1
|
Parodis I, Lanata C, Nikolopoulos D, Blazer A, Yazdany J. Reframing health disparities in SLE: A critical reassessment of racial and ethnic differences in lupus disease outcomes. Best Pract Res Clin Rheumatol 2023; 37:101894. [PMID: 38057256 DOI: 10.1016/j.berh.2023.101894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/27/2023] [Indexed: 12/08/2023]
Abstract
Health disparities in the prevalence and outcomes of systemic lupus erythematosus (SLE) are well documented across racial and ethnic groups. Similar to other chronic diseases, differences in disease severity among individuals with SLE are likely influenced by both genetic predisposition and multiple social determinants of health. However, research in SLE that jointly examines the genetic and environmental contributions to the disease course is limited, resulting in an incomplete understanding of the biologic and social mechanisms that underly health disparities. While research on health disparities can reveal inequalities and inform resource allocation to improve outcomes, research that relies on racial and ethnic categories to describe diverse groups of people can pose challenges. Additionally, results from research comparing outcomes across socially constructed groups without considering other contributing factors can be misleading. We herein comprehensively examine existing literature on health disparities in SLE, including both clinical studies that examine the relationship between self-reported race and ethnicity and disease outcomes and studies that explore the relationships between genomics and lupus outcomes. Having surveyed this body of research, we propose a framework for research examining health disparities in SLE, including ways to mitigate bias in future studies.
Collapse
Affiliation(s)
- Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden; Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Cristina Lanata
- Genomics of Autoimmune Rheumatic Disease Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Dionysis Nikolopoulos
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Ashira Blazer
- Division of Rheumatology, Department of Medicine, Hospital for Special, Surgery, New York, NY, USA
| | - Jinoos Yazdany
- Division of Rheumatology, University of California, San Francisco, USA
| |
Collapse
|
2
|
Buie J, McMillan E, Kirby J, Cardenas LA, Eftekhari S, Feldman CH, Gawuga C, Knight AM, Lim SS, McCalla S, McClamb D, Polk B, Williams E, Yelin E, Shah S, Costenbader KH. Disparities in Lupus and the Role of Social Determinants of Health: Current State of Knowledge and Directions for Future Research. ACR Open Rheumatol 2023; 5:454-464. [PMID: 37531095 PMCID: PMC10502817 DOI: 10.1002/acr2.11590] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 06/28/2023] [Accepted: 07/01/2023] [Indexed: 08/03/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease. The complex relationships between race and ethnicity and social determinants of health (SDOH) in influencing SLE and its course are increasingly appreciated. Multiple SDOH have been strongly associated with lupus incidence and outcomes and contribute to health disparities in lupus. Measures of socioeconomic status, including economic instability, poverty, unemployment, and food insecurity, as well as features of the neighborhood and built environment, including lack of safe and affordable housing, crime, stress, racial segregation, and discrimination, are associated with race and ethnicity in the US and are risk factors for poor outcomes in lupus. In this scientific statement, we aimed to summarize current evidence on the role of SDOH in relation to racial and ethnic disparities in SLE and SLE outcomes, primarily as experienced in the U.S. Lupus Foundation of America's Health Disparities Advisory Panel, comprising 10 health disparity experts, including academic researchers and patients, who met 12 times over the course of 18 months in assembling and reviewing the data for this study. Sources included articles published from 2011 to 2023 in PubMed, Centers for Disease Control and Prevention data, and bibliographies and recommendations. Search terms included lupus, race, ethnicity, and SDOH domains. Data were extracted and synthesized into this scientific statement. Poorer neighborhoods correlate with increased damage, reduced care, and stress-induced lupus flares. Large disparities in health care affordability, accessibility, and acceptability exist in the US, varying by region, insurance status, and racial and minority groups. Preliminary interventions targeted social support, depression, and shared-decision-making, but more research and intervention implementation and evaluation are needed. Disparities in lupus across racial and ethnic groups in the US are driven by SDOH, some of which are more easily remediable than others. A multidimensional and multidisciplinary approach involving various stakeholder groups is needed to address these complex challenges, address these diminish disparities, and improve outcomes.
Collapse
Affiliation(s)
- Joy Buie
- Lupus Foundation of AmericanWashingtonDC
| | | | | | | | - Sanaz Eftekhari
- Asthma and Allergy Foundation of AmericaGreater LandoverMaryland
| | - Candace H. Feldman
- Harvard Medical School and Brigham and Women's HospitalBostonMassachusetts
| | - Cyrena Gawuga
- Preparedness and Treatment Equity CoalitionNew York CityNew York
| | - Andrea M. Knight
- Hospital for Sick Children and University of TorontoTorontoOntarioCanada
| | - S. Sam Lim
- Emory University and Grady Health SystemAtlantaGeorgia
| | | | | | - Barbara Polk
- John F. Kennedy Center for the Performing Arts and Amplify People AdvisorsWashingtonDC
| | | | - Ed Yelin
- University of California San Francisco
| | - Sanoja Shah
- Charles River AssociatesSan FranciscoCalifornia
| | | |
Collapse
|
3
|
Toledano M. Neurologic Manifestations of Rheumatologic Disease. Continuum (Minneap Minn) 2023; 29:734-762. [PMID: 37341329 DOI: 10.1212/con.0000000000001263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
OBJECTIVE This article describes the neurologic manifestations of systemic rheumatologic disorders. LATEST DEVELOPMENTS Although most have historically been classified as autoimmune disorders, rheumatologic diseases are increasingly conceptualized as distributed along a spectrum with various contributions of autoimmune (adaptive immune dysregulation) and autoinflammatory (innate immune dysregulation) mechanisms. Our evolving understanding of systemic immune-mediated disorders has been accompanied by an expansion in our differential diagnoses and therapeutic options. ESSENTIAL POINTS Rheumatologic disease involves both autoimmune and autoinflammatory mechanisms. Neurologic symptoms can be the first manifestation of these disorders, and familiarity with the systemic manifestations of specific diseases is essential to establish the correct diagnosis. Conversely, knowledge of the neurologic syndromes that are most likely to be associated with specific systemic disorders can help narrow the differential and increase confidence when attributing a neuropsychiatric symptom to an underlying systemic disorder.
