, MD, Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez; M. Domínguez-Quintana, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; R. Morán-Contla, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Núñez-Alvarez, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; P. Lara-Reyes, LICSW, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Aguilar-Salinas, MD, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Sánchez-Guerrero, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, and Division of Rheumatology, Mount Sinai Hospital/Toronto Western Hospital, University of Toronto
| | - Carlos Núñez-Alvarez
- From the Department of Immunology and Rheumatology, and the Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez, México, DF, México; Division of Rheumatology, Mount Sinai Hospital/Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.,J. Romero-Díaz, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; R.I. Acosta-Hernández, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; S. Criales-Vera, MD, Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez; E. Kimura-Hayama, MD, Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez; M. Domínguez-Quintana, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; R. Morán-Contla, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Núñez-Alvarez, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; P. Lara-Reyes, LICSW, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Aguilar-Salinas, MD, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Sánchez-Guerrero, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, and Division of Rheumatology, Mount Sinai Hospital/Toronto Western Hospital, University of Toronto
| | - Pilar Lara-Reyes
- From the Department of Immunology and Rheumatology, and the Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez, México, DF, México; Division of Rheumatology, Mount Sinai Hospital/Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.,J. Romero-Díaz, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; R.I. Acosta-Hernández, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; S. Criales-Vera, MD, Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez; E. Kimura-Hayama, MD, Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez; M. Domínguez-Quintana, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; R. Morán-Contla, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Núñez-Alvarez, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; P. Lara-Reyes, LICSW, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Aguilar-Salinas, MD, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Sánchez-Guerrero, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, and Division of Rheumatology, Mount Sinai Hospital/Toronto Western Hospital, University of Toronto
| | - Carlos Aguilar-Salinas
- From the Department of Immunology and Rheumatology, and the Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez, México, DF, México; Division of Rheumatology, Mount Sinai Hospital/Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.,J. Romero-Díaz, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; R.I. Acosta-Hernández, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; S. Criales-Vera, MD, Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez; E. Kimura-Hayama, MD, Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez; M. Domínguez-Quintana, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; R. Morán-Contla, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Núñez-Alvarez, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; P. Lara-Reyes, LICSW, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Aguilar-Salinas, MD, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Sánchez-Guerrero, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, and Division of Rheumatology, Mount Sinai Hospital/Toronto Western Hospital, University of Toronto
| | - Jorge Sánchez-Guerrero
- From the Department of Immunology and Rheumatology, and the Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez, México, DF, México; Division of Rheumatology, Mount Sinai Hospital/Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada. .,J. Romero-Díaz, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; R.I. Acosta-Hernández, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; S. Criales-Vera, MD, Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez; E. Kimura-Hayama, MD, Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez; M. Domínguez-Quintana, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; R. Morán-Contla, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Núñez-Alvarez, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; P. Lara-Reyes, LICSW, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Aguilar-Salinas, MD, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Sánchez-Guerrero, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, and Division of Rheumatology, Mount Sinai Hospital/Toronto Western Hospital, University of Toronto.
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153
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Chen DQ, Cancienne JM, Werner BC, Cui Q. Is osteonecrosis due to systemic lupus erythematosus associated with increased risk of complications following total hip arthroplasty? INTERNATIONAL ORTHOPAEDICS 2018; 42:1485-1490. [PMID: 29550912 DOI: 10.1007/s00264-018-3871-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 02/27/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE As the medical treatment of systemic lupus erythematosus (SLE) has evolved, the rate of total hip arthroplasty (THA) in SLE patients has increased, with osteonecrosis (ON) being the primary indication for arthroplasty in a quarter of cases. Comparative literature evaluating outcomes following THA for patients with SLE and ON versus patients with non-SLE-related ON or patients with osteoarthritis (OA) is limited. The goal of the present study was to investigate the current trend in SLE patients undergoing THA and compare complications following THA for ON with SLE, ON without SLE, and OA. METHODS The PearlDiver patient records database ( www.pearldiverinc.com , Colorado Springs, CO), a for-fee insurance-based patient records database, was utilized for this study. Two hundred forty-four patients who underwent THA for ON associated with SLE were identified and compared to control cohorts of 7836 patients with ON without SLE and 64,235 patients with OA using a multivariate analysis. RESULTS We found patients with SLE undergoing THA for ON experienced lower rates of infection and revision but a higher rate of medical complications compared to patients undergoing THA for non-SLE ON diagnoses. Patients with SLE undergoing THA for ON experienced decreased rates of infection but increased rates of transfusion and medical complications compared to patients undergoing THA for OA. CONCLUSIONS Our data demonstrate that THA can be safely performed on SLE patients with ON without significantly increased morbidity compared to that in patients with non-SLE-associated ON or patients with OA.
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Affiliation(s)
- Dennis Q Chen
- Department of Orthopaedic Surgery, University of Virginia Health System, 400 Ray C. Hunt Drive, Suite 330, Charlottesville, VA, 22903, USA
| | - Jourdan M Cancienne
- Department of Orthopaedic Surgery, University of Virginia Health System, 400 Ray C. Hunt Drive, Suite 330, Charlottesville, VA, 22903, USA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia Health System, 400 Ray C. Hunt Drive, Suite 330, Charlottesville, VA, 22903, USA
| | - Quanjun Cui
- Department of Orthopaedic Surgery, University of Virginia Health System, 400 Ray C. Hunt Drive, Suite 330, Charlottesville, VA, 22903, USA.
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154
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Abstract
PURPOSE OF REVIEW Systemic lupus erythematosus (SLE) is the prototypical systemic autoimmune disease with a significant disease burden across the world among different ethnic, racial, and age groups. The pathophysiological understanding of SLE is constantly evolving and with it, the need for a better definition of the disease itself, for understanding the risk among the different affected populations, and for identifying the factors responsible for the damage accrual through the years. RECENT FINDINGS More accurate estimates of incidence and prevalence of SLE among different ethnicities and minority groups not only in the USA, but also in Europe, Middle East, and Asia have provided new insights into the disease burden around the world. Despite advances in treatment, mortality among SLE patients remains high with significant ethnic and geographic variations. SUMMARY Sex, race, and ethnicity significantly affect SLE incidence, prevalence, and mortality.
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Affiliation(s)
- George Stojan
- Division of Rheumatology, Johns Hopkins University, Baltimore, United States
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University, Baltimore, United States
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155
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Brodie EJ, Infantino S, Low MSY, Tarlinton DM. Lyn, Lupus, and (B) Lymphocytes, a Lesson on the Critical Balance of Kinase Signaling in Immunity. Front Immunol 2018; 9:401. [PMID: 29545808 PMCID: PMC5837976 DOI: 10.3389/fimmu.2018.00401] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 02/13/2018] [Indexed: 01/23/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is a progressive autoimmune disease characterized by increased sensitivity to self-antigens, auto-antibody production, and systemic inflammation. B cells have been implicated in disease progression and as such represent an attractive therapeutic target. Lyn is a Src family tyrosine kinase that plays a major role in regulating signaling pathways within B cells as well as other hematopoietic cells. Its role in initiating negative signaling cascades is especially critical as exemplified by Lyn-/- mice developing an SLE-like disease with plasma cell hyperplasia, underscoring the importance of tightly regulating signaling within B cells. This review highlights recent advances in our understanding of the function of the Src family tyrosine kinase Lyn in B lymphocytes and its contribution to positive and negative signaling pathways that are dysregulated in autoimmunity.
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Affiliation(s)
- Erica J. Brodie
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia
| | - Simona Infantino
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia
| | - Michael S. Y. Low
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia
- Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
- Immunology Division, Walter and Eliza Hall Institute of Medical Research, University of Melbourne, Parkville, VIC, Australia
- Department of Haematology, Monash Health, Monash Hospital, Clayton, VIC, Australia
| | - David M. Tarlinton
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia
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156
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Gholson JJ, Wilkinson BG, Brown TS, Gao Y, Dowdle SB, Callaghan JJ. Systemic Lupus Erythematosus is a Risk Factor for Complications in Total Joint Arthroplasty. THE IOWA ORTHOPAEDIC JOURNAL 2018; 38:183-190. [PMID: 30104943 PMCID: PMC6047393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Introduction Systemic Lupus Erythematosus (SLE) has been associated with increased complications following hip and knee arthroplasty. The Purpose of this study was to determine the extent to which SLE is a risk factor in outcomes following total joint arthroplasty (TJA). Methods The nationwide inpatient sample was used to identify a cohort of 505,841 patients who had a total hip arthroplasty (THA) or total knee arthroplasty (TKA) between 2009-2011. Of these patients, 2,284 patients (0.45%) had been previously diagnosed with SLE. The impact of SLE on short-term TJA outcomes was determined using multivariate logistic regression. Differences in discharge destination and length of stay were also evaluated. Results SLE patients were more likely to have an all-cause medical complication, (OR 1.9, p<0.0001) and more likely to have an all-cause surgical complication (OR 1.3, p<0.0001). SLE patients were four times more likely to become septic in the post-operative period (OR 3.8, p<0.0487). SLE patients were more likely to have a genitourinary complication (OR 1.7, p<0.0001) and bleeding complications requiring transfusion (OR 2.1, p<0.0001). Patients with SLE also had an increased length of stay (0.38 days, p<0.0001) and increased probability of discharging to a facility (OR 2.1, p<0.0001). Discussion Patients with SLE had an increased rate of both medical and surgical all-cause complications. Patients were specifically found to be at higher risk for sepsis, genitourinary complications, and blood transfusions. Future risk adjustment models should include SLE as a contributor to medical and surgical complications in the postoperative period.
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Affiliation(s)
| | | | | | - Yubo Gao
- University of Iowa Hospitals and Clinics
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157
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Rees F, Doherty M, Grainge MJ, Lanyon P, Zhang W. The worldwide incidence and prevalence of systemic lupus erythematosus: a systematic review of epidemiological studies. Rheumatology (Oxford) 2017; 56:1945-1961. [PMID: 28968809 DOI: 10.1093/rheumatology/kex260] [Citation(s) in RCA: 399] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Indexed: 01/26/2023] Open
Abstract
Objectives The aim was to review the worldwide incidence and prevalence of SLE and variation with age, sex, ethnicity and time. Methods A systematic search of MEDLINE and EMBASE search engines was carried out using Medical Subject Headings and keyword search terms for Systemic Lupus Erythematosus combined with incidence, prevalence and epidemiology in August 2013 and updated in September 2016. Author, journal, year of publication, country, region, case-finding method, study period, number of incident or prevalent cases, incidence (per 100 000 person-years) or prevalence (per 100 000 persons) and age, sex or ethnic group-specific incidence or prevalence were collected. Results The highest estimates of incidence and prevalence of SLE were in North America [23.2/100 000 person-years (95% CI: 23.4, 24.0) and 241/100 000 people (95% CI: 130, 352), respectively]. The lowest incidences of SLE were reported in Africa and Ukraine (0.3/100 000 person-years), and the lowest prevalence was in Northern Australia (0 cases in a sample of 847 people). Women were more frequently affected than men for every age and ethnic group. Incidence peaked in middle adulthood and occurred later for men. People of Black ethnicity had the highest incidence and prevalence of SLE, whereas those with White ethnicity had the lowest incidence and prevalence. There appeared to be an increasing trend of SLE prevalence with time. Conclusion There are worldwide differences in the incidence and prevalence of SLE that vary with sex, age, ethnicity and time. Further study of genetic and environmental risk factors may explain the reasons for these differences. More epidemiological studies in Africa are warranted.
