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Slief M, Kheir JM, Smith M, Mowery C, Macwana S, DeJager W, Wagner CA, Aberle T, James JA, Guthridge JM. Genetic load in incomplete lupus erythematosus. Lupus Sci Med 2023; 10:e000843. [PMID: 36599633 PMCID: PMC9815005 DOI: 10.1136/lupus-2022-000843] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/22/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Patients with incomplete lupus erythematosus (ILE) have lupus features but insufficient criteria for SLE classification. Some patients with ILE transition to SLE, but most avoid major organ involvement. This study tested whether the milder disease course in ILE is influenced by reduced SLE risk allele genetic load. METHODS We calculated the genetic load based on 99 SLE-associated risk alleles in European American patients with SLE (≥4 American College of Rheumatology (ACR) 1997 criteria, n=170), patients with ILE (3 ACR 1997 criteria, n=169), a subset of patients with ILE not meeting Systemic Lupus International Collaborating Clinics (SLICC) classification (ILESLICC, n=119) and healthy controls (n=133). Unweighted genetic loads were calculated as the total sum of risk alleles for each individual, while weighted genetic loads were defined as the sum of risk alleles multiplied by the natural logarithm of the previously published OR of each risk allele for SLE susceptibility. RESULTS The median unweighted and weighted SLE risk allele genetic load was significantly greater in patients with ILE (unweighted: 81, p value=0.01; weighted: 16.3, p value=0.001) and patients with SLE (80, p value=0.02; 16.29, p value=0.0006) compared with healthy controls (78, 15.76). Patients with ILESLICC trended towards an increased genetic load, although not statistically significant (unweighted: 80, p value=0.14; weighted: 16.05, p value=0.07). However, the median genetic load did not significantly differ between ILE and SLE, and genetic load did not differentiate patients with ILE and SLE (area under the curve=0.51, p=0.78) by receiver operator characteristic analysis. CONCLUSIONS Patients with ILE and SLE have comparable genetic loads of SLE risk loci, suggesting similar genetic predispositions between these conditions. Phenotypical differences between SLE and ILE may instead be influenced by ILE-specific variants and gene-environment interactions.
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Affiliation(s)
- Matt Slief
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Joseph M Kheir
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Miles Smith
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Colin Mowery
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Susan Macwana
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Wade DeJager
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Catriona A Wagner
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Teresa Aberle
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Judith A James
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
- Department of Medicine, Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Joel M Guthridge
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
- Department of Medicine, Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Differentiating between UCTD and early-stage SLE: from definitions to clinical approach. Nat Rev Rheumatol 2022; 18:9-21. [PMID: 34764455 DOI: 10.1038/s41584-021-00710-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 12/14/2022]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease with heterogeneous clinical manifestations that can potentially affect every organ and system. SLE is usually identified on the basis of clinical or serological manifestations; however, some individuals can present with signs and symptoms that are consistent with SLE but are not sufficient for a definite diagnosis. Disease in these individuals can either progress over time to definite SLE or remain stable, in which case their disease is often described as intermediate, possible or probable SLE. Alternatively, such individuals might have undifferentiated connective tissue disease (UCTD). Being able to differentiate between those with stable UCTD and those with SLE at an early stage is important to avoid irreversible target-organ damage from occurring. This Review provides insight into existing and evolving perceptions of the early stages of SLE, including clinical and mechanistic considerations, as well as potential paths towards early identification and intervention. Further research into the earliest phases of SLE will be important for the development of targeted diagnostic approaches and biomarkers for the identification of individuals with early disease who are likely to progress to definite SLE.