Collapse
|
4
|
Bello N, Meyers KJ, Workman J, Hartley L, McMahon M. Cardiovascular events and risk in patients with systemic lupus erythematosus: Systematic literature review and meta-analysis. Lupus 2023; 32:325-341. [PMID: 36547368 PMCID: PMC10012401 DOI: 10.1177/09612033221147471] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is an autoimmune disease that typically affects women aged 16-55 years. Cardiovascular disease (CVD) is a well-recognized complication of SLE. This systematic literature review and meta-analysis evaluated the relative risk (RR; compared with non-SLE controls), absolute risk (AR; as incidence proportion, n/N), and incidence rate (IR) of CVD events (including stroke, myocardial infarction [MI], and CVD [composite or undefined]) in adult patients with SLE. The RR of CV risk factors (including hypertension, diabetes, and metabolic syndrome [MetS]) was also examined. METHODS PubMed and Embase were searched on September 10, 2020. Observational studies published between January 2010 and September 2020 that reported RR, AR, and/or IR of CVD events, or RR of CV risk factors, were eligible. Pooled risk estimates were calculated using a random-effects model. RESULTS Forty-six studies (16 cross-sectional, 15 retrospective cohort, 14 prospective cohort, and 1 case-control) were included in meta-analyses. Most studies were considered high quality (Critical Appraisal Skills Programme checklists). Compared with adults without SLE, patients with SLE had statistically significantly higher RRs (95% CIs) of stroke (2.51 [2.03-3.10]; 12 studies), MI (2.92 [2.45-3.48]; 11 studies), CVD (2.24 [1.94-2.59]; 8 studies), and hypertension (2.70 [1.48-4.92]; 7 studies). RRs of diabetes (1.24 [0.78-1.96]; 3 studies) and MetS (1.49 [0.95-2.33]; 7 studies) were elevated but not significant. RRs of stroke and MI were generally higher in younger versus older patients with SLE. In patients with SLE, the pooled estimate of AR (95% CI) was 0.03 (0.02-0.05), 0.01 (0.00-0.02), and 0.06 (0.03-0.10) for stroke (7 studies), MI (6 studies), and CVD (8 studies), respectively. The pooled estimate of IR per 1000 person-years (95% CI) was 4.72 (3.35-6.32), 2.81 (1.61-4.32), and 11.21 (8.48-14.32) for stroke (10 studies), MI (6 studies), and CVD (8 studies), respectively. Although heterogeneity (based on I2 value) was high in most analyses, sensitivity analyses confirmed the robustness of the pooled estimates. CONCLUSIONS This meta-analysis found an increased risk of stroke, MI, CVD, and hypertension in patients with SLE compared with the general population, despite substantial heterogeneity across the included studies.
Collapse
Affiliation(s)
| | | | | | | | - Maureen McMahon
- Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, 8783University of California Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
5
|
Shehjar F, Maktabi B, Rahman ZA, Bahader GA, James AW, Naqvi A, Mahajan R, Shah ZA. Stroke: Molecular mechanisms and therapies: Update on recent developments. Neurochem Int 2023; 162:105458. [PMID: 36460240 PMCID: PMC9839659 DOI: 10.1016/j.neuint.2022.105458] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 12/05/2022]
Abstract
Stroke, a neurological disease, is one of the leading causes of death worldwide, resulting in long-term disability in most survivors. Annual stroke costs in the United States alone were estimated at $46 billion recently. Stroke pathophysiology is complex, involving multiple causal factors, among which atherosclerosis, thrombus, and embolus are prevalent. The molecular mechanisms involved in the pathophysiology are essential to understanding targeted drug development. Some common mechanisms are excitotoxicity and calcium overload, oxidative stress, and neuroinflammation. In addition, various modifiable and non-modifiable risk factors increase the chances of stroke manifolds. Once a patient encounters a stroke, complete restoration of motor ability and cognitive skills is often rare. Therefore, shaping therapeutic strategies is paramount for finding a viable therapeutic agent. Apart from tPA, an FDA-approved therapy that is applied in most stroke cases, many other therapeutic strategies have been met with limited success. Stroke therapies often involve a combination of multiple strategies to restore the patient's normal function. Certain drugs like Gamma-aminobutyric receptor agonists (GABA), Glutamate Receptor inhibitors, Sodium, and Calcium channel blockers, and fibrinogen-depleting agents have shown promise in stroke treatment. Recently, a drug, DM199, a recombinant (synthetic) form of a naturally occurring protein called human tissue kallikrein-1 (KLK1), has shown great potential in treating stroke with fewer side effects. Furthermore, DM199 has been found to overcome the limitations presented when using tPA and/or mechanical thrombectomy. Cell-based therapies like Neural Stem Cells, Hematopoietic stem cells (HSCs), and Human umbilical cord blood-derived mesenchymal stem cells (HUCB-MSCs) are also being explored as a treatment of choice for stroke. These therapeutic agents come with merits and demerits, but continuous research and efforts are being made to develop the best therapeutic strategies to minimize the damage post-stroke and restore complete neurological function in stroke patients.
Collapse
Affiliation(s)
- Faheem Shehjar
- Department of Medicinal and Biological Chemistry, College of Pharmacy and Pharmaceutical Sciences, Toledo, OH, USA
| | - Briana Maktabi
- Department of Medicinal and Biological Chemistry, College of Pharmacy and Pharmaceutical Sciences, Toledo, OH, USA
| | - Zainab A Rahman
- Department of Medicinal and Biological Chemistry, College of Pharmacy and Pharmaceutical Sciences, Toledo, OH, USA
| | - Ghaith A Bahader
- Department of Medicinal and Biological Chemistry, College of Pharmacy and Pharmaceutical Sciences, Toledo, OH, USA
| | - Antonisamy William James
- Department of Medicinal and Biological Chemistry, College of Pharmacy and Pharmaceutical Sciences, Toledo, OH, USA
| | - Ahmed Naqvi
- Department of Medicinal and Biological Chemistry, College of Pharmacy and Pharmaceutical Sciences, Toledo, OH, USA
| | - Reetika Mahajan
- Department of Medicinal and Biological Chemistry, College of Pharmacy and Pharmaceutical Sciences, Toledo, OH, USA
| | - Zahoor A Shah
- Department of Medicinal and Biological Chemistry, College of Pharmacy and Pharmaceutical Sciences, Toledo, OH, USA.