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Affiliation(s)
- Frances Rees
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham.,Rheumatology Department, Nottingham University Hospitals NHS Trust
| | - Michael Doherty
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham
| | - Matthew J Grainge
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Peter Lanyon
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham.,Rheumatology Department, Nottingham University Hospitals NHS Trust
| | - Weiya Zhang
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham
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158
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Gordon C, Amissah-Arthur MB, Gayed M, Brown S, Bruce IN, D’Cruz D, Empson B, Griffiths B, Jayne D, Khamashta M, Lightstone L, Norton P, Norton Y, Schreiber K, Isenberg D. The British Society for Rheumatology guideline for the management of systemic lupus erythematosus in adults. Rheumatology (Oxford) 2017; 57:e1-e45. [DOI: 10.1093/rheumatology/kex286] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Indexed: 12/15/2022] Open
Affiliation(s)
- Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham,
- Rheumatology Department, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust,
- Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham,
| | - Maame-Boatemaa Amissah-Arthur
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham,
| | - Mary Gayed
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham,
- Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham,
| | - Sue Brown
- Royal National Hospital for Rheumatic Diseases, Bath,
| | - Ian N. Bruce
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute for Inflammation and Repair, University of Manchester, Manchester Academic Health Sciences Centre,
- The Kellgren Centre for Rheumatology, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester,
| | - David D’Cruz
- Louise Coote Lupus Unit, Guy’s Hospital, London,
| | - Benjamin Empson
- Laurie Pike Health Centre, Modality Partnership, Birmingham,
| | | | - David Jayne
- Department of Medicine, University of Cambridge,
- Lupus and Vasculitis Unit, Addenbrooke’s Hospital, Cambridge,
| | - Munther Khamashta
- Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital,
- Division of Women’s Health, King’s College London,
| | - Liz Lightstone
- Section of Renal Medicine and Vascular Inflammation, Division of Immunology and Inflammation, Department of Medicine, Imperial College London, London,
| | | | | | | | - David Isenberg
- Centre for Rheumatology, University College London, London, UK
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159
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Chen YF, Xu JH, Zou YF, Lian L, Wang F, Chen SY, Cai J, Li M. Association of glucocorticoid receptor gene polymorphisms with systemic lupus erythematosus in a Chinese population. Int J Rheum Dis 2017; 20:2053-2061. [PMID: 28984075 DOI: 10.1111/1756-185x.13191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Yang-Fan Chen
- Department of Rheumatology and Immunology; the First Affiliated Hospital of Anhui Medical University; Hefei Anhui China
| | - Jian-Hua Xu
- Department of Rheumatology and Immunology; the First Affiliated Hospital of Anhui Medical University; Hefei Anhui China
| | - Yan-Feng Zou
- Department of Epidemiology and Biostatistics; School of Public Health, Anhui Medical University; Hefei Anhui China
| | - Li Lian
- Department of Rheumatology and Immunology; the First Affiliated Hospital of Anhui Medical University; Hefei Anhui China
| | - Fen Wang
- Department of Rheumatology and Immunology; the First Affiliated Hospital of Anhui Medical University; Hefei Anhui China
| | - Shan-Yu Chen
- Department of Rheumatology and Immunology; the First Affiliated Hospital of Anhui Medical University; Hefei Anhui China
| | - Jing Cai
- Department of Rheumatology and Immunology; the First Affiliated Hospital of Anhui Medical University; Hefei Anhui China
| | - Mu Li
- Department of Rheumatology and Immunology; the First Affiliated Hospital of Anhui Medical University; Hefei Anhui China
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160
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Environmental triggers in systemic lupus erythematosus. Semin Arthritis Rheum 2017; 47:710-717. [PMID: 29169635 DOI: 10.1016/j.semarthrit.2017.10.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/20/2017] [Accepted: 10/02/2017] [Indexed: 12/25/2022]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect almost any organ in the human body. Despite significant advancements in our understanding of SLE over the recent years, its exact mode of onset and disease progression remains elusive. Low concordance rates among monozygotic twins with SLE (as low as 24%), clustering of disease prevalence around polluted regions and an urban-rural difference in prevalence all highlight the importance of environmental influences in SLE. Experimental data strongly suggests a complex interaction between the exposome (or environmental influences) and genome (genetic material) to produce epigenetic changes (epigenome) that can alter the expression of genetic material and lead to development of disease in the susceptible individual. In this review, we focus on the available literature to explore the role of environmental factors in SLE disease onset and progression and to better understand the role of exposome-epigenome-genome interactions in this dreaded disease.
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161
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Manzi S, Merrill J. Editorial: Lupus, the Chameleon: Many Disguises Difficult to Capture. Arthritis Rheumatol 2017; 69:1921-1924. [PMID: 28891123 DOI: 10.1002/art.40190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/22/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Susan Manzi
- Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Joan Merrill
- Oklahoma Medical Research Foundation, Oklahoma City
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162
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Dall'Era M, Cisternas MG, Snipes K, Herrinton LJ, Gordon C, Helmick CG. The Incidence and Prevalence of Systemic Lupus Erythematosus in San Francisco County, California: The California Lupus Surveillance Project. Arthritis Rheumatol 2017; 69:1996-2005. [PMID: 28891237 DOI: 10.1002/art.40191] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 06/22/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Estimates of the incidence and prevalence of systemic lupus erythematosus (SLE) in the US have varied widely. The purpose of this study was to conduct the California Lupus Surveillance Project (CLSP) to determine credible estimates of SLE incidence and prevalence, with a special focus on Hispanics and Asians. METHODS The CLSP, which is funded by the Centers for Disease Control and Prevention, is a population-based registry of individuals with SLE residing in San Francisco County, CA, from January 1, 2007 through December 31, 2009. Data sources included hospitals, rheumatologists, nephrologists, commercial laboratories, and a state hospital discharge database. We abstracted medical records to ascertain SLE cases, which we defined as patients who met ≥4 of the 11 American College of Rheumatology classification criteria for SLE. We estimated crude and age-standardized incidence and prevalence, which were stratified by sex and race/ethnicity. RESULTS The overall age-standardized annual incidence rate was 4.6 per 100,000 person-years. The average annual period prevalence was 84.8 per 100,000 persons. The age-standardized incidence rate in women and men was 8.6 and 0.7 per 100,000 person-years, respectively. This rate was highest among black women (30.5), followed by Hispanic women (8.9), Asian women (7.2), and white women (5.3). The age-standardized prevalence in women per 100,000 persons was 458.1 in blacks, 177.9 in Hispanics, 149.7 in Asians, and 109.8 in whites. Capture-recapture modeling estimated 33 additional incident cases and 147 additional prevalent cases. CONCLUSION Comprehensive methods that include intensive case-finding provide more credible estimates of SLE in Hispanics and Asians, and confirm racial and ethnic disparities in SLE. The disease burden of SLE is highest in black women, followed by Hispanic women, Asian women, and white women.
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Affiliation(s)
| | | | - Kurt Snipes
- California Department of Public Health, Sacramento
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163
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Izmirly PM, Wan I, Sahl S, Buyon JP, Belmont HM, Salmon JE, Askanase A, Bathon JM, Geraldino-Pardilla L, Ali Y, Ginzler EM, Putterman C, Gordon C, Helmick CG, Parton H. The Incidence and Prevalence of Systemic Lupus Erythematosus in New York County (Manhattan), New York: The Manhattan Lupus Surveillance Program. Arthritis Rheumatol 2017; 69:2006-2017. [PMID: 28891252 PMCID: PMC11102806 DOI: 10.1002/art.40192] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 06/22/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The Manhattan Lupus Surveillance Program (MLSP) is a population-based registry designed to determine the prevalence of systemic lupus erythematosus (SLE) in 2007 and the incidence from 2007 to 2009 among residents of New York County (Manhattan), New York, and to characterize cases by race/ethnicity, including Asians and Hispanics, for whom data are lacking. METHODS We identified possible SLE cases from hospital records, rheumatologist records, and administrative databases. Cases were defined according to the American College of Rheumatology (ACR) classification criteria, the Systemic Lupus International Collaborating Clinics (SLICC) classification criteria, or the treating rheumatologist's diagnosis. Rates among Manhattan residents were age-standardized, and capture-recapture analyses were conducted to assess case underascertainment. RESULTS By the ACR definition, the age-standardized prevalence and incidence rates of SLE were 62.2 and 4.6 per 100,000 person-years, respectively. Rates were ∼9 times higher in women than in men for prevalence (107.4 versus 12.5) and incidence (7.9 versus 1.0). Compared with non-Hispanic white women (64.3), prevalence was higher among non-Hispanic black (210.9), Hispanic (138.3), and non-Hispanic Asian (91.2) women. Incidence rates were higher among non-Hispanic black women (15.7) compared with non-Hispanic Asian (6.6), Hispanic (6.5), and non-Hispanic white (6.5) women. Capture-recapture adjustment increased the prevalence and incidence rates (75.9 and 6.0, respectively). Alternate SLE definitions without capture-recapture adjustment revealed higher age-standardized prevalence and incidence rates (73.8 and 6.2, respectively, by the SLICC definition and 72.6 and 5.0 by the rheumatologist definition) than the ACR definition, with similar patterns by sex and race/ethnicity. CONCLUSION The MLSP confirms findings from other registries on disparities by sex and race/ethnicity, provides new estimates among Asians and Hispanics, and provides estimates using the SLICC criteria.
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Affiliation(s)
| | - Isabella Wan
- New York University School of Medicine, New York, New York
| | - Sara Sahl
- New York University School of Medicine, New York, New York
| | - Jill P. Buyon
- New York University School of Medicine, New York, New York
| | | | - Jane E. Salmon
- Hospital for Special Surgery, Weill Cornell Medical College, New York, New York
| | - Anca Askanase
- Columbia University College of Physicians and Surgeons, New York, New York
| | - Joan M. Bathon
- Columbia University College of Physicians and Surgeons, New York, New York
| | | | - Yousaf Ali
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ellen M. Ginzler
- State University of New York Downstate College of Medicine, Brooklyn
| | | | | | | | - Hilary Parton
- New York City Department of Health and Mental Hygiene, Long Island City, New York
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164
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Plantinga L, Lim SS, Bowling CB, Drenkard C. Perceived stress and reported cognitive symptoms among Georgia patients with systemic lupus erythematosus. Lupus 2017; 26:1064-1071. [PMID: 28420055 PMCID: PMC5494014 DOI: 10.1177/0961203317693095] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To examine associations of perceived stress with cognitive symptoms among adults with systemic lupus erythematosus (SLE). Methods Among 777 adult (≥18 years) SLE patients, the association of Perceived Stress Scale (PSS) scores with two self-reported cognitive symptoms was examined: forgetfulness (severe/moderate vs. mild/none; from the Systemic Lupus Activity Questionnaire) and difficulty concentrating (all/most vs. some/little/none of the time; from the Lupus Impact Tracker). The study used multivariable logistic regression to estimate the odds ratios (ORs) per minimal important difference (MID = 0.5*SD) of PSS score and cognitive symptoms. Results Forgetfulness and difficulty concentrating were reported by 41.7% and 29.5%, respectively. Women and those with less education and high disease activity had higher PSS scores and were more likely to report cognitive symptoms than their counterparts. With adjustment for age, race, sex, education, and disease activity, each MID increase in PSS score was associated with higher prevalence of forgetfulness (OR = 1.43, 95% CI 1.29-1.47) and difficulty concentrating (OR = 2.19, 95% CI 1.90-2.52). No substantial differences in this association by age, race, sex, or disease activity were noted. Conclusions SLE patients, particularly those with high disease activity, report a high burden of cognitive symptoms, for which stress may be a modifiable risk factor.
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Affiliation(s)
- Laura Plantinga
- Division of Renal Medicine, Department of Medicine, Emory University
- Division of Geriatrics and General Medicine, Department of Medicine, Emory University
| | - S. Sam Lim
- Division of Rheumatology, Department of Medicine, Emory University
| | - C. Barrett Bowling
- Division of Geriatrics and General Medicine, Department of Medicine, Emory University
- Birmingham/Atlanta VA Geriatrics Research and Clinical Center, Atlanta, Georgia, United States
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165
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Ramsey-Goldman R, Li J, Dervieux T, Alexander RV. Cell-bound complement activation products in SLE. Lupus Sci Med 2017; 4:e000236. [PMID: 29214038 PMCID: PMC5704741 DOI: 10.1136/lupus-2017-000236] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/02/2017] [Indexed: 01/04/2023]
Abstract
Diagnosis of SLE is based on clinical manifestations and laboratory findings. Timely diagnosis and treatment are important to control disease activity and prevent organ damage. However, diagnosis is challenging because of the heterogeneity in clinical signs and symptoms, and also because the disease presents with alternating periods of flare and quiescence. As SLE is an autoimmune disease characterised by the formation of autoantibodies, diagnostic immunology laboratory tests for detecting and quantifying autoantibodies are commonly used for the diagnosis and classification of SLE. These include ANA, anti-double-stranded DNA antibodies and anti-Smith antibodies, together with other antibodies such as antiphospholipid or anti-Cq1. Complement proteins C3 and C4 are commonly measured in patients with SLE, but their serum levels do not necessarily reflect complement activation. Cell-bound complement activation products (CB-CAPs) are fragments formed upon complement activation that bind covalently to haematopoietic cells. This review focuses on the complement system and, in particular, on CB-CAPs as biomarkers for the diagnosis and monitoring of SLE, vis-à-vis complement proteins and other biomarkers of complement activation.