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Chavatza K, Kostopoulou M, Nikolopoulos D, Gioti O, Togia K, Andreoli L, Aringer M, Boletis J, Doria A, Houssiau FA, Jayne D, Mosca M, Svenungsson E, Tincani A, Bertsias G, Fanouriakis A, Boumpas DT. Quality indicators for systemic lupus erythematosus based on the 2019 EULAR recommendations: development and initial validation in a cohort of 220 patients. Ann Rheum Dis 2021; 80:1175-1182. [PMID: 34162597 DOI: 10.1136/annrheumdis-2021-220438] [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: 03/26/2021] [Accepted: 05/11/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Quality of care is receiving increased attention in systemic lupus erythematosus (SLE). We developed quality indicators (QIs) for SLE based on the 2019 update of European League Against Rheumatism recommendations. METHODS A total of 44 candidate QIs corresponding to diagnosis, monitoring and treatment, were independently rated for validity and feasibility by 12 experts and analysed by a modified Research and Development Corporation/University of California Los Angeles model. Adherence to the final set of QIs and correlation with disease outcomes (flares, hospitalisations and organ damage) was tested in a cohort of 220 SLE patients with a median monitoring of 2 years (IQR 2-4). RESULTS The panel selected a total of 18 QIs as valid and feasible. On average, SLE patients received 54% (95% CI 52.3% to 56.2%) of recommended care, with adherence ranging from 44.7% (95% CI 40.8% to 48.6%) for diagnosis-related QIs to 84.3% (95% CI 80.6% to 87.5%) for treatment-related QIs. Sustained remission or low disease activity were achieved in 26.8% (95% CI 21.1% to 33.2%). Tapering of prednisone dose to less than 7.5 mg/day was achieved in 93.6% (95% CI 88.2% to 97.0%) while 73.5% (95% CI 66.6% to 79.6%) received the recommended hydroxychloroquine dose. Higher adherence to monitoring-related QIs was associated with reduced risk for a composite adverse outcome (flare, hospitalisation or damage accrual) during the last year of observation (OR 0.97 per 1% adherence rate, 95% CI 0.96 to 0.99). CONCLUSION We developed QIs for assessing and improving the care of SLE patients. Initial real-life data suggest face validity, but a variable degree of adherence and a need for further improvement.
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Affiliation(s)
- Katerina Chavatza
- Rheumatology and Clinical Immunology, Medical School, National and Kapodistrian University of Athens, "Attikon" University Hospital of Athens, Athens, Greece
| | - Myrto Kostopoulou
- Department of Nephrology, "G. Gennimatas" General Hospital, Athens, Greece
| | - Dionysis Nikolopoulos
- Rheumatology and Clinical Immunology, Medical School, National and Kapodistrian University of Athens, "Attikon" University Hospital of Athens, Athens, Greece
| | - Ourania Gioti
- Department of Rheumatology, "Asklepieion" General Hospital, Voula, Athens, Greece
| | - Konstantina Togia
- Rheumatology and Clinical Immunology, Medical School, National and Kapodistrian University of Athens, "Attikon" University Hospital of Athens, Athens, Greece
| | - Laura Andreoli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Unit of Rheumatology and Clinical Immunology, Spedali Civili, Brescia, Italy
| | - Martin Aringer
- Division of Rheumatology, Department of Medicine III, University Medical Center & Faculty of Medicine Carl Gustav Carus at the TU Dresden, Dresden, Germany
| | - John Boletis
- Nephrology Department and Renal Transplantation Unit, "Laikon" Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Frederic A Houssiau
- Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elisabet Svenungsson
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Angela Tincani
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - George Bertsias
- Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Antonis Fanouriakis
- Rheumatology and Clinical Immunology, Medical School, National and Kapodistrian University of Athens, "Attikon" University Hospital of Athens, Athens, Greece.,Department of Rheumatology, "Asklepieion" General Hospital, Voula, Athens, Greece
| | - Dimitrios T Boumpas
- Rheumatology and Clinical Immunology, Medical School, National and Kapodistrian University of Athens, "Attikon" University Hospital of Athens, Athens, Greece .,Laboratory of Autoimmunity and Inflammation, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
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Lambers WM, Westra J, Jonkman MF, Bootsma H, de Leeuw K. Incomplete Systemic Lupus Erythematosus: What Remains After Application of American College of Rheumatology and Systemic Lupus International Collaborating Clinics criteria? Arthritis Care Res (Hoboken) 2020; 72:607-614. [PMID: 30932354 PMCID: PMC7217202 DOI: 10.1002/acr.23894] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 03/26/2019] [Indexed: 12/22/2022]
Abstract
Incomplete systemic lupus (iSLE) is an acknowledged condition of patients with clinical signs of lupus who do not fulfill classification criteria for SLE. Some patients with iSLE have persistent mild disease, but others have serious organ involvement, and up to 55% progress to established SLE. Research on this subject could reveal predictive or diagnostic biomarkers for SLE. Ideally, it would become possible to discern those patients with critical organ involvement or a high risk for progression to SLE. This high‐risk group might benefit from early treatment, which would preferably be confirmed in randomized controlled trials. This process would, however, require agreement on a definition of iSLE. The Systemic Lupus International Collaborating Clinics (SLICC) classification criteria was composed in order to diagnose SLE earlier. The present review outlines the clinical characteristics of iSLE after introduction of SLICC criteria and furthermore proposes a definition of iSLE with the aim of discriminating the high‐risk group from those with a lower risk.