| |
Collapse
|
6
|
Owen KA, Grammer AC, Lipsky PE. Deconvoluting the heterogeneity of SLE: The contribution of ancestry. J Allergy Clin Immunol 2021; 149:12-23. [PMID: 34857396 DOI: 10.1016/j.jaci.2021.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 12/23/2022]
Abstract
Systemic lupus erythematosus (SLE) is a multiorgan autoimmune disorder with a prominent genetic component. Evidence has shown that individuals of non-European ancestry experience the disease more severely, exhibiting an increased incidence of cardiovascular disease, renal involvement, and tissue damage compared with European ancestry populations. Furthermore, there seems to be variability in the response of individuals within different ancestral groups to standard medications, including cyclophosphamide, mycophenolate, rituximab, and belimumab. Although the widespread application of candidate gene, Immunochip, and genome-wide association studies has contributed to our understanding of the link between genetic variation (typically single nucleotide polymorphisms) and SLE, despite decades of research it is still unclear why ancestry remains a key determinant of poorer outcome in non-European-ancestry patients with SLE. Here, we will discuss the impact of ancestry on SLE disease burden in patients from diverse backgrounds and highlight how research efforts using novel bioinformatic and pathway-based approaches have begun to disentangle the complex genetic architecture linking ancestry to SLE susceptibility. Finally, we will illustrate how genomic and gene expression analyses can be combined to help identify novel molecular pathways and drug candidates that might uniquely impact SLE among different ancestral populations.
Collapse
|
7
|
Yu HH, Hsieh CJ. Integrative Therapy Combining Chinese Herbal Medicines With Conventional Treatment Reduces the Risk of Cardiovascular Disease Among Patients With Systemic Lupus Erythematosus: A Retrospective Population-Based Cohort Study. Front Pharmacol 2021; 12:737105. [PMID: 34646137 PMCID: PMC8502802 DOI: 10.3389/fphar.2021.737105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/13/2021] [Indexed: 11/21/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease that involves multiple systems and organs. Advanced conventional treatment does not appear to markedly reduce the risk of cardiovascular disease (CVD) among patients with SLE. Chinese medicine is a complementary and alternative medicine system, and some SLE patients in Taiwan also use Chinese herbal medicines (CHMs). Thus, we aimed to investigate whether integrative therapy combining CHMs with conventional therapy reduces the risk of CVD among patients with SLE. We performed a 12-years population-based retrospective cohort study using the “Systemic Lupus Erythematosus Health Database” of the National Health Insurance Research Database (NHIRD) in Taiwan. Patients newly diagnosed with SLE between 2004 and 2013 were divided into CHM and non-CHM groups and followed up until the end of 2015. We applied 1:1 individual matching by age, gender, and year of being newly diagnosed with SLE; accordingly, 2,751 patients were included in both CHM and non-CHM groups after matching. We applied the Cox proportional hazard regression model to determine the risk of CVD in relation to CHM use. During the follow-up period, 407 patients in the CHM group and 469 patients in the non-CHM group developed CVD, with incidence rates of 337 and 422 per 10,000 person-years, respectively. The Cox proportional hazards model demonstrated a significantly decreased risk of CVD among SLE patients using CHMs (adjusted HR: 0.83; 95% CI 0.73–0.95; p = 0.008). Further analyses of different types of CVDs also showed a significantly decreased risk of ischemic stroke in the CHM group (adjusted HR: 0.74; 95% CI 0.57–0.97; p = 0.032). Among the frequently used single herbs and polyherbal formulas, Shu-Jing-Huo-Xue-Tang was associated with a significantly decreased risk of CVD (adjusted HR: 0.76; 95% CI 0.58–0.99; p = 0.041). In conclusion, CHM use reduced the risk of CVD among patients with SLE in Taiwan. Further randomized studies may be needed to determine the definite causal relationship between CHM use and its protective effects against CVD among patients with SLE.
Collapse
Affiliation(s)
- Han-Hua Yu
- Division of Rheumatology, Allergy and Immunology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Chinese Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chia-Jung Hsieh
- Department of Public Health, Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
8
|
Giani T, Smith EMD, Al-Abadi E, Armon K, Bailey K, Ciurtin C, Davidson J, Gardner-Medwin J, Haslam K, Hawley DP, Leahy A, Leone V, McErlane F, Mewar D, Modgil G, Moots R, Pilkington C, Pregnolato F, Ramanan AV, Rangaraj S, Riley P, Sridhar A, Wilkinson N, Cimaz R, Beresford MW, Hedrich CM. Neuropsychiatric involvement in juvenile-onset systemic lupus erythematosus: Data from the UK Juvenile-onset systemic lupus erythematosus cohort study. Lupus 2021; 30:1955-1965. [PMID: 34601989 PMCID: PMC8649437 DOI: 10.1177/09612033211045050] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 08/19/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Juvenile-onset systemic lupus erythematosus (JSLE) is a rare autoimmune/inflammatory disease with significant morbidity and mortality. Neuropsychiatric (NP) involvement is a severe complication, encompassing a heterogeneous range of neurological and psychiatric manifestations. METHODS Demographic, clinical, and laboratory features of NP-SLE were assessed in participants of the UK JSLE Cohort Study, and compared to patients in the same cohort without NP manifestations. RESULTS A total of 428 JSLE patients were included in this study, 25% of which exhibited NP features, half of them at first visit. Most common neurological symptoms among NP-JSLE patients included headaches (78.5%), mood disorders (48.6%), cognitive impairment (42%), anxiety (23.3%), seizures (19.6%), movement disorders (17.7%), and cerebrovascular disease (14.9%). Peripheral nervous system involvement was recorded in 7% of NP-SLE patients. NP-JSLE patients more frequently exhibited thrombocytopenia (<100 × 109/L) (p = 0.04), higher C-reactive protein levels (p = 0.01), higher global pBILAG score at first visit (p < 0.001), and higher SLICC damage index score at first (p = 0.02) and last (p < 0.001) visit when compared to JSLE patients without NP involvement. CONCLUSIONS A significant proportion of JSLE patients experience NP involvement (25%). Juvenile-onset NP-SLE most commonly affects the CNS and is associated with increased overall disease activity and damage.