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Affiliation(s)
- Rosalind Ramsey-Goldman
- Department of Medicine/Division of Rheumatology, Northwestern University, Chicago, Illinois, USA
| | - Jian Li
- Department of Medicine/Division of Rheumatology, Northwestern University, Chicago, Illinois, USA
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166
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Barbhaiya M, Feldman CH, Guan H, Gómez-Puerta JA, Fischer MA, Solomon DH, Everett B, Costenbader KH. Race/Ethnicity and Cardiovascular Events Among Patients With Systemic Lupus Erythematosus. Arthritis Rheumatol 2017; 69:1823-1831. [PMID: 28598016 DOI: 10.1002/art.40174] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 06/06/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) is more prevalent and results in more severe outcomes among blacks, Asians, and Hispanics than among whites. Cardiovascular disease (CVD) is the leading cause of death among SLE patients. We undertook this study to examine racial/ethnic variations in risk of CVD events among SLE patients. METHODS Within the Medicaid Analytic eXtract from 2000 to 2010, we identified patients ages 18-65 years with SLE (≥3 International Classification of Diseases, Ninth Revision 710.0 codes, ≥30 days apart) and with ≥12 months of continuous enrollment. Subjects were followed up from the index date to the first CVD event (myocardial infarction [MI] or stroke), death, disenrollment, loss to follow-up, or end of follow-up period. Race/ethnicity-specific annual CVD event rates were calculated. Cox regression models estimated hazard ratios (HRs) with 95% confidence intervals (95% CIs), accounting for competing risk of death and adjusting for baseline demographics and comorbidities. RESULTS Of 65,788 SLE patients, 93.1% were women and ∼42% were black, 38% were white, 16% were Hispanic, 3% were Asian, and 1% were American Indian/Alaska Native. Mean ± SD follow-up was 3.8 ± 3.1 years. CVD event rates were highest among blacks (incidence rate [IR] 10.57 [95% CI 9.96-11.22]) and lowest among Asians (IR 6.63 [95% CI 4.97-8.85]). After multivariable adjustment, risk of CVD events was increased among blacks (HR 1.14 [95% CI 1.03-1.26]) compared to whites. Hispanics and Asians had a lower risk of MI (HR 0.61 [95% CI 0.48-0.77] and HR 0.57 [95% CI 0.34-0.96], respectively), while blacks and Hispanics had a higher risk of stroke (HR 1.31 [95% CI 1.15-1.49] and HR 1.22 [95% CI 1.03-1.44], respectively). CONCLUSION Among SLE patients enrolled in Medicaid, the risk of MI was lower among Hispanics and Asians compared to whites, while the risk of stroke was elevated among blacks and Hispanics compared to whites.
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Affiliation(s)
| | | | - Hongshu Guan
- Brigham and Women's Hospital, Boston, Massachusetts
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167
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Walunas TL, Jackson KL, Chung AH, Mancera-Cuevas KA, Erickson DL, Ramsey-Goldman R, Kho A. Disease Outcomes and Care Fragmentation Among Patients With Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2017; 69:1369-1376. [PMID: 27899012 DOI: 10.1002/acr.23161] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 11/02/2016] [Accepted: 11/22/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the impact of care fragmentation across multiple health care institutions on disease outcomes in patients with systemic lupus erythematosus (SLE). METHODS Using the Chicago HealthLNK Data Repository, an assembly of electronic health records from 6 institutions, we identified patients with SLE, using International Classification of Diseases, Ninth Revision (ICD-9) codes, whose care was delivered at more than 1 organization. We examined whether patients had severe infections or comorbidities (ICD-9 code defined) that indicated SLE-induced damage. T-tests and chi-square tests were used to examine differences between fragmentation groups. Logistic regression was used to assess factors contributing to the occurrence of disease outcomes. RESULTS We identified 4,276 patients with SLE. A total of 856 (20%) received care from more than 1 health care institution. African American patients and patients with public insurance were more likely to experience care fragmentation compared to white and private insurance patients (odds ratio [OR] 1.66, 95% confidence interval [95% CI] 1.44-1.97 and OR 1.63, 95% CI 1.42-1.95). We identified increased risk of infections (OR 1.57, 95% CI 1.30-1.88), cardiovascular disease (OR 1.51, 95% CI 1.23-1.86), end-stage renal disease (OR 1.34, 95% CI 1.05-1.70), nephritis (OR 1.28, 95% CI 1.07-1.54), and stroke (OR 1.28, 95% CI 1.01-1.62) among patients with fragmented care, adjusted for age, sex, race, insurance status, length of followup time, and total visit count. CONCLUSION In this cross-site cohort of SLE patients, care fragmentation is associated with increased risk of severe infection and comorbidities. These results suggest that improved health information exchange could positively impact outcomes for SLE patients.
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Affiliation(s)
- Theresa L Walunas
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kathryn L Jackson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anh H Chung
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Daniel L Erickson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Abel Kho
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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168
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Gergianaki I, Fanouriakis A, Repa A, Tzanakakis M, Adamichou C, Pompieri A, Spirou G, Bertsias A, Kabouraki E, Tzanakis I, Chatzi L, Sidiropoulos P, Boumpas DT, Bertsias GK. Epidemiology and burden of systemic lupus erythematosus in a Southern European population: data from the community-based lupus registry of Crete, Greece. Ann Rheum Dis 2017; 76:1992-2000. [DOI: 10.1136/annrheumdis-2017-211206] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 07/04/2017] [Accepted: 07/18/2017] [Indexed: 01/11/2023]
Abstract
ObjectivesSeveral population-based studies on systemic lupus erythematosus (SLE) have been reported, yet community-based, individual-case validated, comprehensive reports are missing. We studied the SLE epidemiology and burden on the island of Crete during 1999–2013.MethodsMultisource case-finding included patients ≥15 years old. Cases were ascertained by the ACR 1997, SLICC 2012 criteria and rheumatologist diagnosis, and validated through synthesis of medical charts, administrative and patient-generated data.ResultsOverall age-adjusted/sex-adjusted incidence was 7.4 (95% CI 6.8 to 7.9) per 100 000 persons/year, with stabilising trends in women but increasing in men, and average (±SD) age of diagnosis at 43 (±15) years. Adjusted and crude prevalence (December 2013) was 123.4 (113.9 to 132.9) and 143 (133 to 154)/105 (165/105 in urban vs 123/105 in rural regions, p<0.001), respectively. Age-adjusted/sex-adjusted nephritis incidence was 0.6 (0.4 to 0.8) with stable trends, whereas that of neuropsychiatric SLE was 0.5 (0.4 to 0.7) per 100 000 persons/year and increasing. Although half of prevalent cases had mild manifestations, 30.5% developed organ damage after 7.2 (±6.6) years of disease duration, with the neuropsychiatric domain most frequently afflicted, and 4.4% of patients with nephritis developed end-stage renal disease. The ACR 1997 and SLICC 2012 classification criteria showed high concordance (87%), yet physician-based diagnosis occurred earlier than criteria-based in about 20% of cases.ConclusionsBy the use of a comprehensive methodology, we describe the full spectrum of SLE from the community to tertiary care, with almost half of the cases having mild disease, yet with significant damage accrual. SLE is not rare, affects predominantly middle-aged women and is increasingly recognised in men. Neuropsychiatric disease is an emerging frontier in lupus prevention and care.
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169
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Hanly JG, Thompson K, Skedgel C. Utilization of Ambulatory Physician Encounters, Emergency Room Visits, and Hospitalizations by Systemic Lupus Erythematosus Patients: A 13-Year Population Health Study. Arthritis Care Res (Hoboken) 2017; 68:1128-34. [PMID: 26662554 DOI: 10.1002/acr.22808] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 12/01/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine total physician encounters, emergency room (ER) visits, and hospitalizations in an incident cohort of systemic lupus erythematosus (SLE) cases and matched control patients over 13 years. METHODS A retrospective cohort study was performed utilizing administrative health care data from approximately 1 million people with access to universal health care. Using International Classification of Diseases, Ninth and Tenth Revisions diagnostic codes, 7 SLE case definitions were used. Each case was matched by age and sex to 4 randomly selected controls. Data included physician billings, ER visits, and hospital discharges over 13 years. RESULTS The number of incident SLE cases varied from 564 to 4,494 depending on the case definition used. The mean age varied from 47.7 to 50.6 years and the proportion of females from 78.0% to 85.1%. SLE utilization of physicians was highest in the index year, and declined significantly thereafter for all case definitions. By the fourth year, encounters with subspecialty physicians fell by 60% (rheumatologists), 50% (internists), and 31% (other physicians). In contrast, visits to family physicians fell by only 9%. Visits to the ER and hospital admissions for SLE cases were also more frequent early in the disease course and fell significantly over the study for both ER visits (all case definitions) and hospitalizations (2 of 7 case definitions). CONCLUSION In SLE patients, health care utilization is highest in the first few years following the diagnosis, which is also the time of maximal involvement by rheumatologists. Utilization declines over time, and encounters with patients' family physicians predominate over those of other physician groups.
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Affiliation(s)
- John G Hanly
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kara Thompson
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Chris Skedgel
- Capital Health, Halifax, Nova Scotia, Canada, and Norwich Medical School, University of East Anglia, Norwich, UK
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170
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Rees F, Doherty M, Grainge M, Lanyon P, Davenport G, Zhang W. Burden of Comorbidity in Systemic Lupus Erythematosus in the UK, 1999-2012. Arthritis Care Res (Hoboken) 2017; 68:819-27. [PMID: 26473719 DOI: 10.1002/acr.22751] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/18/2015] [Accepted: 09/29/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To estimate the comorbidity associated with systemic lupus erythematosus (SLE) in the UK during 1999-2012. METHODS A retrospective cohort study using the UK Clinical Practice Research Datalink was conducted. Prevalent cases of SLE were matched by age, sex, and practice to 4 controls. The incidence of cardiovascular disease (CVD), stroke, end-stage renal failure (ESRF), cancer, osteoporosis, and infection were calculated per 1,000 person-years during the study period and compared to controls using Poisson regression to obtain incidence rate ratios (IRRs). IRRs were adjusted for baseline age, sex, body mass index, smoking status, alcohol intake, hypertension, hyperlipidemia, Charlson Index scores, and prednisolone use. Age- and sex-specific incidence rates were calculated. RESULTS When comparing the 7,732 prevalent cases of SLE with 28,079 matched controls, the unadjusted IRR was 1.98 (95% confidence interval [95% CI] 1.69-2.31) for CVD, 1.81 (95% CI 1.49-2.19) for stroke, 7.81 (95% CI 4.68-13.05) for ESRF, 1.28 (95% CI 1.17-1.40) for cancer, 2.53 (95% CI 2.27-2.82) for osteoporosis, and 1.49 (95% CI 1.40-1.58) for infection. After adjustment, the rates remained significantly higher in cases. Men with SLE had higher rates of CVD, stroke, and cancer, whereas women had higher rates of infection and osteoporosis. Those at younger ages were at the greatest relative risk compared with controls. Cases had significantly higher Charlson Index scores at baseline. CONCLUSION People with SLE in the UK have a greater burden of comorbidity and are more likely to develop CVD, stroke, ESRF, cancer, osteoporosis, and infection than people of the same age and sex.
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Affiliation(s)
- Frances Rees
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | - Peter Lanyon
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Graham Davenport
- Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
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171
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Broder A, Mowrey WB, Izmirly P, Costenbader KH. Validation of Systemic Lupus Erythematosus Diagnosis as the Primary Cause of Renal Failure in the US Renal Data System. Arthritis Care Res (Hoboken) 2017; 69:599-604. [PMID: 27390299 DOI: 10.1002/acr.22972] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 05/20/2016] [Accepted: 06/21/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Using American College of Rheumatology (ACR) and Systemic Lupus International Collaborating Clinics (SLICC) criteria for systemic lupus erythematosus (SLE) classification as gold standards, we determined sensitivity, specificity, positive and negative predictive values (PPV and NPV) of having SLE denoted as the primary cause of end-stage renal disease (ESRD) in the US Renal Data System (USRDS). METHODS ESRD patients were identified by International Classification of Diseases, Ninth Revision codes in electronic medical records of 1 large tertiary care center, Montefiore Hospital, from 2006 to 2012. Clinical data were extracted and reviewed to establish SLE diagnosis. Data were linked by social security number, name, and date of birth to the USRDS, where primary causes of ESRD were ascertained. RESULTS Of 7,396 ESRD patients at Montefiore, 97 met ACR/SLICC SLE criteria, and 86 had SLE by record only. Among the 97 SLE patients, the attributed causes of ESRD in the USRDS were 77 SLE and 12 with other causes (unspecified glomerulonephritis, hypertension, scleroderma), and 8 missing. Sensitivity, specificity, PPV, and NPV for SLE in the USRDS were 79%, 99.9%, 93%, and 99.7%, respectively. Of the 60 patients with biopsy-proven lupus nephritis, 44 (73%) had SLE as primary ESRD cause in the USRDS. Attribution of the primary ESRD causes among SLE patients with ACR/SLICC criteria differed by race, ethnicity, and transplant status. CONCLUSION The diagnosis of SLE as the primary cause of ESRD in the USRDS has good sensitivity, and excellent specificity, PPV, and NPV. Nationwide access to medical records and biopsy reports may significantly improve sensitivity of SLE diagnosis.