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Affiliation(s)
- Wietske M Lambers
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Johanna Westra
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marcel F Jonkman
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hendrika Bootsma
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Karina de Leeuw
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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5
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Remission and low disease activity state prevent hospitalizations in systemic lupus erythematosus patients. Lupus 2019; 28:1344-1349. [DOI: 10.1177/0961203319876998] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective The aim of this study was to determine whether remission and low disease activity state protect systemic lupus erythematosus patients from being hospitalized. Materials and methods Patients from the Almenara Lupus Cohort were included. Visits were performed every 6 months. Variables were measured at each visit. Hospitalizations were evaluated in the interval between two visits. Remission was defined as: a SLEDAI-2 K of 0, prednisone ≤5 mg/day and immunosuppressants on maintenance dose; low disease activity state as: a SLEDAI-2 K of ≤4, prednisone ≤7.5 mg/day and immunosuppressants on maintenance dose. Univariable and multivariable interval-censored survival regression models were used. In multivariable analysis, possible confounders were gender, age at diagnosis, socioeconomic status, educational level, disease duration, antimalarial use, the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index (SDI) and Charlson comorbidity index. Confounders were determined in the same visit as disease activity state. Results Of the 308 patients, 92.5% of them ( n = 285) were women, had a mean age at diagnosis of 34.8 (13.4) years and a disease duration of 7.7 (6.5) years. At baseline the mean SDI was 1.13 (1.34). A total of 163 of the patients were hospitalized. In the multivariable analysis remission (hazard ratio 0.445 (0.274–0.725), P = 0.001) and low disease activity state (relative risk 0.504 (0.336–0.757), P = 0.001) at baseline were found to decrease the risk of hospitalization in systemic lupus erythematosus patients. A total of 158 hospitalizations presented a discernible cause. Disease activity was the most common cause of hospitalization, with 84 admissions (53.16%), the majority, 38, was due to active kidney disease (45.23%). Conclusion Remission and low disease activity state decreased the risk of hospitalizations in these systemic lupus erythematosus patients. Disease activity, particularly renal, was the most frequent cause of hospitalization.
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6
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Reppe Moe SE, Molberg Ø, Strøm EH, Lerang K. Assessing the relative impact of lupus nephritis on mortality in a population-based systemic lupus erythematosus cohort. Lupus 2019; 28:818-825. [PMID: 31072277 DOI: 10.1177/0961203319847275] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE There is limited knowledge on the relative impact of lupus nephritis (LN) on morbidity and mortality in population-based systemic lupus erythematous (SLE) cohorts. Here, the primary aim was to compare mortality rates between patients with and without LN in a population-based SLE cohort. METHODS The study cohort included all SLE patients resident in the city of Oslo during 1999-2008. Follow-up time was median 14 (0-15) years. Presence of LN was defined according to the 1987 American College of Rheumatology classification criteria for SLE. LN class was determined by renal biopsy. Data on kidney function, including presence of end-stage renal disease (ESRD), were obtained from patient charts. Standardized mortality ratios (SMRs) were estimated by comparing deaths in the SLE cohort with age- and gender-matched population controls. RESULTS We found that 98/325 SLE patients (30%) developed LN, 92% of whom had occurrence within the first five years from disease onset. Incidence rate of ESRD was 2.3 per 1000 patient-years. A total of 56 deaths occurred during the study period, corresponding to an overall SMR in the SLE cohort of 2.1 (95% confidence interval (CI) 1.2-3.4). Estimated SMR for LN patients was 3.8 (95% CI 2.1-6.2), and for SLE patients without LN it was 1.7 (95% CI 0.9-2.7). CONCLUSION In this population-based SLE cohort, we found that LN was associated with increased morbidity and mortality, whereas SLE patients who did not develop LN had good overall prognoses regarding survival.