Collapse
Affiliation(s)
- Teresa Giani
- Rheumatology Unit, AOU Meyer, Florence, Italy
- Department of Medical
Biotechnology, University of Siena, Siena, Italy
| | - Eve MD Smith
- Department of Women’s &
Children’s Health, Institute of Life Course and Medical
Sciences, University of Liverpool, Liverpool, UK
- Department of Paediatric
Rheumatology, Alder Hey Children’s NHS Foundation
Trust Hospital, Liverpool, UK
| | - Eslam Al-Abadi
- Department of Rheumatology, Birmingham Children’s
Hospital, Birmingham, UK
| | - Kate Armon
- Department of Paediatric
Rheumatology, Cambridge University
Hospitals, Cambridge, UK
| | - Kathryn Bailey
- Department of Paediatric
Rheumatology, Oxford University Hospitals NHS
Foundation Trust, Oxford, UK
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology, University College
London, London, UK
| | - Joyce Davidson
- Department of Paediatric
Rheumatology, Royal Hospital for Sick
Children, Edinburgh, UK
| | | | - Kirsty Haslam
- Department of Paediatrics, Bradford Royal
Infirmary, Bradford, UK
| | - Dan P Hawley
- Department of Paediatric
Rheumatology, Sheffield Children’s
Hospital, Sheffield, UK
| | - Alice Leahy
- Department of Paediatric
Rheumatology, Southampton General
Hospital, Southampton, UK
| | - Valentina Leone
- Department of Paediatric
Rheumatology, Leeds Children Hospital, Leeds, UK
| | - Flora McErlane
- Paediatric Rheumatology, Great
North Children’s Hospital, Royal Victoria Infirmary, Institute of Cellular Medicine,
Newcastle University, Newcastle Upon Tyne, UK
| | - Devesh Mewar
- Department of Rheumatology, Royal Liverpool University
Hospital, Liverpool, UK
| | - Gita Modgil
- Department of Paediatrics, Musgrove Park Hospital, Taunton, UK
| | - Robert Moots
- Department of Rheumatology, University Hospital
Aintree, Liverpool, UK
| | - Clarissa Pilkington
- Department of Paediatric
Rheumatology, Great Ormond Street
Hospital, London, UK
| | | | - Athimalaipet V Ramanan
- University Hospitals Bristol NHS
Foundation Trust & Bristol Medical School, University of Bristol, Bristol, UK
| | - Satyapal Rangaraj
- Department of Paediatric
Rheumatology, Nottingham University
Hospitals, Nottingham, UK
| | - Phil Riley
- Department of Paediatric
Rheumatology, Royal Manchester Children’s
Hospital, Manchester, UK
| | - Arani Sridhar
- Department of Paediatrics, Leicester Royal
Infirmary, Leicester, UK
| | - Nick Wilkinson
- Guy’s & St Thomas’s NHS
Foundation Trust, Evelina Children’s
Hospital, London, UK
| | - Rolando Cimaz
- ASST Gaetano Pini-CTO, Milan, Italy
- Department of Clinical Sciences
and Community Health, Research Center for Adult and
Pediatric Rheumatic Diseases, University of Milan, Milan, Italy
| | - Michael W Beresford
- Department of Women’s &
Children’s Health, Institute of Life Course and Medical
Sciences, University of Liverpool, Liverpool, UK
- Department of Paediatric
Rheumatology, Alder Hey Children’s NHS Foundation
Trust Hospital, Liverpool, UK
| | - Christian M Hedrich
- Department of Women’s &
Children’s Health, Institute of Life Course and Medical
Sciences, University of Liverpool, Liverpool, UK
- Department of Paediatric
Rheumatology, Alder Hey Children’s NHS Foundation
Trust Hospital, Liverpool, UK
| | - on behalf of the UK JSLE Cohort Study
- Rheumatology Unit, AOU Meyer, Florence, Italy
- Department of Medical
Biotechnology, University of Siena, Siena, Italy
- Department of Women’s &
Children’s Health, Institute of Life Course and Medical
Sciences, University of Liverpool, Liverpool, UK
- Department of Paediatric
Rheumatology, Alder Hey Children’s NHS Foundation
Trust Hospital, Liverpool, UK
- Department of Rheumatology, Birmingham Children’s
Hospital, Birmingham, UK
- Department of Paediatric
Rheumatology, Cambridge University
Hospitals, Cambridge, UK
- Department of Paediatric
Rheumatology, Oxford University Hospitals NHS
Foundation Trust, Oxford, UK
- Centre for Adolescent Rheumatology, University College
London, London, UK
- Department of Paediatric
Rheumatology, Royal Hospital for Sick
Children, Edinburgh, UK
- Department of Child Health, University of Glasgow, Glasgow, UK
- Department of Paediatrics, Bradford Royal
Infirmary, Bradford, UK
- Department of Paediatric
Rheumatology, Sheffield Children’s
Hospital, Sheffield, UK
- Department of Paediatric
Rheumatology, Southampton General
Hospital, Southampton, UK
- Department of Paediatric
Rheumatology, Leeds Children Hospital, Leeds, UK
- Paediatric Rheumatology, Great
North Children’s Hospital, Royal Victoria Infirmary, Institute of Cellular Medicine,
Newcastle University, Newcastle Upon Tyne, UK
- Department of Rheumatology, Royal Liverpool University
Hospital, Liverpool, UK
- Department of Paediatrics, Musgrove Park Hospital, Taunton, UK
- Department of Rheumatology, University Hospital
Aintree, Liverpool, UK
- Department of Paediatric
Rheumatology, Great Ormond Street
Hospital, London, UK
- Immunorheumatology Research
Laboratory, Auxologico Institute, Milan, Italy
- University Hospitals Bristol NHS
Foundation Trust & Bristol Medical School, University of Bristol, Bristol, UK
- Department of Paediatric
Rheumatology, Nottingham University
Hospitals, Nottingham, UK
- Department of Paediatric
Rheumatology, Royal Manchester Children’s
Hospital, Manchester, UK
- Department of Paediatrics, Leicester Royal
Infirmary, Leicester, UK
- Guy’s & St Thomas’s NHS
Foundation Trust, Evelina Children’s
Hospital, London, UK
- ASST Gaetano Pini-CTO, Milan, Italy
- Department of Clinical Sciences
and Community Health, Research Center for Adult and
Pediatric Rheumatic Diseases, University of Milan, Milan, Italy
| |
Collapse
|
9
|