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Affiliation(s)
- Anna Broder
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | | | | | - Karen H Costenbader
- Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
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172
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Barbhaiya M, Lu B, Sparks JA, Malspeis S, Chang SC, Karlson EW, Costenbader KH. Influence of Alcohol Consumption on the Risk of Systemic Lupus Erythematosus Among Women in the Nurses' Health Study Cohorts. Arthritis Care Res (Hoboken) 2017; 69:384-392. [PMID: 27273851 DOI: 10.1002/acr.22945] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/08/2016] [Accepted: 05/24/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Moderate alcohol consumption has antiinflammatory properties and is associated with reduced cardiovascular disease and rheumatoid arthritis risks. We investigated the association between alcohol consumption and systemic lupus erythematosus (SLE) risk among women followed in the Nurses' Health Study (NHS) cohorts. METHODS We conducted a prospective cohort analysis among 204,055 women in NHS (1980-2012) and NHSII (1989-2011) who were free of connective tissue disease and provided alcohol information at baseline. Alcohol consumption was assessed using a semiquantitative food frequency questionnaire every 2-4 years. We validated incident SLE through medical record review after self-report. Cox proportional hazards models estimated hazard ratios (HRs) for SLE based on cumulative average alcohol intake, adjusting for potential confounders. Results were meta-analyzed using DerSimonian and Laird random-effects models. We further investigated SLE risk associated with wine, beer, and liquor intake. RESULTS We identified 125 incident SLE cases in NHS and 119 in NHSII. Mean ± SD age at SLE diagnosis was 55.8 ± 9.5 years in NHS and 43.4 ± 7.7 years in NHSII. Compared to no alcohol intake, the meta-analyzed multivariable HR for cumulative alcohol consumption ≥5 gm/day was 0.61 (95% confidence interval [95% CI] 0.41-0.89). When limiting alcohol exposure to >4 years prior to SLE diagnosis, the multivariable HR was similar: 0.61 (95% CI 0.41-0.91). Women who drank ≥2 servings/week of wine had significantly decreased SLE risk (HR 0.65, 95% CI 0.45-0.96) compared to women who did not drink wine. CONCLUSION In these large prospective cohorts, we demonstrated an inverse association between moderate alcohol consumption (≥5 grams or 0.5 drink/day) and SLE risk in women.
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Affiliation(s)
- Medha Barbhaiya
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bing Lu
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jeffrey A Sparks
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Susan Malspeis
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Shun-Chiao Chang
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elizabeth W Karlson
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Karen H Costenbader
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Hanly JG, Su L, Urowitz MB, Romero-Diaz J, Gordon C, Bae SC, Bernatsky S, Clarke AE, Wallace DJ, Merrill JT, Isenberg DA, Rahman A, Ginzler EM, Petri M, Bruce IN, Dooley MA, Fortin P, Gladman DD, Sanchez-Guerrero J, Steinsson K, Ramsey-Goldman R, Khamashta MA, Aranow C, Alarcón GS, Fessler BJ, Manzi S, Nived O, Sturfelt GK, Zoma AA, van Vollenhoven RF, Ramos-Casals M, Ruiz-Irastorza G, Lim SS, Kalunian KC, Inanc M, Kamen DL, Peschken CA, Jacobsen S, Askanase A, Theriault C, Farewell V. A Longitudinal Analysis of Outcomes of Lupus Nephritis in an International Inception Cohort Using a Multistate Model Approach. Arthritis Rheumatol 2017; 68:1932-44. [PMID: 26991067 DOI: 10.1002/art.39674] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 03/01/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study bidirectional change and predictors of change in estimated glomerular filtration rate (GFR) and proteinuria in lupus nephritis (LN) using a multistate modeling approach. METHODS Patients in the Systemic Lupus International Collaborating Clinics inception cohort were classified annually into estimated GFR state 1 (>60 ml/minute), state 2 (30-60 ml/minute), or state 3 (<30 ml/minute) and estimated proteinuria state 1 (<0.25 gm/day), state 2 (0.25-3.0 gm/day), or state 3 (>3.0 gm/day), or end-stage renal disease (ESRD) or death. Using multistate modeling, relative transition rates between states indicated improvement and deterioration. RESULTS Of 1,826 lupus patients, 700 (38.3%) developed LN. During a mean ± SD follow-up of 5.2 ± 3.5 years, the likelihood of improvement in estimated GFR and estimated proteinuria was greater than the likelihood of deterioration. After 5 years, 62% of patients initially in estimated GFR state 3 and 11% of patients initially in estimated proteinuria state 3 transitioned to ESRD. The probability of remaining in the initial states 1, 2, and 3 was 85%, 11%, and 3%, respectively, for estimated GFR and 62%, 29%, and 4%, respectively, for estimated proteinuria. Male sex predicted improvement in estimated GFR states; older age, race/ethnicity, higher estimated proteinuria state, and higher renal biopsy chronicity scores predicted deterioration. For estimated proteinuria, race/ethnicity, earlier calendar years, damage scores without renal variables, and higher renal biopsy chronicity scores predicted deterioration; male sex, presence of lupus anticoagulant, class V nephritis, and mycophenolic acid use predicted less improvement. CONCLUSION In LN, the expected improvement or deterioration in renal outcomes can be estimated by multistate modeling and is preceded by identifiable risk factors. New therapeutic interventions for LN should meet or exceed these expectations.
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Affiliation(s)
- John G Hanly
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Li Su
- Institute of Public Health and University of Cambridge, University Forvie Site, Cambridge, UK
| | - Murray B Urowitz
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | | | - Caroline Gordon
- University of Birmingham, College of Medical and Dental Sciences, Birmingham, UK
| | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | | | | | - Daniel J Wallace
- Cedars-Sinai Medical Center and University of California, Los Angeles, David Geffen School of Medicine
| | | | | | | | - Ellen M Ginzler
- State University of New York Downstate Medical Center, Brooklyn
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ian N Bruce
- Arthritis Research UK Epidemiology Unit, Manchester Academic Health Sciences Centre, University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, and Manchester Academic Health Science Centre, Manchester, UK
| | - M A Dooley
- University of North Carolina, Chapel Hill
| | - Paul Fortin
- Centre Hospitalier Universitaire de Québec and Université Laval, Quebec City, Canada
| | - Dafna D Gladman
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Munther A Khamashta
- The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK
| | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, New York
| | | | | | - Susan Manzi
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ola Nived
- University Hospital Lund, Lund, Sweden
| | | | - Asad A Zoma
- Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, UK
| | | | - Manuel Ramos-Casals
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Barcelona, Spain
| | - Guillermo Ruiz-Irastorza
- BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
| | - S Sam Lim
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | | | - Soren Jacobsen
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anca Askanase
- Hospital for Joint Diseases, New York University, Seligman Centre for Advanced Therapeutics, New York, New York
| | - Chris Theriault
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Vernon Farewell
- Institute of Public Health and University of Cambridge, University Forvie Site, Cambridge, UK
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174
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Lewis MJ, Jawad AS. The effect of ethnicity and genetic ancestry on the epidemiology, clinical features and outcome of systemic lupus erythematosus. Rheumatology (Oxford) 2017; 56:i67-i77. [PMID: 27940583 DOI: 10.1093/rheumatology/kew399] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Indexed: 01/03/2023] Open
Abstract
In this in-depth review, we examine the worldwide epidemiology of SLE and summarize current knowledge on the influence of race/ethnicity on clinical manifestations, disease activity, damage accumulation and outcome in SLE. Susceptibility to SLE has a strong genetic component, and trans-ancestral genetic studies have revealed a substantial commonality of shared genetic risk variants across different genetic ancestries that predispose to the development of SLE. The highest increased risk of developing SLE is observed in black individuals (incidence 5- to 9-fold increased, prevalence 2- to 3-fold increased), with an increased risk also observed in South Asians, East Asians and other non-white groups, compared with white individuals. Black, East Asian, South Asian and Hispanic individuals with SLE tend to develop more severe disease with a greater number of manifestations and accumulate damage from lupus more rapidly. Increased genetic risk burden in these populations, associated with increased autoantibody reactivity in non-white individuals with SLE, may explain the more severe lupus phenotype. Even after taking into account socio-economic factors, race/ethnicity remains a key determinant of poor outcome, such as end-stage renal failure and mortality, in SLE. Community measures to expedite diagnosis through increased awareness in at-risk racial/ethnic populations and ethnically personalized treatment algorithms may help in future to improve long-term outcomes in SLE.
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Affiliation(s)
- Myles J Lewis
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ali S Jawad
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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175
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Sanz I. New Perspectives in Rheumatology: May You Live in Interesting Times: Challenges and Opportunities in Lupus Research. Arthritis Rheumatol 2017; 69:1552-1559. [PMID: 28371318 DOI: 10.1002/art.40109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/21/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Iñaki Sanz
- Emory University School of Medicine, Atlanta, Georgia
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176
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Buyon JP, Kim MY, Guerra MM, Lu S, Reeves E, Petri M, Laskin CA, Lockshin MD, Sammaritano LR, Branch DW, Porter TF, Sawitzke A, Merrill JT, Stephenson MD, Cohn E, Salmon JE. Kidney Outcomes and Risk Factors for Nephritis (Flare/ De Novo) in a Multiethnic Cohort of Pregnant Patients with Lupus. Clin J Am Soc Nephrol 2017; 12:940-946. [PMID: 28400421 PMCID: PMC5460714 DOI: 10.2215/cjn.11431116] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 03/16/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Kidney disease is a critical concern in counseling patients with lupus considering pregnancy. This study sought to assess the risk of renal flares during pregnancy in women with previous lupus nephritis in partial or complete remission, particularly in those with antidouble-stranded DNA antibodies and low complement levels, and the risk of new-onset nephritis in patients with stable/mildly active SLE. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We assessed active nephritis (renal flares and de novo kidney disease) and associated predictors during pregnancy in patients with lupus with urine protein ≤1000 mg and serum creatinine <1.2 mg/dl at baseline; 373 patients (52% ethnic/racial minorities) enrolled between 2003 and 2012 were prospectively followed in the Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Syndrome and Systemic Lupus Erythematosus Study. Active nephritis was defined by proteinuria increase of >500 mg and/or red blood cell casts. RESULTS Of 118 patients with previous kidney disease, 13 renal flares (11%) occurred (seven of 89 in complete remission and six of 29 in partial remission) compared with four with de novo kidney involvement (2%) in 255 patients without past kidney disease (P<0.001). Active nephritis was not associated with ethnicity, race, age, creatinine, BP, or antihypertensive and other medications. In multivariable logistic regression analyses, patients with past kidney disease in complete or partial remission more often experienced active nephritis (adjusted odds ratio, 6.88; 95% confidence interval, 1.84 to 25.71; P=0.004 and adjusted odds ratio, 20.98; 95% confidence interval, 4.69 to 93.98; P<0.001, respectively) than those without past kidney disease. Low C4 was associated with renal flares/de novo disease (adjusted odds ratio, 5.59; 95% confidence interval, 1.64 to 19.13; P<0.01) but not low C3 or positive anti-dsDNA alone. CONCLUSIONS De novo kidney involvement in SLE, even in ethnic/racial minorities, is uncommon during pregnancy. Past kidney disease and low C4 at baseline independently associate with higher risk of developing active nephritis. Antibodies to dsDNA alone should not raise concern, even in patients with past kidney disease, if in remission.
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Affiliation(s)
- Jill P Buyon
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Parks CG, de Souza Espindola Santos A, Barbhaiya M, Costenbader KH. Understanding the role of environmental factors in the development of systemic lupus erythematosus. Best Pract Res Clin Rheumatol 2017; 31:306-320. [PMID: 29224673 PMCID: PMC5729939 DOI: 10.1016/j.berh.2017.09.005] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/16/2017] [Accepted: 09/03/2017] [Indexed: 12/20/2022]
Abstract
Systemic lupus erythematosus (SLE) is a multisystem disease with a complex etiology. Its risk is higher among women, racial and ethnic minorities, and individuals with a family history of SLE or related autoimmune diseases. It is believed that genetic factors interact with environmental exposures throughout the lifespan to influence susceptibility to developing SLE. The strongest epidemiologic evidence exists for increased risk of SLE associated with exposure to crystalline silica, current cigarette smoking, use of oral contraceptives, and postmenopausal hormone replacement therapy, while there is an inverse association with alcohol use. Emerging research results suggest possible associations of SLE risk with exposure to solvents, residential and agricultural pesticides, heavy metals, and air pollution. Ultraviolet light, certain infections, and vaccinations have also been hypothesized to be related to SLE risk. Mechanisms linking environmental exposures and SLE include epigenetic modifications resulting from exposures, increased oxidative stress, systemic inflammation and inflammatory cytokine upregulation, and hormonal effects. Research needs to include new studies of environmental risk factors for SLE in general, with a focus on lifetime exposure assessment. In addition, studies in susceptible subgroups, such as family members, studies based on genetic risk profiles, and studies in individuals with evidence of pre-clinical autoimmunity based on the detection of specific auto-antibodies are also required. Understanding the role of environmental exposures in the development of SLE may help identify modifiable risk factors and potential etiological mechanisms.