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Affiliation(s)
- S E Reppe Moe
- 1 Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | - Ø Molberg
- 1 Department of Rheumatology, Oslo University Hospital, Oslo, Norway.,2 Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - E H Strøm
- 3 Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - K Lerang
- 1 Department of Rheumatology, Oslo University Hospital, Oslo, Norway
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7
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Yuan Y, Zhao L, Ye Z, Ma H, Wang X, Jiang Z. Association of toll-like receptor 9 expression with prognosis of systemic lupus erythematosus. Exp Ther Med 2019; 17:3247-3254. [PMID: 30937000 DOI: 10.3892/etm.2019.7290] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 07/20/2017] [Indexed: 11/05/2022] Open
Abstract
The current study assessed the association between toll-like receptor 9 (TLR9) and systemic lupus erythematosus (SLE) and subsequently determined the predictive value of TLR9 in assessing the prognosis of SLE. A total of 90 newly diagnosed patients with SLE and 49 healthy control subjects were enrolled in the current study. The expression of TLR9 mRNA was measured in whole blood samples from patients and controls. All patients were followed up for ≥2 years and their clinical parameters were recorded. After 2 years, 30 patients were randomly chosen from patient subgroups with high (n=20) or low (n=10) TLR9 levels and the expression of TLR9 mRNA were measured again. Cox proportional hazards regression was used to identify the risk factors of SLE prognosis. Patients with SLE and high SLE disease activity exhibited significantly increased TLR9 expression (P<0.05). Persistent proteinuria of >0.5 g/day [hazard ratio (HR), 6.314; 95% confidence interval (CI), 2.858-13.947], C-reactive protein levels (HR, 1.013; 95% CI, 1.007-1.019) and high-TLR9 mRNA expression (HR, 3.852; 95% CI, 1.931-7.684) were independent risk factors of poor prognosis during a 2-year follow-up period, whereas patient treatment with >1 immunosuppressant (HR, 0.374; 95% CI, 0.173-0.808) was a factor indicating favorable prognosis. Furthermore, the expression of TLR9 mRNA remained high in patients with poor prognosis at the end of a 2-year follow-up period but in patients with a favorable prognosis, TLR9 mRNA expression was significantly reduced compared with the levels measured at SLE onset (P<0.0001). Therefore, the expression of TLR9 mRNA in whole blood samples at SLE onset is associated with SLE disease activity and its expression may be used as an indicator of poor prognosis in patients with SLE.
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Affiliation(s)
- Yi Yuan
- Department of Rheumatology and Immunology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China.,Institute of Translational Medicine, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Ling Zhao
- Department of Rheumatology and Immunology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Zhuang Ye
- Department of Rheumatology and Immunology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Hongshuang Ma
- Department of Rheumatology and Immunology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xiaosong Wang
- Institute of Translational Medicine, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Zhenyu Jiang
- Department of Rheumatology and Immunology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Li J, Pan Z, Liu H, Ding F, Shu Q, Li X. Retrospective analysis of the risk of hemorrhage associated with moderate and severe thrombocytopenia of 173 patients with systemic lupus erythematosus. Medicine (Baltimore) 2018; 97:e11356. [PMID: 29979417 PMCID: PMC6076144 DOI: 10.1097/md.0000000000011356] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The aim of the study was to observe the risk of hemorrhage from moderate and severe thrombocytopenia in systemic lupus erythematosus (SLE).A retrospective analysis was undertaken of cases admitted to Qilu Hospital, China. Blood platelet counts (BPCs) of ≤20 × 10/L represent severe thrombocytopenia, and a BPC of 21 to 50 × 10/L indicates moderate thrombocytopenia. A comparison was made from the perspective of severity with a view to determine the influence of thrombocytopenia on the risk of hemorrhage and the results.Moderate and severe thrombocytopenia occurred in 173 cases, accounting for 15.2% of the total hospitalized patients with SLE with a male to female ratio of 1:23.7. The average age of those patients was 34.8 ± 14.6 years. In the group of severe thrombocytopenia, patients without visceral involvement had a mean age of onset of 31.4 ± 14.2 years with a median of 28.0 years compared with 37.8 ± 14.8 years with a median of 38.5 years for patients with visceral involvement; this difference was statistically significant (P = .034). Seventy-one (76.3%) of 93 patients with severe thrombocytopenia and 20 (25.0%) of 80 patients with moderate thrombocytopenia developed hemorrhagic conditions of various grades, the difference between both were markedly statistically significant. Twenty-three patients with SLE died. Nine deaths were due to a hemorrhage caused by thrombocytopenia, while more were caused by infection.Severe thrombocytopenia is a significant adverse prognostic factor of SLE. SLE with the main manifestation of thrombocytopenia tends to make younger visceral organ owners suffer.