Choi MY, Li D, Feldman CH, Yoshida K, Guan H, Kim SC, Everett BM, Costenbader KH. Comparative risks of cardiovascular disease events among SLE patients receiving immunosuppressive medications. Rheumatology (Oxford) 2021; 60:3789-3798. [PMID: 33369672 DOI: 10.1093/rheumatology/keaa862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/18/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES SLE patients have elevated cardiovascular disease (CVD) risk, but it is unclear whether this risk is affected by choice of immunosuppressive drug. We compared CVD risks among SLE patients starting MMF, CYC or AZA. METHODS Using Medicaid Analytic eXtract (2000-2012), adult SLE patients starting MMF, CYC or AZA were identified and propensity scores (PS) were estimated for receipt of MMF vs CYC and MMF vs AZA. We examined rates of first CVD event (primary outcome), all-cause mortality, and a composite of first CVD event and all-cause mortality (secondary outcomes). After 1:1 PS-matching, Fine-Gray regression models estimated subdistribution hazard ratios (HRs.d.) for risk of CVD events. Cox regression models estimated HRs for all-cause mortality. The primary analysis was as-treated; 6- and 12-month intention-to-treat (ITT) analyses were secondary. RESULTS We studied 680 PS-matched pairs of patients with SLE initiating MMF vs CYC and 1871 pairs initiating MMF vs AZA. Risk of first CVD event was non-significantly reduced for MMF vs CYC [HRs.d 0.72 (95% CI: 0.37, 1.39)] and for MMF vs AZA [HRs.d 0.88 (95% CI: 0.59, 1.32)] groups. In the 12-month ITT, first CVD event risk was lower among MMF than AZA new users [HRs.d 0.68 (95% CI: 0.47, 0.98)]. CONCLUSION In this head-to-head PS-matched analysis, CVD event risks among SLE patients starting MMF vs CYC or AZA were not statistically reduced except in one 12-month ITT analysis of MMF vs AZA, suggesting longer-term use may convey benefit. Further studies of potential cardioprotective benefit of MMF are necessary.
Collapse
Affiliation(s)
- May Y Choi
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Daniel Li
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Candace H Feldman
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Kazuki Yoshida
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Hongshu Guan
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Seoyoung C Kim
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Division of Pharmacoepidemiology and Pharmacoeconomics Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston, Boston, MA, USA
| | - Brendan M Everett
- Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Karen H Costenbader
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
10
|
Zhen C, Wang Y, Wang H, Wang X. The risk of ischemic stroke in patients with idiopathic inflammatory myopathies: a systematic review and meta-analysis. Clin Rheumatol 2021; 40:4101-4108. [PMID: 33934269 DOI: 10.1007/s10067-021-05751-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 03/22/2021] [Accepted: 04/25/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Idiopathic inflammatory myopathies (IIM) are a group of chronic rheumatic diseases that can affect multiple systems; the risk of ischemic stroke in patients with IIM remains controversial. We aimed to systematically evaluate the risk of ischemic stroke in IIMs. METHODS The PubMed, Embase, and Cochrane library were searched for relevant studies. Pooled relative risk (RR) with a 95% confidence interval (CI) was calculated as effect size to evaluate the risk of ischemic stroke in patients with IIM. Random effects model was chosen when I2 > 50%. We pooled all studies in a first total analysis to assess the risk of ischemic stroke in IIM. Subgroup analyses were conducted based on the subtypes of IIM (dermatomyositis) and country. Sensitivity analysis was performed to identify the heterogeneity sources. RESULTS A total of 6 studies with 5,114 IIM cases and 14,516,099 controls were included, and the results demonstrated that IIMs were associated with an increased risk of ischemic stroke (RR = 2.41, 95% CI: 1.31, 4.45). Subgroup analysis indicated that patients with dermatomyositis (DM) had a 49% excess risk of ischemic stroke than controls; Asian patients with IIM had an increased risk of ischemic stroke, although not for American patients. CONCLUSION IIMs, especially patients with DM, are associated with an increased risk of ischemic stroke. Appropriate intervention may be taken into account for patients with IIM, especially when accompanied by other traditional risk factors of ischemic stroke. Key Points • This study evaluated the risk of ischemic stroke in patients with IIMs. • Generally, IIMs are associated with an increased risk of ischemic stroke. • Patients with DM had a 49% excess risk of ischemic stroke than controls. • Subgroup analysis showed that Asian patients with IIMs were at increased risk of ischemic stroke, but not Americans.
Collapse
Affiliation(s)
- Chao Zhen
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, No. 5 Donghai Middle Road, Qingdao, Shandong Province, 266071, China
| | - Yabo Wang
- Department of Emergency, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Haifeng Wang
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, No. 5 Donghai Middle Road, Qingdao, Shandong Province, 266071, China
| | - Xin Wang
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, No. 5 Donghai Middle Road, Qingdao, Shandong Province, 266071, China.
| |
Collapse
|
11
|
Abstract
PURPOSE This article describes the neurologic manifestations of systemic autoimmune diseases. RECENT FINDINGS Systemic autoimmune diseases can be associated with a wide spectrum of neurologic comorbidities involving the central and peripheral nervous systems. Systemic lupus erythematosus (SLE) can be associated with a number of manifestations predominantly affecting the central nervous system (CNS), whereas peripheral neuropathy is less common. Sjögren syndrome can be associated with peripheral neuropathy in 10% of cases and CNS disease in 2% to 5% of cases. The risk of stroke is increased in SLE, rheumatoid arthritis, temporal arteritis, psoriatic arthritis, and ankylosing spondylitis. Systemic vasculitides present most commonly with mononeuritis multiplex but can also affect the CNS. Cognitive dysfunction is a common symptom among patients with systemic autoimmune diseases, most commonly seen in patients with SLE or Sjögren syndrome. SUMMARY Neurologic manifestations of systemic autoimmune disease are important to recognize, as they may often be the presenting manifestation leading to diagnosis of the systemic disease or may be associated with increased morbidity, other complications, or mortality. Timely diagnosis and institution of appropriate treatment, often requiring multidisciplinary care, is essential to minimize morbidity and decrease the risk of permanent neurologic deficits.