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Affiliation(s)
- Christine G Parks
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Durham, NC, USA
| | - Aline de Souza Espindola Santos
- Occupational and Environmental Health Branch, Public Health Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Medha Barbhaiya
- Department of Medicine, Division of Rheumatology, Hospital for Special Surgery, Weill-Cornell Medical School, New York, NY, USA
| | - Karen H Costenbader
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Yap KS, Urowitz MB, Mahood Q, Medina-Rosas J, Sabapathy A, Lawson D, Su J, Gladman DD, Touma Z. The utility of lupus serology in predicting outcomes of renal transplantation in lupus patients: Systematic literature review and analysis of the Toronto lupus cohort. Semin Arthritis Rheum 2017; 46:791-797. [PMID: 27769590 DOI: 10.1016/j.semarthrit.2016.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 09/13/2016] [Accepted: 09/14/2016] [Indexed: 11/25/2022]
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179
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Zaman GS. Introduction and Physiology of Lupus. Lupus 2017. [DOI: 10.5772/intechopen.68635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
INTRODUCTION Systemic lupus erythematosus (SLE) is a disease distributed worldwide, which occurs in both genders, and across racial/ethnic and age groups; however, higher rates are observed in adults, in women and in non-Caucasians. Genetic, environmental, sociodemographic and methodological issues are responsible not only for these differences but for the variable course and outcome of the disease. Non-Caucasians have a more severe disease with a higher risk for early mortality and damage accrual. Males also have a more severe disease; however, a negative impact of male gender on lupus outcomes has not been firmly established. Childhood-onset is associated with a more severe disease; moreover, it is also associated with higher damage and diminished survival; finally, late-onset lupus is mild but it is associated with higher damage accrual and a diminished survival. Areas covered: In this review, we discuss the incidence and prevalence of SLE, the impact of age, gender and race/ethnicity in SLE and in the survival of those affected. Expert commentary: Age, gender and race/ethnicity impact disease expression in SLE patients; despite improvements in survival, mortality in SLE remains almost three times higher than in the general population.
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Affiliation(s)
- Guillermo J Pons-Estel
- a Department of Autoimmune Diseases , Institut Clinic de Medicina I Dermatologia, Hospital Clinic , Barcelona , Catalonia , Spain.,b Division of Rheumatology and Autoimmune Diseases , Sanatorio Parque, Grupo Oroño , Rosario , Argentina
| | - Manuel F Ugarte-Gil
- c Servicio de Reumatología , Hospital Nacional Guillermo Almenara Irigoyen, EsSalud , Lima , Perú.,d School of Medicine , Universidad Científica del Sur , Lima , Perú
| | - Graciela S Alarcón
- e Division of Clinical Immunology and Rheumatology, School of Medicine , The University of Alabama at Birmingham , Birmingham , AL , USA.,f Department of Medicine, School of Medicine , Universidad Peruana Cayetano Heredia , Lima , Perú
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181
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Margery-Muir AA, Bundell C, Nelson D, Groth DM, Wetherall JD. Gender balance in patients with systemic lupus erythematosus. Autoimmun Rev 2017; 16:258-268. [DOI: 10.1016/j.autrev.2017.01.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 11/16/2016] [Indexed: 12/19/2022]
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182
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Mathias SD, Berry P, De Vries J, Askanase A, Pascoe K, Colwell HH, Chang DJ. Development of the Systemic Lupus Erythematosus Steroid Questionnaire (SSQ): a novel patient-reported outcome tool to assess the impact of oral steroid treatment. Health Qual Life Outcomes 2017; 15:43. [PMID: 28245854 PMCID: PMC5331641 DOI: 10.1186/s12955-017-0609-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 02/02/2017] [Indexed: 12/27/2022] Open
Abstract
Background Oral glucocorticoids (steroids) are the mainstay of treatment for systemic lupus erythematosus (SLE), but their use is often associated with short- and long-term side effects. Following a literature review and discussions with patients with SLE, clinicians, and payers, a need was identified for a comprehensive SLE-specific tool that can be used to evaluate the side effects and benefits of steroids over time from a patient perspective. The objective of this study was to develop a patient-reported outcome (PRO) measure to assess general impact (baseline burden), benefits, side effects, and impacts associated with the use of oral steroids in patients with SLE. Methods A qualitative research protocol was developed in which adults with SLE currently receiving or who had received steroids in the past year were recruited from six US rheumatology practices to participate in concept elicitation (CE) interviews. The SLE Steroid Questionnaire (SSQ) was developed based on CE interview results and clinical input. Cognitive debriefing interviews with a second group of patients with SLE evaluated the content, clarity, and relevance of the items. The SSQ was refined using patient feedback, clinician review, and a translatability assessment. The protocol received central independent review board approval. Results Thirty-three patients (52% moderate disease severity; 58% currently receiving steroids, mean dose 8.7 mg/day) completed CE interviews. Patients reported benefits, side effects, and impacts from steroids. The refined SSQ contains 50 items assessing steroid dose/duration (4 items), general impact (baseline burden; 19 items), benefits (7 items), work/productivity (3 items), side effects (10 items), emotions (6 items), and overall satisfaction (1 item). Conclusion The SSQ is a unique PRO, developed using robust scientific methodology in accordance with the Food and Drug Administration PRO Guidance. It was designed to comprehensively assess the patient experience with steroid therapy and better understand the benefits and burden of steroids for patients with SLE.
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Affiliation(s)
- Susan D Mathias
- Health Outcomes Solutions, PO Box 2343, Winter Park, FL, 32790, USA.
| | | | | | - Anca Askanase
- Columbia University Medical Center, New York, NY, USA
| | | | - Hilary H Colwell
- Health Outcomes Solutions, PO Box 2343, Winter Park, FL, 32790, USA
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183
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Flower C, Hambleton I, Corbin D, Marquez S, Edghill R. The spectrum of neuropsychiatric lupus in a Black Caribbean population: a report of the Barbados National Lupus Registry. Lupus 2017; 26:1034-1041. [PMID: 28420049 DOI: 10.1177/0961203317692431] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective The objective of this study was to examine neuropsychiatric lupus in a Black Caribbean population. Methods We reviewed Barbados National Lupus Registry patients with ≥4 American College of Rheumatology criteria and a diagnosis of neuropsychiatric lupus using the American College of Rheumatology 19 case definitions. Results From 366 patients with four or more American College of Rheumatology criteria for systemic lupus erythematosus, 55 (15%) had evidence of neuropsychiatric lupus. There were 51 females and four males (F:M = 13:1) with a median age of 31 years. A total of 76.4% had a single neuropsychiatric lupus complication and 23.6% had two or three complications occurring sequentially or concurrently. The top three complications were psychosis - 49.1% (95% CI 35.8, 62.5); ischaemic stroke - 32.7% (21.4, 46.5); and generalized tonic-clonic seizures - 12.7% (6.0, 24.8). Twelve of the American College of Rheumatology 19 neuropsychiatric syndromes were represented: 91.2% central; 8.8% peripheral. There were 521 observation years, and for 32 patients (58%) neuropsychiatric lupus was a presenting feature. For the remaining 23 (42%) the first neuropsychiatric lupus event came after systemic lupus erythematosus diagnosis - median time of two years. Of the 22 deaths, systemic lupus erythematosus nephritis caused almost half (45.5%) at a median age of 32. The prevalence of nephritis was lower in the neuropsychiatric lupus subgroup (25.5%) compared with the Barbados National Lupus Registry data (47%) ( P = 0.01). Ischaemic stroke caused 22.7% of deaths at a median age of 46 and was the main cause of chronic neurologic deficits amongst survivors. Conclusion Neuropsychiatric lupus was an early cause of morbidity in systemic lupus erythematosus with predominantly singular central nervous system complications, the most common of which was psychosis. Most deaths occurred at a young age, principally from systemic lupus erythematosus nephritis. Ischaemic stroke was the main neurologic cause of death and disability.
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Affiliation(s)
- C Flower
- 1 Queen Elizabeth Hospital, St. Michael, Barbados.,4 University of the West Indies Cave Hill, St. Michael, Barbados
| | - I Hambleton
- 2 Chronic Disease Research Centre, St. Michael, Barbados.,4 University of the West Indies Cave Hill, St. Michael, Barbados
| | - D Corbin
- 1 Queen Elizabeth Hospital, St. Michael, Barbados.,4 University of the West Indies Cave Hill, St. Michael, Barbados
| | - S Marquez
- 3 Neurodiagnostic Clinic, St. Michael, Barbados.,4 University of the West Indies Cave Hill, St. Michael, Barbados
| | - R Edghill
- 1 Queen Elizabeth Hospital, St. Michael, Barbados.,4 University of the West Indies Cave Hill, St. Michael, Barbados
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184
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Nightingale AL, Davidson JE, Molta CT, Kan HJ, McHugh NJ. Presentation of SLE in UK primary care using the Clinical Practice Research Datalink. Lupus Sci Med 2017; 4:e000172. [PMID: 28243454 PMCID: PMC5307373 DOI: 10.1136/lupus-2016-000172] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 12/19/2016] [Accepted: 12/30/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To describe the presenting symptoms of SLE in primary care using the Clinical Practice Research Database (CPRD) and to calculate the time from symptom presentation to SLE diagnosis. METHODS Incident cases of SLE were identified from the CPRD between 2000 and 2012. Presenting symptoms were identified from the medical records of cases in the 5 years before diagnosis and grouped using the British Isles Lupus Activity Group (BILAG) symptom domains. The time from the accumulation of one, two and three BILAG domains to SLE diagnosis was investigated, stratified by age at diagnosis (<30, 30-49 and ≥50 years). RESULTS We identified 1426 incident cases (170 males and 1256 females) of SLE. The most frequently recorded symptoms and signs prior to diagnosis were musculoskeletal, mucocutaneous and neurological. The median time from first musculoskeletal symptom to SLE diagnosis was 26.4 months (IQR 9.3-43.6). There was a significant difference in the time to diagnosis (log rank p<0.01) when stratified by age and disease severity at baseline, with younger patients <30 years and those with severe disease having the shortest times and patients aged ≥50 years and those with mild disease having the longest (6.4 years (IQR 5.8-6.8)). CONCLUSIONS The time from symptom onset to SLE diagnosis is long, especially in older patients. SLE should be considered in patients presenting with flaring or chronic musculoskeletal, mucocutaneous and neurological symptoms.
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Affiliation(s)
| | - Julie E Davidson
- Worldwide Epidemiology, GlaxoSmithKline R&D, Stockley Park , London , UK
| | - Charles T Molta
- U.S. Health Outcomes, GlaxoSmithKline, Research Triangle Park , North Carolina , USA
| | - Hong J Kan
- U.S. Medical Affairs, GlaxoSmithKline , Philadelphia, Pennsylvania , USA
| | - Neil J McHugh
- Department of Pharmacy & Pharmacology, University of Bath, Bath, UK; Royal National Hospital for Rheumatic Diseases, Bath, UK
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185
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Abstract
Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease that is highly heterogeneous in its presentation. This can pose significant challenges for physicians responsible for the diagnosis and treatment of such patients. SLE arises from a combination of genetic, epigenetic and environmental factors. Pathologically, the disease is primarily driven by loss of immune tolerance and abnormal B- and T-cell function. Major organ involvement may lead to significant morbidity and mortality. Classification criteria for SLE have been developed largely for research purposes; however, these are also widely used in clinical practice. Antinuclear antibodies are the hallmark serological feature, occurring in over 95% of patients with SLE at some point during their disease. The mainstay of treatment is antimalarial drugs such as hydroxychloroquine, combined with corticosteroids and conventional immunosuppressive drugs. An increasing understanding of pathogenesis has facilitated a move towards the development of targeted biologic therapies, with the introduction of rituximab and belimumab into clinical practice.