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Busch RW, Kay SD, Voss A. Hospitalizations among Danish SLE patients: a prospective study on incidence, causes of admission and risk factors in a population-based cohort. Lupus 2017; 27:165-171. [PMID: 29050537 DOI: 10.1177/0961203317734919] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective To determine the incidence, duration and cause of hospitalization in a cohort of Danish patients with systemic lupus erythematosus (SLE). In addition, we investigated risk factors for admission and prolonged hospital stay. Methods A total of 155 SLE patients from a population-based cohort were included in the study during a period of 70 months, from January 2007 to October 2012. Data on frequency, cause and duration of hospitalizations were obtained by review of medical charts. Data on disease manifestations, organ damage and treatment were collected prospectively. Results A total of 101 of the 155 SLE patients (65%) had one or more hospitalization during the study period. The incidence rate of all hospitalizations was 0.50 per year. Leading causes of admission were complications to SLE or its treatment, but infections were also common. Mean duration of hospital stay was 6.4 ± 10.5 days, and SLE Disease Activity Index 2000 (SLEDAI-2K) on admission emerged as a risk factor for prolonged hospital stay. Conclusion Danish SLE patients experience frequent admissions to hospital. Complications to SLE or its treatment, as well as infections, are leading causes of admission. High SLEDAI-2K on admission is a risk factor for prolonged hospital stay.
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Affiliation(s)
- R W Busch
- Department of Rheumatology, Odense University Hospital, Denmark
| | - S D Kay
- Department of Rheumatology, Odense University Hospital, Denmark
| | - A Voss
- Department of Rheumatology, Odense University Hospital, Denmark
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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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11
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Peng L, Wang Z, Li M, Wang Y, Xu D, Wang Q, Zhang S, Zhao J, Tian X, Zeng X. Flares in Chinese systemic lupus erythematosus patients: a 6-year follow-up study. Clin Rheumatol 2017; 36:2727-2732. [PMID: 28929239 DOI: 10.1007/s10067-017-3842-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 08/31/2017] [Accepted: 09/11/2017] [Indexed: 01/05/2023]
Abstract
This study determined the flare status of SLE patients in a single-center Chinese cohort and identified the predictors of flare in this underreported Asian population. The patients were recruited from April 2009 to February 2010 at the Peking Union Medical College Hospital (PUMCH), and then followed up regularly at our clinic until December 2015. Flare was defined as an increase in SLEDAI-2K to ≥ 4 points from the previous visit, or appearing of a new SLE manifestation or worsening of a preexisting clinical or hematological manifestation (not included in SLEDAI-2K) that results in restarting or increasing corticosteroids or immunosuppressant. Baseline and follow-up data were collected, and some of them were used as variables in survival analysis for time-to-flare outcome with Kaplan-Meier survival analysis and log-rank tests. Potential predictors with significant differences were further included in a multivariate Cox regression model for confounders adjustment and hazard ratio (HR) calculation. A total of 254 patients were finally included in our analysis. Yearly flare proportion rate was 13.0-15.7%. Renal, hematologic, and neurologic were the most frequently involved organs. Multivariate analysis confirmed onset age up to 18 years (HR 2.14, 95% CI 1.09-4.19) as a flare predictor. Organ damage at entry also showed an association trend with flare (HR = 1.693, 95% CI 0.943 ~ 3.041, p = 0.078). Chinese SLE patients showed a higher prevalence for disease flare compared with other ethnics. Future studies should be designed for figuring out the prediction role of fluctuation of anti-dsDNA antibody for disease flare.
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Affiliation(s)
- Liying Peng
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Beijing, 100730, China
| | - Ziqian Wang
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Beijing, 100730, China
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Beijing, 100730, China.
| | - Yanhong Wang
- Department of Epidemiology and Bio-statistics (YW), Institute of Basic Medical Science, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100005, China
| | - Dong Xu
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Beijing, 100730, China
| | - Qian Wang
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Beijing, 100730, China
| | - Shangzhu Zhang
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Beijing, 100730, China
| | - Jiuliang Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Beijing, 100730, China
| | - Xinping Tian
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Beijing, 100730, China
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Beijing, 100730, China.