Collapse
|
12
|
Gergianaki I, Garantziotis P, Adamichou C, Saridakis I, Spyrou G, Sidiropoulos P, Bertsias G. High Comorbidity Burden in Patients with SLE: Data from the Community-Based Lupus Registry of Crete. J Clin Med 2021; 10:jcm10050998. [PMID: 33801229 PMCID: PMC7957898 DOI: 10.3390/jcm10050998] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 01/28/2021] [Accepted: 02/22/2021] [Indexed: 01/14/2023] Open
Abstract
Comorbidities and multimorbidity, often complicating the disease course of patients with chronic inflammatory rheumatic diseases, may be influenced by disease-intrinsic and extrinsic determinants including regional and social factors. We analyzed the frequency and co-segregation of self-reported comorbid diseases in a community-based Mediterranean registry of patients (n = 399) with systemic lupus erythematosus (SLE). Predictors for multimorbidity were identified by multivariable logistic regression, strongly-associated pairs of comorbidities by the Cramer's V-statistic, and comorbidities clusters by hierarchical agglomerative clustering. Among the most prevalent comorbidities were thyroid (45.6%) and metabolic disorders (hypertension: 24.6%, dyslipidemia: 33.3%, obesity: 35.3%), followed by osteoporosis (22.3%), cardiovascular (20.8%), and allergic (20.6%) disorders. Mental comorbidities were also common, particularly depression (26.7%) and generalized anxiety disorder (10.7%). Notably, 51.0% of patients had ≥3 physical and 33.1% had ≥2 mental comorbidities, with a large fraction (n = 86) displaying multimorbidity from both domains. Sociodemographic (education level, marital status) and clinical (disease severity, neurological involvement) were independently associated with physical or mental comorbidity. Patients were grouped into five distinct clusters of variably prevalent comorbid diseases from different organs and domains, which correlated with SLE severity patterns. Conclusively, our results suggest a high multimorbidity burden in patients with SLE at the community, advocating for integrated care to optimize outcomes.
Collapse
Affiliation(s)
- Irini Gergianaki
- Department of Rheumatology and Clinical Immunology, University of Crete School of Medicine, 71500 Giofirakia, Greece; (I.G.); (C.A.); (I.S.); (G.S.); (P.S.)
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion, 71500 Heraklion, Greece
- Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology-Hellas (FORTH), 70013 Heraklion, Greece
| | - Panagiotis Garantziotis
- Laboratory of Immune Regulation and Tolerance, Autoimmunity and Inflammation, Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece;
- Division of Immunology and Rheumatology, Hannover Medical University, 30625 Hannover, Germany
| | - Christina Adamichou
- Department of Rheumatology and Clinical Immunology, University of Crete School of Medicine, 71500 Giofirakia, Greece; (I.G.); (C.A.); (I.S.); (G.S.); (P.S.)
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Ioannis Saridakis
- Department of Rheumatology and Clinical Immunology, University of Crete School of Medicine, 71500 Giofirakia, Greece; (I.G.); (C.A.); (I.S.); (G.S.); (P.S.)
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Georgios Spyrou
- Department of Rheumatology and Clinical Immunology, University of Crete School of Medicine, 71500 Giofirakia, Greece; (I.G.); (C.A.); (I.S.); (G.S.); (P.S.)
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Prodromos Sidiropoulos
- Department of Rheumatology and Clinical Immunology, University of Crete School of Medicine, 71500 Giofirakia, Greece; (I.G.); (C.A.); (I.S.); (G.S.); (P.S.)
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion, 71500 Heraklion, Greece
- Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology-Hellas (FORTH), 70013 Heraklion, Greece
| | - George Bertsias
- Department of Rheumatology and Clinical Immunology, University of Crete School of Medicine, 71500 Giofirakia, Greece; (I.G.); (C.A.); (I.S.); (G.S.); (P.S.)
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion, 71500 Heraklion, Greece
- Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology-Hellas (FORTH), 70013 Heraklion, Greece
- Correspondence: ; Tel.: +30-2810-394635
| |
Collapse
|
13
|
Disparities in Lupus and Lupus Nephritis Care and Outcomes Among US Medicaid Beneficiaries. Rheum Dis Clin North Am 2020; 47:41-53. [PMID: 34042053 DOI: 10.1016/j.rdc.2020.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Systemic lupus erythematosus (SLE) is a serious chronic autoimmune disease with substantial morbidity and mortality. Although improved diagnostics and therapeutics have contributed to declining mortality rates, important disparities exist in SLE survival rates by race, ethnicity, gender, age, country, and social disadvantage. This review highlights the burden of SLE and lupus nephritis among Medicaid beneficiaries, outlines barriers in access to high-quality SLE care and medication adherence in the Medicaid SLE population, and summarizes disparities in adverse outcomes among SLE patients enrolled in Medicaid.