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Affiliation(s)
- Maliha F Shaikh
- Department of Rheumatology, Addenbrooke's Hospital, Cambridge, UK
| | - Natasha Jordan
- Department of Rheumatology, Addenbrooke's Hospital, Cambridge, UK
| | - David P D'Cruz
- Louis Coote Lupus Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
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Zhang J, Zhan W, Yang B, Tian A, Chen L, Liao Y, Wu Y, Cai B, Wang L. Genetic Polymorphisms of rs3077 and rs9277535 in HLA-DP associated with Systemic lupus erythematosus in a Chinese population. Sci Rep 2017; 7:39757. [PMID: 28094303 PMCID: PMC5240340 DOI: 10.1038/srep39757] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 11/28/2016] [Indexed: 02/05/2023] Open
Abstract
Although the SLE risk gene loci of HLA-DR and HLA-DQ within the major histocompatibility complex (MHC) region has been gradually revealed by recent Genome-Wide Association studies (GWAS), the association of HLA-DP polymorphisms with SLE was minimally reported. Considering that the variants in rs3077 and rs9277535 in the HLA-DP region could influence the immune response by affecting antigen presentation of HLA class II molecules to CD4+ T cells, the present study aimed to explore the role of HLA-DP polymorphisms in SLE. In total, samples from 335 SLE patients and 635 healthy controls were collected and genotyped by a polymerase chain reaction-high resolution melting (PCR-HRM) assay. A significant positive correlation was observed between the SNP rs3077, rs9277535 of HLA-DP and SLE susceptibility (rs3077, OR = 0.74, 95%CI = 0.60-0.91, P = 0.004; rs9277535, OR = 0.72, 95%CI = 0.59-0.88, P = 0.001). Rs3077 polymorphism was corelated to IL-17, INF-γ and cutaneous vasculitis (P = 0.037, P = 0.020 and P = 0.006, respectively). Additionally, rs3077 AA genotype carriers showed lower concentration of inflammatory cytokines and lower cutaneous vasculitis incidence than did the other two genotype. No significant association was observed between rs9277535 and cytokines or any clinical features. In conclusion, HLA-DP polymorphisms (rs3077 and rs9277535) were associated with SLE susceptibility and the levels of some inflammatory cytokines in SLE patients.
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Affiliation(s)
- Junlong Zhang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Wenli Zhan
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Bin Yang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Anning Tian
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Lin Chen
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yun Liao
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yongkang Wu
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Bei Cai
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Lanlan Wang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Lim SS, Kivitz AJ, McKinnell D, Pierson ME, O’Brien FS. Simulating clinical trial visits yields patient insights into study design and recruitment. Patient Prefer Adherence 2017; 11:1295-1307. [PMID: 28814837 PMCID: PMC5545635 DOI: 10.2147/ppa.s137416] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We elicited patient experiences from clinical trial simulations to aid in future trial development and to improve patient recruitment and retention. PATIENTS AND METHODS Two simulations of draft Phase II and Phase III anifrolumab studies for systemic lupus erythematosus (SLE)/lupus nephritis (LN) were performed involving African-American patients from Grady Hospital, an indigent care hospital in Atlanta, GA, USA, and white patients from Altoona Arthritis and Osteoporosis Center in Altoona, PA, USA. The clinical trial simulation included an informed consent procedure, a mock screening visit, a mock dosing visit, and a debriefing period for patients and staff. Patients and staff were interviewed to obtain sentiments and perceptions related to the simulated visits. RESULTS The Atlanta study involved 6 African-American patients (5 female) aged 27-60 years with moderate to severe SLE/LN. The Altoona study involved 12 white females aged 32-75 years with mild to moderate SLE/LN. Patient experiences had an impact on four patient-centric care domains: 1) information, communication, and education; 2) responsiveness to needs; 3) access to care; and 4) coordination of care; and continuity and transition. Patients in both studies desired background material, knowledgeable staff, family and friend support, personal results, comfortable settings, shorter wait times, and greater scheduling flexibility. Compared with the Altoona study patients, Atlanta study patients reported greater preferences for information from the Internet, need for strong community and online support, difficulties in discussing SLE, emphasis on transportation and child care help during the visits, and concerns related to financial matters; and they placed greater importance on time commitment, understanding of potential personal benefit, trust, and confidentiality of patient data as factors for participation. Using these results, we present recommendations to improve study procedures to increase retention, recruitment, and compliance for clinical trials. CONCLUSION Insights from these two studies can be applied to the development and implementation of future clinical trials to improve patient recruitment, retention, compliance, and advocacy.
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Affiliation(s)
- S Sam Lim
- Division of Rheumatology, Department of Medicine, Emory University, Atlanta, GA, USA
- Correspondence: S Sam Lim, Division of Rheumatology, Department of Medicine, Emory University, Grady Health System, 49 Jesse Hill Jr Drive, SE Atlanta, GA 30303, USA, Email
| | - Alan J Kivitz
- Altoona Center for Clinical Research, Altoona, PA, USA
| | | | - M Edward Pierson
- Clinical Operations, Global Medicines Development, AstraZeneca, Gaithersburg, MD, USA
| | - Faye S O’Brien
- Clinical Operations, Global Medicines Development, AstraZeneca, Gaithersburg, MD, USA
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Somers EC, Monrad SU, Warren JS, Solano M, Schnaas L, Hernandez-Avila M, Tellez-Rojo MM, Hu H. Antinuclear antibody prevalence in a general pediatric cohort from Mexico City: discordance between immunofluorescence and multiplex assays. Clin Epidemiol 2016; 9:1-8. [PMID: 28053555 PMCID: PMC5192054 DOI: 10.2147/clep.s121632] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To characterize antinuclear antibody (ANA) prevalence according to distinct assay methodologies in a pediatric cohort from Mexico City, and to further examine associations with age and sex. METHODS Serum ANA were measured by indirect immunofluorescence assay (IFA) and multiplex immunoassay in 114 children aged 9-17 years. IFA was considered positive at a cutoff titer of ≥1:80. Agreement between assay methods was assessed by kappa statistic. Sensitivity, specificity, and 95% confidence intervals (CIs) of the multiplex were computed with IFA as the reference standard. RESULTS Of the 114 children (mean age 14.7 [standard deviation 2.1] years; 54 [47%] female), 18 of 114 (15.8%) were ANA positive by IFA, and 11 of 114 (9.6%) by 11-antigen multiplex assay. ANA prevalence was higher in females compared with males by both of the methods (ratios 1.6-1.9 to 1). Agreement between tests was classified as slight by kappa (κ=0.177 [95% CI -0.051, 0.406]). The multiplex immunoassay had sensitivity of 22.2% (95% CI 6.4, 47.6) and specificity of 92.7% (95% CI 85.6, 97.0), and failed to capture 3 of 4 (75%) of the high-titer (≥1:1280) IFA-positives. CONCLUSION Up to 15% of children in this general population cohort were ANA positive, with a higher rate of positivity among females according to both assay methods. Substantial discordance in ANA results was found between IFA and multiplex methods, even for high-titer IFA positives. These findings underscore the need to sufficiently account for assay characteristics when interpreting ANA test results, and support IFA as the more appropriate assay for studies of subclinical autoimmunity.
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Affiliation(s)
- Emily C Somers
- Divison of Rheumatology, Department of Internal Medicine; Department of Environmental Health Sciences; Department of Obstetrics & Gynecology
| | | | - Jeffrey S Warren
- Division of Clinical Pathology, Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Maritsa Solano
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos
| | - Lourdes Schnaas
- Department of Developmental Neurobiology, National Institute of Perinatology, Mexico City, Mexico
| | - Mauricio Hernandez-Avila
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos
| | - Martha Maria Tellez-Rojo
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos
| | - Howard Hu
- Occupational and Environmental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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189
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Arriens C, Chen S, Karp DR, Saxena R, Sambandam K, Chakravarty E, James JA, Merrill JT. Prognostic significance of repeat biopsy in lupus nephritis: Histopathologic worsening and a short time between biopsies is associated with significantly increased risk for end stage renal disease and death. Clin Immunol 2016; 185:3-9. [PMID: 27923701 DOI: 10.1016/j.clim.2016.11.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/28/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND/PURPOSE Approximately half of patients with systemic lupus erythematosus (SLE) develop lupus nephritis (LN), a major cause of morbidity and early mortality in that disease. Prolonged renal inflammation is associated with irreversible kidney damage which confers a 30% risk of end stage renal disease (ESRD), making early, aggressive treatment mandatory. Failure to achieve therapeutic response or recurrence of renal flare often prompts repeat biopsy. However, the role of repeat biopsy in determining long-term renal prognosis remains controversial. For this reason repeat biopsies are usually not utilized unless clinical evidence of refractory or recurrent disease is already present, despite known mismatches between clinical and biopsy findings. The current study quantifies the degree to which histopathologic worsening between first and second biopsies and duration between them predicts ESRD and death. METHODS Medical records of 141 LN patients with more than one biopsy were obtained from a single large urban medical center. Cases were attained using billing codes for diagnosis and procedures from 1/1999-1/2015. Biopsy worsening was defined as unfavorable histopathologic classification transitions and/or increased chronicity; if neither were present, the patient was defined as non-worsening. We used Cox proportional hazard models to study the relationship between ESRD and survival adjusting for covariates which included age at first biopsy, gender, race, initial biopsy class, and initial induction therapy. RESULTS Of 630 patients screened, 141 had more than one biopsy. Advancing chronicity was detected in 48 (34.0%) and a renal class switch to worse grade of pathology was found in 54 (38.3%). At least one of these adverse second biopsy features was reported in 79 (56.0%) patients. Five years following initial biopsy, 28 (35.4%) of those with worsening histopathology on second biopsy developed ESRD, compared to 6 (9.7%) of non-worsening patients and 10 (12.7%) of patients with worsening histopathology had died compared to 2 (3.2%) of non-worsening patients. Biopsy worsening was associated with a significantly greater 15-year risk of ESRD (Hazard Ratio 4.2, p=0.0001) and death (Hazard Ratio 4.3, p=0.022), adjusting for age, gender, race, biopsy class, and treatment. Time between first and second biopsies was <1year in 32 patients, 1-5years in 81, and >5years in 28. Over a 15-year period, those with <1year between first and second biopsies (presumably enriched for patients with early clinical signs of progression) had a significantly greater risk of ESRD (Hazard Ratio 13.7, p<0.0001) and death (Hazard Ratio 16.9, p=0.0022) after adjusting for age, gender, race, biopsy class, and treatment. CONCLUSION A repeat renal biopsy demonstrating worsening pathology increases the risk of ESRD and death more than four-fold compared to non-worsening patients. Given known potential mismatch between biopsy and clinical data, repeat biopsies may add important information and justify changes in treatment not considered on clinical grounds. Earlier detection of poor prognostic signs in those without early clinical deterioration might improve outcomes in enough patients to reconsider cost effectiveness of routine repeat biopsy.
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Affiliation(s)
- Cristina Arriens
- Oklahoma Medical Research Foundation, 825 NE 13th Street, Oklahoma City, OK 73104, United States.
| | - Sixia Chen
- University of Oklahoma Health Sciences Center, 801 NE 13th Street, Oklahoma City, OK 73104, United States.
| | - David R Karp
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States.
| | - Ramesh Saxena
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States.
| | - Kamalanathan Sambandam
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States.
| | - Eliza Chakravarty
- Oklahoma Medical Research Foundation, 825 NE 13th Street, Oklahoma City, OK 73104, United States.
| | - Judith A James
- Oklahoma Medical Research Foundation, 825 NE 13th Street, Oklahoma City, OK 73104, United States.
| | - Joan T Merrill
- Oklahoma Medical Research Foundation, 825 NE 13th Street, Oklahoma City, OK 73104, United States.
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Mossell J, Goldman JA, Barken D, Alexander RV. The Avise Lupus Test and Cell-bound Complement Activation Products Aid the Diagnosis of Systemic Lupus Erythematosus. Open Rheumatol J 2016; 10:71-80. [PMID: 27867431 PMCID: PMC5101629 DOI: 10.2174/1874312901610010071] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 10/08/2016] [Accepted: 10/08/2016] [Indexed: 12/22/2022] Open
Abstract
Background: Systemic lupus erythematosus (SLE) is a multifaceted disease, and its diagnosis may be challenging. A blood test for the diagnosis of SLE, the Avise Lupus test, has been recently commercialized and validated in clinical studies. Objectives: To evaluate the use of the Avise Lupus test by community rheumatologists. Methods: The study is a longitudinal, case-control, retrospective review of medical charts. Cases had a positive test result, and controls had a negative result; all patients were anti-nuclear antibodies (ANA) positive but negative for SLE-specific autoantibodies. Features of SLE, diagnosis, and medications at two time points were recorded. Results: Twenty of the 23 cases (87%) and 4 of the 23 controls (17%) were diagnosed with SLE (sensitivity=83%; specificity=86%). More cases than controls (43% vs. 17%) fulfilled 4 American College of Rheumatology (ACR) classification criteria of SLE. Sensitivity of the test was significantly higher than the ACR score (83% vs. 42%, p=0.006). A higher percentage of patients who met the classification criteria had elevated cell-bound complement activation products (CB-CAPs) compared to patients who did not. Anti-rheumatic medications were used in a higher percentage of cases than controls (83% vs. 35% at baseline, p=0.002), suggesting that cases were treated more aggressively early on. Conclusion: A positive Avise Lupus test result aids in formulating a SLE diagnosis when diagnosis based on standard-of-care tests and clinical features may be challenging, and impacts patient management. Prospective studies will be performed to better evaluate the clinical utility of the test and of CB-CAPs as biomarkers of SLE.