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Ugarte-Gil MF, Wojdyla D, Pastor-Asurza CA, Gamboa-Cárdenas RV, Acevedo-Vásquez EM, Catoggio LJ, García MA, Bonfá E, Sato EI, Massardo L, Pascual-Ramos V, Barile LA, Reyes-Llerena G, Iglesias-Gamarra A, Molina-Restrepo JF, Chacón-Díaz R, Alarcón GS, Pons-Estel BA. Predictive factors of flares in systemic lupus erythematosus patients: data from a multiethnic Latin American cohort. Lupus 2017; 27:536-544. [PMID: 28857715 DOI: 10.1177/0961203317728810] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Purpose The purpose of this paper is to determine the factors predictive of flares in systemic lupus erythematosus (SLE) patients. Methods A case-control study nested within the Grupo Latino Americano De Estudio de Lupus (GLADEL) cohort was conducted. Flare was defined as an increase ≥4 points in the SLEDAI. Cases were defined as patients with at least one flare. Controls were selected by matching cases by length of follow-up. Demographic and clinical manifestations were systematically recorded by a common protocol. Glucocorticoid use was recorded as average daily dose of prednisone and antimalarial use as percentage of time on antimalarial and categorized as never (0%), rarely (>0-25%), occasionally (>25%-50%), commonly (˃50%-75%) and frequently (˃75%). Immunosuppressive drugs were recorded as used or not used. The association between demographic, clinical manifestations, therapy and flares was examined using univariable and multivariable conditional logistic regression models. Results A total of 465 cases and controls were included. Mean age at diagnosis among cases and controls was 27.5 vs 29.9 years, p = 0.003; gender and ethnic distributions were comparable among both groups and so was the baseline SLEDAI. Independent factors protective of flares identified by multivariable analysis were older age at diagnosis (OR = 0.929 per every five years, 95% CI 0.869-0.975; p = 0.004) and antimalarial use (frequently vs never, OR = 0.722, 95% CI 0.522-0.998; p = 0.049) whereas azathioprine use (OR = 1.820, 95% CI 1.309-2.531; p < 0.001) and SLEDAI post-baseline were predictive of them (OR = 1.034, 95% CI 1.005-1.064; p = 0.022). Conclusions In this large, longitudinal Latin American cohort, older age at diagnosis and more frequent antimalarial use were protective whereas azathioprine use and higher disease activity were predictive of flares.
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Affiliation(s)
- M F Ugarte-Gil
- 1 Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú.,2 Universidad Científica del Sur, Lima, Perú
| | - D Wojdyla
- 3 Universidad Nacional de Rosario, Rosario, Argentina
| | - C A Pastor-Asurza
- 1 Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú.,4 Universidad Nacional Mayor de San Marcos, Lima, Perú
| | | | - E M Acevedo-Vásquez
- 1 Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú.,4 Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - L J Catoggio
- 5 Sección de Reumatología, Servicio de Clínica Médica, Hospital Italiano, Instituto Universitario Escuela de Medicina Hospital Italiano and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina
| | - M A García
- 6 Hospital Interzonal General de Agudos "General San Martín," La Plata, Argentina
| | - E Bonfá
- 7 Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - E I Sato
- 8 Disciplina de Reumatología, Escola Paulista de Medicina, Universidade Federal da São Paulo-UNIFESP, São Paulo, Brazil
| | - L Massardo
- 9 Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - V Pascual-Ramos
- 10 Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán," Ciudad de Mexico, Mexico
| | - L A Barile
- 11 Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de Mexico, Mexico
| | - G Reyes-Llerena
- 12 Centro de Investigaciones Médico Quirúrgicas-CIMEQ, Habana, Cuba
| | | | | | - R Chacón-Díaz
- 15 Servicio de Reumatología, Centro Nacional de Enfermedades Reumáticas, Hospital Universitario de Caracas, Caracas, Venezuela
| | - G S Alarcón
- 16 Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