Collapse
|
14
|
Li D, Yoshida K, Feldman CH, Speyer C, Barbhaiya M, Guan H, Solomon DH, Everett BM, Costenbader KH. Initial disease severity, cardiovascular events and all-cause mortality among patients with systemic lupus erythematosus. Rheumatology (Oxford) 2020; 59:495-504. [PMID: 31321417 DOI: 10.1093/rheumatology/kez288] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/16/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE SLE is associated with high risks of cardiovascular disease (CVD) and mortality, and has a wide spectrum of presentations. We investigated whether SLE severity at diagnosis was associated with CVD or mortality risk. METHODS Within Medicaid (2000-10), we identified patients 18-65 years of age with incident SLE. Initial SLE severity was classified-mild, moderate, or severe-during the baseline year prior to the start of follow-up (incident index date) using a published algorithm based on SLE-related medications and diagnoses. Patients were followed from the index date to the first CVD event or death, disenrollment, loss to follow-up or end of follow-up period. Cox and Fine-Gray regression models, adjusted for demographics and comorbidities accounting for the competing risk of death (for CVD), estimated CVD and mortality risks by baseline SLE severity. RESULTS Of 15 120 incident SLE patients, 48.7% had mild initial SLE severity, 33.9% moderate and 17.4% severe. Mean (s.d.) follow-up was 3.3 (2.4) years. After multivariable adjustment, CVD subdistribution hazard ratios (HRSD) were higher for initially severe [HRSD 1.64 (95% CI 1.32, 2.04)] and moderate [HRSD 1.19 (95% CI 1.00, 1.41)] SLE vs mild SLE. Mortality HRs were also higher for initially severe [HR 3.11 (95% CI 2.49, 3.89)] and moderate [HR 1.61 (95% CI 1.29, 2.01)] SLE vs mild SLE. CONCLUSION SLE patients with high initial severity had elevated mortality and CVD events risks compared with those who presented with milder disease. This has implications for clinical care and risk stratification of newly diagnosed SLE patients.
Collapse
Affiliation(s)
- Daniel Li
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, MA, USA
| | - Kazuki Yoshida
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, MA, USA
| | - Candace H Feldman
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, MA, USA
| | - Cameron Speyer
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, MA, USA
| | - Medha Barbhaiya
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, MA, USA
| | - Hongshu Guan
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, MA, USA
| | - Daniel H Solomon
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, MA, USA
| | - Brendan M Everett
- Divisions of Cardiovascular and Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Karen H Costenbader
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, MA, USA
| |
Collapse
|
15
|
Chen SK, Barbhaiya M, Solomon DH, Guan H, Yoshida K, Feldman CH, Everett BM, Costenbader KH. Atrial Fibrillation/flutter Hospitalizations among US Medicaid Recipients with and without Systemic Lupus Erythematosus. J Rheumatol 2019; 47:1359-1365. [PMID: 31676703 DOI: 10.3899/jrheum.190502] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) is a multisystem chronic inflammatory autoimmune disease with high prevalence of several risk factors for atrial fibrillation/flutter (AF). However, the incidence and risk of AF in SLE have not been well quantified. METHODS We used the United States Medicaid Analytic eXtract from 2007 to 2010 to identify beneficiaries aged 18-65 years, with prevalent SLE, each matched by age and sex to 4 non-SLE general Medicaid recipients. We estimated the incidence rates (IR) per 1000 person-years (PY) for AF hospitalizations and used multivariable Cox regression to estimate the HR for AF hospitalization. RESULTS We identified 46,876 US Medicaid recipients with SLE, and 187,504 age- and sex-matched non-SLE controls (93% female; mean age 41.5 ± 12.2 yrs). Known AF risk factors such as hypertension (HTN), cardiovascular disease (CVD), and kidney disease were more prevalent in patients with SLE. During a mean followup of 1.9 ± 1.1 years for SLE, and 1.8 ± 1.1 years for controls, the IR per 1000 PY for AF was 1.4 (95% CI 1.1-1.6) among patients with SLE and 0.7 (95% CI 0.6-0.8) among non-SLE controls. In age- and sex-matched and race-adjusted Cox models, the HR for AF was 1.79 (95% CI 1.43-2.24); after adjustment for baseline HTN and CVD, the adjusted HR was reduced to 1.17 (95% CI 0.92-1.48). CONCLUSION SLE was associated with a doubled rate of hospitalization for AF compared to age- and sex-matched general Medicaid patients. In a race-adjusted model, the risk was 80% higher. However, the AF risk factors HTN and CVD were more prevalent among patients with SLE and accounted for the excess risk.
Collapse
Affiliation(s)
- Sarah K Chen
- From the Division of Rheumatology, Immunology and Allergy, the Division of Pharmacoepidemiology and Pharmacoeconomics, and the Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, New York, USA. .,S.K. Chen, MD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; M. Barbhaiya, MD, MPH, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery; D.H. Solomon, MD, MPH, Division of Rheumatology, Immunology and Allergy, Department of Medicine, and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital; H. Guan, PhD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; K. Yoshida, MD, MPH, ScD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; C.H. Feldman, MD, MPH, ScD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; B.M. Everett, MD, MPH, Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women's Hospital; K.H. Costenbader, MD, MPH, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital. B.M. Everett and K.H. Costenbader are co-senior authors.