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191
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Knight JH, Howards PP, Spencer JB, Tsagaris KC, Lim SS. Characteristics related to early secondary amenorrhoea and pregnancy among women diagnosed with systemic lupus erythematosus: an analysis using the GOAL study. Lupus Sci Med 2016; 3:e000139. [PMID: 27752335 PMCID: PMC5051470 DOI: 10.1136/lupus-2015-000139] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 07/30/2016] [Accepted: 09/03/2016] [Indexed: 01/23/2023]
Abstract
Objective Systemic lupus erythematosus (SLE) disproportionately affects women and often develops during their reproductive years. Research suggests that some women who receive cyclophosphamide as treatment for SLE experience earlier decline in menstrual function, but reproductive health among women with SLE who have not taken this drug is less well understood. This study aims to better understand the relation between SLE and reproduction by assessing early secondary amenorrhoea and pregnancy in women treated with and without cyclophosphamide from a population-based cohort with large numbers of African-Americans. Methods Female patients with SLE, ages 20–40 at time of diagnosis, who were 40 years or older at the time of the survey were included in this analysis (N=147). Participants in the Georgians Organized Against Lupus (GOAL) study were asked about their reproductive histories including early secondary amenorrhoea, defined as loss of menstruation before age 40. Results Women who were cyclophosphamide naïve had an increased prevalence of early secondary amenorrhoea compared with population estimates, 13–17% compared with 1–5%. Factors associated with early secondary amenorrhoea in women not treated with cyclophosphamide were marital status and receipt of a kidney transplant. Treatment with cyclophosphamide doubled the prevalence after adjustment for patient characteristics. Over 88% of women reported being pregnant at least once, and about 83% of these had a child, but the majority of pregnancies occurred before diagnosis. Conclusions SLE diagnosed in early adulthood may affect women's reproductive health even if they are not treated with cyclophosphamide. Better understanding of other factors related to reproductive health in this population will improve clinicians' and patients' abilities to make treatment and family planning decisions.
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Affiliation(s)
- Jessica H Knight
- Department of Epidemiology , Rollins School of Public Health, Emory University , Atlanta, Georgia , USA
| | - Penelope P Howards
- Department of Epidemiology , Rollins School of Public Health, Emory University , Atlanta, Georgia , USA
| | - Jessica B Spencer
- Department of Gynecology and Obstetrics , Emory University School of Medicine , Atlanta, Georgia , USA
| | - Katina C Tsagaris
- Department of Rheumatology , Emory University School of Medicine , Atlanta, Georgia , USA
| | - Sam S Lim
- Department of Rheumatology , Emory University School of Medicine , Atlanta, Georgia , USA
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192
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Carter EE, Barr SG, Clarke AE. The global burden of SLE: prevalence, health disparities and socioeconomic impact. Nat Rev Rheumatol 2016; 12:605-20. [PMID: 27558659 DOI: 10.1038/nrrheum.2016.137] [Citation(s) in RCA: 273] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that can potentially lead to serious organ complications and even death. Its global burden - in terms of incidence and prevalence, differential impact on populations, economic costs and capacity to compromise health-related quality of life - remains incompletely understood. The reported worldwide incidence and prevalence of SLE vary considerably; this variation is probably attributable to a variety of factors, including ethnic and geographic differences in the populations being studied, the definition of SLE applied, and the methods of case identification. Despite the heterogeneous nature of the disease, distinct patterns of disease presentation, severity and course can often be related to differences in ethnicity, income level, education, health insurance status, level of social support and medication compliance, as well as environmental and occupational factors. Given the potential for the disease to cause such severe and widespread organ damage, not only are the attendant direct costs high, but these costs are sometimes exceeded by indirect costs owing to loss of economic productivity. As an intangible cost, patients with SLE are, not surprisingly, likely to endure considerably reduced health-related quality of life.
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Affiliation(s)
- Erin E Carter
- University of Calgary, Richmond Road Diagnostic and Treatment Centre, 1820 Richmond Road S.W., Calgary, Alberta T2T 5C7, Canada
| | - Susan G Barr
- University of Calgary, Richmond Road Diagnostic and Treatment Centre, 1820 Richmond Road S.W., Calgary, Alberta T2T 5C7, Canada
| | - Ann E Clarke
- University of Calgary, Health Research Innovation Centre, 3280 Hospital Drive N.W., Calgary, Alberta T2N 4N1, Canada
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193
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Williams EM, Bruner L, Adkins A, Vrana C, Logan A, Kamen D, Oates JC. I too, am America: a review of research on systemic lupus erythematosus in African-Americans. Lupus Sci Med 2016; 3:e000144. [PMID: 27651918 PMCID: PMC5013381 DOI: 10.1136/lupus-2015-000144] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 07/27/2016] [Accepted: 07/28/2016] [Indexed: 12/21/2022]
Abstract
Systemic lupus erythematosus (SLE) is a multi-organ autoimmune disorder that can cause significant morbidity and mortality. A large body of evidence has shown that African-Americans experience the disease more severely than other racial-ethnic groups. Relevant literature for the years 2000 to August 2015 were obtained from systematic searches of PubMed, Scopus, and the EBSCOHost platform that includes MEDLINE, CINAHL, etc. to evaluate research focused on SLE in African-Americans. Thirty-six of the 1502 articles were classified according to their level of evidence. The systematic review of the literature reported a wide range of adverse outcomes in African-American SLE patients and risk factors observed in other mono and multi-ethnic investigations. Studies limited to African-Americans with SLE identified novel methods for more precise ascertainment of risk and observed novel findings that hadn't been previously reported in African-Americans with SLE. Both environmental and genetic studies included in this review have highlighted unique African-American populations in an attempt to isolate risk attributable to African ancestry and observed increased genetic influence on overall disease in this cohort. The review also revealed emerging research in areas of quality of life, race-tailored interventions, and self-management. This review reemphasizes the importance of additional studies to better elucidate the natural history of SLE in African-Americans and optimize therapeutic strategies for those who are identified as being at high risk.
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Affiliation(s)
- Edith M Williams
- Division of Rheumatology, Department of Public Health Sciences, Medicine,MUSC Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Larisa Bruner
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Alyssa Adkins
- University of South Carolina, Columbia, South Carolina, USA
| | - Caroline Vrana
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ayaba Logan
- The Department of Public Health and Programs in Nurse Anesthesia, Liaison for College of Nursing, Medical University of South Carolina Library, Charleston, South Carolina, USA
| | - Diane Kamen
- Department of Rheumatology and Immunology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - James C Oates
- Department of Medicine, Division of Rheumatology,Medical University of South Carolina, Charleston, South Carolina, USA
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Plantinga L, Lim SS, Bowling CB, Drenkard C. Association of age with health-related quality of life in a cohort of patients with systemic lupus erythematosus: the Georgians Organized Against Lupus study. Lupus Sci Med 2016; 3:e000161. [PMID: 27547440 PMCID: PMC4964216 DOI: 10.1136/lupus-2016-000161] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/24/2016] [Accepted: 06/27/2016] [Indexed: 01/23/2023]
Abstract
Objective To examine whether older age was associated with lower health-related quality of life (HRQOL) among patients with systemic lupus erythematosus (SLE) and whether differential disease-related damage and activity explained these associations. Methods We used cross-sectional data on 684 patients with SLE aged ≥20 years from the Georgians Organized Against Lupus cohort to estimate the associations between age (categorised as 20–39, 40–59 and ≥60 years) and HRQOL (Short Form-12 norm-based domain and physical component summary (PCS) and mental component summary (MCS) scores), using multivariable linear regression. We then examined the effect of disease-related damage and activity on these associations. Results The mean age of the cohort was 48.2±13.1 years (range, 20–88 years), with 28.0%, 52.9% and 19.1% of participants being aged 20–39, 40–59 and ≥60 years, respectively; 79.0% were African-American and 93.7% were female. The mean PCS score was 39.3 (41.8, 38.7 and 37.4 among those aged 20–39, 40–59 and ≥60 years, respectively), while the mean MCS score was 44.3 (44.2, 43.8 and 46.1, respectively). In general, lower physical but not mental HRQOL scores were associated with older age. With adjustment, older ages (40–59 and ≥60, respectively, vs 20–39) remained associated (β (95% CI)) with lower PCS (−2.53 (−4.58 to −0.67) and −3.57 (−6.19 to −0.96)) but not MCS (0.47 (−1.46 to 2.41) and 1.20 (−1.52 to 3.92)) scores. Associations of age with HRQOL domain and summary scores were not substantially changed by further adjustment for disease-related damage and/or activity. Conclusions Nearly one in five participants in this large, predominantly African-American cohort of patients with SLE was at least 60 years old. The associations of older age with lower physical, but not mental, HRQOL were independent of accumulated SLE damage and current SLE activity. The results suggest that studies of important geriatric outcomes in the setting of SLE are needed to inform patient-centred clinical care of the ageing SLE population.
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Affiliation(s)
- Laura Plantinga
- Division of Renal Medicine, Emory University, Atlanta, Georgia, USA; Division of Geriatrics and General Medicine, Emory University, Atlanta, Georgia, USA
| | - S Sam Lim
- Division of Rheumatology, Department of Medicine , Emory University , Atlanta, Georgia , USA
| | - C Barrett Bowling
- Division of Geriatrics and General Medicine, Emory University, Atlanta, Georgia, USA; Birmingham/Atlanta VA Geriatrics Research and Clinical Center, Atlanta, Georgia, USA
| | - Cristina Drenkard
- Division of Rheumatology, Department of Medicine , Emory University , Atlanta, Georgia , USA
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195
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Ungprasert P, Sagar V, Crowson CS, Amin S, Makol A, Ernste FC, Osborn TG, Moder KG, Niewold TB, Maradit-Kremers H, Ramsey-Goldman R, Chowdhary VR. Incidence of systemic lupus erythematosus in a population-based cohort using revised 1997 American College of Rheumatology and the 2012 Systemic Lupus International Collaborating Clinics classification criteria. Lupus 2016; 26:240-247. [PMID: 27365370 DOI: 10.1177/0961203316657434] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In 2012, the Systemic Lupus International Collaborating Clinics (SLICC) group published a new set of classification criteria for systemic lupus erythematosus (SLE). Studies applying these criteria to real-life scenarios have found either equal or greater sensitivity and equal or lower specificity to the 1997 ACR classification criteria (ACR 97). Nonetheless, there are no studies that have used the SLICC 12 criteria to investigate the incidence of lupus. We used the resource of the Rochester Epidemiology Project to identify incident SLE patients in Olmsted County, Minnesota, from 1993 to 2005, who fulfilled the ACR 97 or SLICC 12 criteria. A total of 58 patients met criteria by SLICC 12 and 44 patients met criteria by ACR 97. The adjusted incidence of 4.9 per 100,000 person-years by SLICC 12 was higher than that by ACR 97 (3.7 per 100,000 person-years, p = 0.04). The median duration from the appearance of first criterion to fulfillment of the criteria was shorter for the SLICC 12 than for ACR 97 (3.9 months vs 8.1 months). The higher incidence by SLICC 12 criteria came primarily from the ability to classify patients with renal-limited disease, the expansion of the immunologic criteria and the expansion of neurologic criteria.
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Affiliation(s)
- P Ungprasert
- 1 Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - V Sagar
- 1 Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - C S Crowson
- 1 Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,2 Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - S Amin
- 1 Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,3 Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - A Makol
- 1 Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - F C Ernste
- 1 Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - T G Osborn
- 1 Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - K G Moder
- 1 Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - T B Niewold
- 1 Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - H Maradit-Kremers
- 3 Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,4 Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - R Ramsey-Goldman
- 5 Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - V R Chowdhary
- 1 Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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196
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Cruz GI, Shao X, Quach H, Ho KA, Sterba K, Noble JA, Patsopoulos NA, Busch MP, Triulzi DJ, Wong WSW, Solomon BD, Niederhuber JE, Criswell LA, Barcellos LF. A Child's HLA-DRB1 genotype increases maternal risk of systemic lupus erythematosus. J Autoimmun 2016; 74:201-207. [PMID: 27388144 DOI: 10.1016/j.jaut.2016.06.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/23/2016] [Accepted: 06/27/2016] [Indexed: 11/17/2022]
Abstract
Systemic lupus erythematosus (SLE) disproportionately affects women of reproductive age. During pregnancy, women are exposed to various sources of fetal material possibly constituting a significant immunologic exposure relevant to the development of SLE. The objective of this study was to investigate whether having any children who carry DRB1 alleles associated with SLE increase the risk of maternal SLE. This case-control study is based on the University of California, San Francisco Mother-Child Immunogenetic Study and from studies at the Inova Translational Medicine Institute. Analyses were conducted using data for 1304 mothers (219 cases/1085 controls) and their respective 1664 children. We selected alleles based on their known association with risk of SLE (DRB1*03:01, *15:01, or *08:01) or Epstein-Barr virus (EBV) glycoproteins (*04:01) due to the established EBV association with SLE risk. We used logistic regression models to estimate odds ratios (OR) and 95% confidence intervals (CI) for each allele of interest, taking into account maternal genotype and number of live births. We found an increase in risk of maternal SLE associated with exposure to children who inherited DRB1*04:01 from their father (OR 1.9; 95% CI, 1.1-3.2), among *04:01 allele-negative mothers. Increased risk was only present among mothers who were positive for one or more SLE risk-associated alleles (*03:01, *15:01 and/or *08:01). We did not find increased risk of maternal SLE associated with any other tested allele. These findings support the hypothesis that a child's alleles inherited from the father influence a mother's subsequent risk of SLE.