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Asgari N, Jarius S, Laustrup H, Skejoe HP, Lillevang ST, Weinshenker BG, Voss A. Aquaporin-4-autoimmunity in patients with systemic lupus erythematosus: A predominantly population-based study. Mult Scler 2017; 24:331-339. [PMID: 28326889 DOI: 10.1177/1352458517699791] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Serum immunoglobulin G targeting the astrocyte water channel aquaporin-4 (AQP4) in the central nervous system (CNS) is a biomarker for neuromyelitis optica spectrum disease (NMOSD). Co-existence of NMOSD with systemic lupus erythematosus (SLE) putatively suggests susceptibility to antibody-mediated autoimmune disease. OBJECTIVE To estimate the prevalence of NMOSD in SLE and investigate the immunogenetic background for an association of NMOSD and SLE. METHODS The study included a predominantly population-based cohort with clinical and serological investigations of 208 patients with SLE, followed prospectively since 1995. All patients received immunosuppressive treatment. NMOSD was evaluated retrospectively based on the 2015 International Panel for NMOSD Diagnosis (IPND) criteria. Polymorphisms in programmed cell death protein 1 (PDCD-1) PD-1.3 G/A were genotyped. AGP4-IgG and other autoantibodies, including myelin oligodendrocyte glycoprotein (MOG), was determined blinded to clinical diagnosis. RESULTS Of 208 patients with SLE, 45(22%) had neuropsychiatric (NP) SLE, and CNS involvement predominated in 30 of 45 (67%) patients. Serum AQP4-IgG was detected in 2 of 30 (6.7%) neuropsychiatric SLE (NPSLE) patients both of whom had myelitis and antiphospholipid syndrome; one patient also had myasthenia gravis. None had MOG-IgG. PD-1.3A allele was not associated with SLE nor with NPSLE. CONCLUSION AQP4-IgG autoimmune syndrome may rarely co-exist with SLE, and such patients have other NMOSD-typical syndromes such as myelitis.
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Affiliation(s)
- Nasrin Asgari
- Neurobiology Research, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark/Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Sven Jarius
- Division of Molecular Neuroimmunology, Department of Neurology, Heidelberg University, Heidelberg, Germany
| | - Helle Laustrup
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Hanne Pb Skejoe
- Department of Radiology, Aleris-Hamlet Hospital, Copenhagen, Denmark
| | - Soeren T Lillevang
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | | | - Anne Voss
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
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Györi N, Giannakou I, Chatzidionysiou K, Magder L, van Vollenhoven RF, Petri M. Disease activity patterns over time in patients with SLE: analysis of the Hopkins Lupus Cohort. Lupus Sci Med 2017; 4:e000192. [PMID: 28243457 PMCID: PMC5307372 DOI: 10.1136/lupus-2016-000192] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/11/2017] [Accepted: 01/13/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To describe SLE disease activity patterns in the Hopkins Lupus Cohort. METHODS Disease activity was studied in 1886 patients followed-up for 1-28 years. Disease activity patterns were defined using (1) Physician Global Assessment (PGA) and (2) modified SLE Disease Activity Index (M-SLEDAI) as follows: long quiescent (LQ), M-SLEDAI=0/PGA=0 at all visits; relapsing-remitting (RR), periods of activity (M-SLEDAI>0/PGA>0) interspersed with inactivity (M-SLEDAI=0/PGA=0); chronic active (CA), M-SLEDAI>0/PGA>0 at all visits. The pattern of first 3 consecutive follow-up years was determined in 916 patients as: persistent LQ (pLQ), persistent RR (pRR) and persistent CA (pCA), LQ, RR and CA pattern in each of the 3 years, respectively; mixed, at least two different pattern types were identified. RESULTS The RR pattern accounted for the greatest proportion of follow-up time both by M-SLEDAI and PGA, representing 53.8% and 49.9% of total patient-years, respectively. The second most frequent pattern was LQ based on M-SLEDAI (30.7%) and CA based on PGA (40.4%). For the first 3-year intervals, the mixed pattern type was the most common (56.6%). The pRR was the second most frequent (M-SLEDAI 33.3%, PGA 26.5%), while pLQ (M-SLEDAI 6.4%, PGA 0.7%) and pCA were less frequent (M-SLEDAI 3.7%, PGA 16.3%). CONCLUSIONS The RR pattern was the most prevalent pattern. LQ was achieved in a subset of patients, using the M-SLEDAI. However, the PGA captured mild activity missed on the M-SLEDAI in these patients. Over a 3-year perspective, less than half of patients maintained their original pattern.