| | - Medha Barbhaiya
- From the Division of Rheumatology, Immunology and Allergy, the Division of Pharmacoepidemiology and Pharmacoeconomics, and the Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, New York, USA.,S.K. Chen, MD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; M. Barbhaiya, MD, MPH, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery; D.H. Solomon, MD, MPH, Division of Rheumatology, Immunology and Allergy, Department of Medicine, and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital; H. Guan, PhD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; K. Yoshida, MD, MPH, ScD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; C.H. Feldman, MD, MPH, ScD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; B.M. Everett, MD, MPH, Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women's Hospital; K.H. Costenbader, MD, MPH, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital. B.M. Everett and K.H. Costenbader are co-senior authors
| | - Daniel H Solomon
- From the Division of Rheumatology, Immunology and Allergy, the Division of Pharmacoepidemiology and Pharmacoeconomics, and the Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, New York, USA.,S.K. Chen, MD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; M. Barbhaiya, MD, MPH, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery; D.H. Solomon, MD, MPH, Division of Rheumatology, Immunology and Allergy, Department of Medicine, and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital; H. Guan, PhD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; K. Yoshida, MD, MPH, ScD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; C.H. Feldman, MD, MPH, ScD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; B.M. Everett, MD, MPH, Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women's Hospital; K.H. Costenbader, MD, MPH, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital. B.M. Everett and K.H. Costenbader are co-senior authors
| | - Hongshu Guan
- From the Division of Rheumatology, Immunology and Allergy, the Division of Pharmacoepidemiology and Pharmacoeconomics, and the Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, New York, USA.,S.K. Chen, MD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; M. Barbhaiya, MD, MPH, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery; D.H. Solomon, MD, MPH, Division of Rheumatology, Immunology and Allergy, Department of Medicine, and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital; H. Guan, PhD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; K. Yoshida, MD, MPH, ScD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; C.H. Feldman, MD, MPH, ScD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; B.M. Everett, MD, MPH, Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women's Hospital; K.H. Costenbader, MD, MPH, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital. B.M. Everett and K.H. Costenbader are co-senior authors
| | - Kazuki Yoshida
- From the Division of Rheumatology, Immunology and Allergy, the Division of Pharmacoepidemiology and Pharmacoeconomics, and the Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, New York, USA.,S.K. Chen, MD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; M. Barbhaiya, MD, MPH, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery; D.H. Solomon, MD, MPH, Division of Rheumatology, Immunology and Allergy, Department of Medicine, and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital; H. Guan, PhD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; K. Yoshida, MD, MPH, ScD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; C.H. Feldman, MD, MPH, ScD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; B.M. Everett, MD, MPH, Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women's Hospital; K.H. Costenbader, MD, MPH, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital. B.M. Everett and K.H. Costenbader are co-senior authors
| | - Candace H Feldman
- From the Division of Rheumatology, Immunology and Allergy, the Division of Pharmacoepidemiology and Pharmacoeconomics, and the Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, New York, USA.,S.K. Chen, MD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; M. Barbhaiya, MD, MPH, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery; D.H. Solomon, MD, MPH, Division of Rheumatology, Immunology and Allergy, Department of Medicine, and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital; H. Guan, PhD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; K. Yoshida, MD, MPH, ScD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; C.H. Feldman, MD, MPH, ScD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; B.M. Everett, MD, MPH, Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women's Hospital; K.H. Costenbader, MD, MPH, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital. B.M. Everett and K.H. Costenbader are co-senior authors
| | - Brendan M Everett
- From the Division of Rheumatology, Immunology and Allergy, the Division of Pharmacoepidemiology and Pharmacoeconomics, and the Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, New York, USA.,S.K. Chen, MD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; M. Barbhaiya, MD, MPH, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery; D.H. Solomon, MD, MPH, Division of Rheumatology, Immunology and Allergy, Department of Medicine, and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital; H. Guan, PhD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; K. Yoshida, MD, MPH, ScD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; C.H. Feldman, MD, MPH, ScD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; B.M. Everett, MD, MPH, Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women's Hospital; K.H. Costenbader, MD, MPH, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital. B.M. Everett and K.H. Costenbader are co-senior authors
| | - Karen H Costenbader
- From the Division of Rheumatology, Immunology and Allergy, the Division of Pharmacoepidemiology and Pharmacoeconomics, and the Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, New York, USA.,S.K. Chen, MD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; M. Barbhaiya, MD, MPH, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery; D.H. Solomon, MD, MPH, Division of Rheumatology, Immunology and Allergy, Department of Medicine, and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital; H. Guan, PhD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; K. Yoshida, MD, MPH, ScD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; C.H. Feldman, MD, MPH, ScD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital; B.M. Everett, MD, MPH, Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women's Hospital; K.H. Costenbader, MD, MPH, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital. B.M. Everett and K.H. Costenbader are co-senior authors
| |
Collapse
|
16
|
Nikolopoulos D, Fanouriakis A, Boumpas DT. Cerebrovascular Events in Systemic Lupus Erythematosus: Diagnosis and Management. Mediterr J Rheumatol 2019; 30:7-15. [PMID: 32185337 PMCID: PMC7045913 DOI: 10.31138/mjr.30.1.7] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 02/22/2019] [Accepted: 02/25/2019] [Indexed: 02/06/2023] Open
Abstract
Stroke is a major cause of morbidity, mortality and disability in systemic lupus erythematosus (SLE). Patients with SLE have a two-fold increase in the risk of stroke with younger patients (ie, less than 50 years of age) having an ever-higher risk (up to 10-fold). Although the prognosis of SLE has improved, mortality due to cerebrovascular events (CVE) remains unchanged. Cerebrovascular disease may be directly attributed to the disease per se, as a manifestation of neuropsychiatric SLE, or be the result of traditional cardiovascular risk factors accompanying the disease. Elucidation of the underlying mechanism(s) of CVE is essential as it may guide the type of therapy (ie, antithrombotic or anticoagulant therapy versus immunosuppressive). Strokes attributed to lupus usually occur early in the course of the disease and are often accompanied by evidence of activity in other organs; those related to antiphospholipid antibodies can occur at any time, in patients with either active or inactive SLE. In this review, we discuss the epidemiology, work-up, management and primary prevention of CVE in patients with lupus. In view of the effectiveness of thrombolysis, physicians need to educate lupus patients and their families for the early recognition of the signs of stroke and the need to seek prompt attention. To this end acronyms, such as FAST (Facial drooping, Arm weakness, Speech difficulties and Time to call emergency service) can be used as a mnemonic to help detect and enhance responsiveness to the needs of a person having a stroke.
Collapse
Affiliation(s)
- Dionysis Nikolopoulos
- Rheumatology and Clinical Immunology Unit, 4th Department of Medicine, "Attikon" University Hospital, Athens, Greece.,Laboratory of Immune Regulation and Tolerance, Autoimmunity and Inflammation, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Antonis Fanouriakis
- Rheumatology and Clinical Immunology Unit, 4th Department of Medicine, "Attikon" University Hospital, Athens, Greece
| | - Dimitrios T Boumpas
- Rheumatology and Clinical Immunology Unit, 4th Department of Medicine, "Attikon" University Hospital, Athens, Greece.,Laboratory of Immune Regulation and Tolerance, Autoimmunity and Inflammation, Biomedical Research Foundation of the Academy of Athens, Athens, Greece.,Medical School, University of Cyprus, Nicosia, Cyprus
| |
Collapse
|