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Affiliation(s)
- Giovanna I Cruz
- Genetic Epidemiology and Genomics Lab, Division of Epidemiology, School of Public Health, University of California Berkeley, 324 Stanley Hall, Berkeley, CA 94720-3220, USA.
| | - Xiaorong Shao
- Genetic Epidemiology and Genomics Lab, Division of Epidemiology, School of Public Health, University of California Berkeley, 324 Stanley Hall, Berkeley, CA 94720-3220, USA.
| | - Hong Quach
- Genetic Epidemiology and Genomics Lab, Division of Epidemiology, School of Public Health, University of California Berkeley, 324 Stanley Hall, Berkeley, CA 94720-3220, USA.
| | - Kimberly A Ho
- Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center, Department of Medicine, University of California San Francisco, 513 Parnassus Avenue, San Francisco, CA 94122, USA.
| | - Kirsten Sterba
- Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center, Department of Medicine, University of California San Francisco, 513 Parnassus Avenue, San Francisco, CA 94122, USA.
| | - Janelle A Noble
- Children's Hospital Oakland Research Institute, 5700 M.L.K. Jr. Way, Oakland, CA 94609, USA.
| | - Nikolaos A Patsopoulos
- Division of Genetics, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA 02115, USA; Program in Translational Neuropsychiatric Genomics, Institute for the Neurosciences, Department of Neurology, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, 415 Main Street, Cambridge, MA 02142, USA.
| | - Michael P Busch
- Blood Systems Research Institute, 270 Masonic Avenue, San Francisco, CA 94118-4417, USA.
| | - Darrell J Triulzi
- Institute for Transfusion Medicine, Department of Pathology, University of Pittsburgh, 3636 Blvd. of the Allies, Pittsburgh, PA 15213, USA.
| | - Wendy S W Wong
- Division of Medical Genomics, Inova Translational Medicine Institute, 8110 Gatehouse Road, Falls Church, VA 22042, USA.
| | - Benjamin D Solomon
- Division of Medical Genomics, Inova Translational Medicine Institute, 8110 Gatehouse Road, Falls Church, VA 22042, USA.
| | - John E Niederhuber
- Division of Medical Genomics, Inova Translational Medicine Institute, 8110 Gatehouse Road, Falls Church, VA 22042, USA.
| | - Lindsey A Criswell
- Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center, Department of Medicine, University of California San Francisco, 513 Parnassus Avenue, San Francisco, CA 94122, USA.
| | - Lisa F Barcellos
- Genetic Epidemiology and Genomics Lab, Division of Epidemiology, School of Public Health, University of California Berkeley, 324 Stanley Hall, Berkeley, CA 94720-3220, USA; California Institute for Quantitative Biosciences (QB3), University of California Berkeley, 174 Stanley Hall, Berkeley, CA 94720-3220, USA.
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197
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Herrinton LJ, Liu L, Goldfien R, Michaels MA, Tran TN. Risk of Serious Infection for Patients with Systemic Lupus Erythematosus Starting Glucocorticoids with or without Antimalarials. J Rheumatol 2016; 43:1503-9. [PMID: 27370880 DOI: 10.3899/jrheum.150671] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare serious infection risk for systemic lupus erythematosus (SLE) patients starting glucocorticoids (GC), antimalarials (AM), or their combination. METHODS We conducted a new-user, historical cohort study, Kaiser Permanente Northern California, 1997-2013. Cox proportional hazards analysis was used to calculate adjusted HR and 95% CI. RESULTS The study included 3030 patients with SLE followed an average of 4 years. Compared with patients starting AM without GC (9 infections/1461 patient-yrs), the HR for the risk of infection was 3.9 (95% CI 1.7-9.2) for those starting GC ≤ 15 mg/day without AM (14 infections/252 patient-yrs), while it was 0.0 (0 infections/128 patient-yrs) for those starting the combination. We split the 14 patients with a serious infection and with GC < 15 mg/day into 2 groups: < 7.5 and ≥ 7.5-15 mg/day. The HR for < 7.5 mg/day was 4.6 (95% CI 1.8-11.4) and for ≥ 7.5-15 mg/day, 3.1 (95% CI 1.0-9.7). For patients starting GC > 15 mg/day (reflecting more severe SLE), the risk of infection was nearly the same for the combination of GC and AM (9 infections/135 patient-yrs) and GC alone (41 infections/460 patient-yrs), but the combination users had evidence of more severe disease. Patients with SLE had a 6- to 7-fold greater risk of serious infection than the general population. CONCLUSION Our findings suggest that the benefits of AM treatment for SLE may extend to preventing serious infections. Although the study included > 3000 patients, the statistical power to examine GC dosages < 15 mg/day was poor.
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Affiliation(s)
- Lisa J Herrinton
- From the Division of Research, Kaiser Permanente Northern California; Department of Rheumatology, The Permanente Medical Group, Oakland, California; Patient Safety Department, AstraZeneca/MedImmune; Observational Research Center, AstraZeneca, Gaithersburg, Maryland, USA.L.J. Herrinton, PhD, Division of Research, Kaiser Permanente Northern California; L. Liu, MD, Division of Research, Kaiser Permanente Northern California; R. Goldfien, MD, Department of Rheumatology, The Permanente Medical Group; M.A. Michaels, MD, Patient Safety Department, AstraZeneca/MedImmune; T.N. Tran, MD, PhD, Observational Research Center, AstraZeneca.
| | - Liyan Liu
- From the Division of Research, Kaiser Permanente Northern California; Department of Rheumatology, The Permanente Medical Group, Oakland, California; Patient Safety Department, AstraZeneca/MedImmune; Observational Research Center, AstraZeneca, Gaithersburg, Maryland, USA.L.J. Herrinton, PhD, Division of Research, Kaiser Permanente Northern California; L. Liu, MD, Division of Research, Kaiser Permanente Northern California; R. Goldfien, MD, Department of Rheumatology, The Permanente Medical Group; M.A. Michaels, MD, Patient Safety Department, AstraZeneca/MedImmune; T.N. Tran, MD, PhD, Observational Research Center, AstraZeneca
| | - Robert Goldfien
- From the Division of Research, Kaiser Permanente Northern California; Department of Rheumatology, The Permanente Medical Group, Oakland, California; Patient Safety Department, AstraZeneca/MedImmune; Observational Research Center, AstraZeneca, Gaithersburg, Maryland, USA.L.J. Herrinton, PhD, Division of Research, Kaiser Permanente Northern California; L. Liu, MD, Division of Research, Kaiser Permanente Northern California; R. Goldfien, MD, Department of Rheumatology, The Permanente Medical Group; M.A. Michaels, MD, Patient Safety Department, AstraZeneca/MedImmune; T.N. Tran, MD, PhD, Observational Research Center, AstraZeneca
| | - M Alex Michaels
- From the Division of Research, Kaiser Permanente Northern California; Department of Rheumatology, The Permanente Medical Group, Oakland, California; Patient Safety Department, AstraZeneca/MedImmune; Observational Research Center, AstraZeneca, Gaithersburg, Maryland, USA.L.J. Herrinton, PhD, Division of Research, Kaiser Permanente Northern California; L. Liu, MD, Division of Research, Kaiser Permanente Northern California; R. Goldfien, MD, Department of Rheumatology, The Permanente Medical Group; M.A. Michaels, MD, Patient Safety Department, AstraZeneca/MedImmune; T.N. Tran, MD, PhD, Observational Research Center, AstraZeneca
| | - Trung N Tran
- From the Division of Research, Kaiser Permanente Northern California; Department of Rheumatology, The Permanente Medical Group, Oakland, California; Patient Safety Department, AstraZeneca/MedImmune; Observational Research Center, AstraZeneca, Gaithersburg, Maryland, USA.L.J. Herrinton, PhD, Division of Research, Kaiser Permanente Northern California; L. Liu, MD, Division of Research, Kaiser Permanente Northern California; R. Goldfien, MD, Department of Rheumatology, The Permanente Medical Group; M.A. Michaels, MD, Patient Safety Department, AstraZeneca/MedImmune; T.N. Tran, MD, PhD, Observational Research Center, AstraZeneca
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198
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Salivary levels of inflammatory cytokines and their association to periodontal disease in systemic lupus erythematosus patients. A case-control study. Cytokine 2016; 85:165-70. [PMID: 27371775 DOI: 10.1016/j.cyto.2016.06.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 05/10/2016] [Accepted: 06/21/2016] [Indexed: 12/16/2022]
Abstract
Both Systemic Lupus Erythematosus (SLE) and periodontal disease (PD) present a similar immunological profile mainly characterized by altered cytokine levels. In this study we sought to investigate the salivary levels of inflammatory cytokines and their association with PD in SLE patients. 60 patients with SLE and 54 systemically healthy individuals underwent a full periodontal clinical examination. They were then grouped according to their periodontal status. Stimulated saliva was collected in order to evaluate the salivary levels of interferon (IFN-γ), Interleukin (IL)-10, IL-17, IL-1β, and IL-4. Systemically healthy individuals with periodontitis (group P) presented higher levels of cytokines when compared to systemically healthy individuals, with no periodontal disease (group S) (p<0.05). Additionally, in the P group, patients presented similar levels of cytokines to those of the patients with SLE, regardless of the presence of PD (p>0.05), for most of the analyzed cytokines. There was a positive correlation in SLE patients, including IL-1β and all periodontal clinical parameters (p<0.05), and between IL-4 and gingival bleeding index and the presence of biofilm (p<0.05). Thus, our results confirmed, that patients with PD showed higher salivary levels of cytokines and, in SLE patients, the increased levels of salivary cytokines were observed even in the absence of periodontitis. IL-1β and IL-4 salivary levels were also positively correlated with periodontal status indicating their potential as markers of the amount and extent of periodontal damage in patients with SLE.
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199
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Insights into the epidemiology and management of lupus nephritis from the US rheumatologist's perspective. Kidney Int 2016; 90:487-92. [PMID: 27344205 DOI: 10.1016/j.kint.2016.03.042] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 03/14/2016] [Accepted: 03/24/2016] [Indexed: 12/13/2022]
Abstract
Lupus nephritis is a common and severe manifestation of systemic lupus erythematosus that disproportionately affects nonwhites and those in lower socioeconomic groups. This review discusses recent data on the incidence, prevalence, and outcomes of patients with lupus nephritis with a focus on low-income US Medicaid patients. We also review recent guidelines on diagnosis, treatment, and screening for new onset and relapses of lupus nephritis. Finally, we discuss the management of lupus nephritis from a rheumatologist's perspective, including vigilance for the common adverse events related to disease and treatment, and we review prevention and new treatment strategies.
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200
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Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect many organs, including the skin, joints, the central nervous system and the kidneys. Women of childbearing age and certain racial groups are typically predisposed to developing the condition. Rare, inherited, single-gene complement deficiencies are strongly associated with SLE, but the disease is inherited in a polygenic manner in most patients. Genetic interactions with environmental factors, particularly UV light exposure, Epstein-Barr virus infection and hormonal factors, might initiate the disease, resulting in immune dysregulation at the level of cytokines, T cells, B cells and macrophages. Diagnosis is primarily clinical and remains challenging because of the heterogeneity of SLE. Classification criteria have aided clinical trials, but, despite this, only one drug (that is, belimumab) has been approved for use in SLE in the past 60 years. The 10-year mortality has improved and toxic adverse effects of older medications such as cyclophosphamide and glucocorticoids have been partially offset by newer drugs such as mycophenolate mofetil and glucocorticoid-sparing regimes. However, further improvements have been hampered by the adverse effects of renal and neuropsychiatric involvement and late diagnosis. Adding to this burden is the increased risk of premature cardiovascular disease in SLE together with the risk of infection made worse by immunosuppressive therapy. Challenges remain with treatment-resistant disease and symptoms such as fatigue. Newer therapies may bring hope of better outcomes, and the refinement to stem cell and genetic techniques might offer a cure in the future.
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