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Affiliation(s)
- Noémi Györi
- ClinTRID-Unit for Clinical Therapy Research, Inflammatory Diseases, Department of Medicine , Karolinska University Hospital, Karolinska Institute , Stockholm , Sweden
| | - Ioanna Giannakou
- ClinTRID-Unit for Clinical Therapy Research, Inflammatory Diseases, Department of Medicine , Karolinska University Hospital, Karolinska Institute , Stockholm , Sweden
| | - Katerina Chatzidionysiou
- ClinTRID-Unit for Clinical Therapy Research, Inflammatory Diseases, Department of Medicine , Karolinska University Hospital, Karolinska Institute , Stockholm , Sweden
| | - Laurence Magder
- Division of Rheumatology , School of Medicine, Johns Hopkins University , Baltimore, MD , USA
| | - Ronald F van Vollenhoven
- ClinTRID-Unit for Clinical Therapy Research, Inflammatory Diseases, Department of Medicine , Karolinska University Hospital, Karolinska Institute , Stockholm , Sweden
| | - Michelle Petri
- Division of Rheumatology , School of Medicine, Johns Hopkins University , Baltimore, MD , USA
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Abstract
Systemic lupus erythematosus (SLE), the prototypic systemic autoimmune disease, follows a chronic disease course, punctuated by flares. Disease flares often occur without apparent cause, perhaps from progressive inherent buildup of autoimmunity. However, there is evidence that certain environmental factors may trigger the disease. These include exposure to UV light, infections, certain hormones, and drugs which may activate the innate and adaptive immune system, resulting in inflammation, cytotoxic effects, and clinical symptoms. Uncontrolled disease flares, as well as their treatment, especially with glucocorticoids, can cause significant organ damage. Tight surveillance and timely control of lupus flares with judicial use of effective treatments to adequately suppress the excessive immune system activation are required to bring about long term remission of the disease. We hope that new clinical trials will soon offer additional effective and target-specific biologic treatments for SLE.
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Affiliation(s)
- David Fernandez
- Division of Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, 10021, USA
| | - Kyriakos A Kirou
- Division of Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, 10021, USA.
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16
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Autoantibodies persist in relatives to systemic lupus erythematosus patients during 12 years follow-up. Lupus 2016; 26:723-728. [DOI: 10.1177/0961203316676378] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Systemic lupus erythematosus (SLE) is an autoimmune disease with presence of autoantibodies and characteristic multi-organ involvement. Relatives of SLE patients have an increased risk of autoantibody production and autoimmune diseases. Methods In 2001, 226 first degree relatives (FDRs) of a population-based cohort of SLE patients were examined for the prevalence of autoantibodies and self-reported health complaints. In 2013, 143 FDRs were re-investigated and deceased’s medical records were examined. Results Participants and non-participants were comparable regarding baseline characteristics, while deceased FDRs were older than participants, but with comparable ANA status. ANA status at baseline correlated to ANA status at follow-up. At follow-up, two FDRs reported SLE and 15 FDRs other autoimmune diseases. No observation at baseline alone could predict self-reported health. During follow-up 33 died at median age 76 years. Three deceased FDRs were diagnosed with an autoimmune disease. Conclusion The study showed that FDRs of SLE patients have an increased prevalence of ANA compared to healthy controls. The prevalence increased during follow-up, and ANA positive FDRs at baseline were prone to be ANA positive at follow-up. ANA positive FDRs had more self-reported autoimmune diseases, including SLE and rheumatoid arthritis, than reported from other population-based investigations.
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17
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Doria A, Zen M, Iaccarino L. Remission in SLE: the duration depends on multiple factors, including the definition. Ann Rheum Dis 2016; 75:e77. [DOI: 10.1136/annrheumdis-2016-210502] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 09/17/2016] [Indexed: 11/03/2022]
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Doria A, Gatto M, Iaccarino L, Punzi L. Value and goals of treat-to-target in systemic lupus erythematosus: knowledge and foresight. Lupus 2015; 24:507-15. [PMID: 25801894 DOI: 10.1177/0961203314559087] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Treat-to-target is a therapeutic strategy aimed at improving disease outcome through the achievement of shared treatment goals, which has dramatically ameliorated the prognosis of widespread disorders, such as hypertension or diabetes. Conversely, efforts to delineate treat-to-target in systemic lupus erythematosus (SLE) have failed in pinpointing common goals and treatment strategies, probably because of disease heterogeneity and lack of measurable biomarkers predicting disease course and ensuring a safe treatment tapering during quiescence. Given the detrimental effects of persistent disease activity and protracted corticosteroid therapy on patients' outcome in lupus, disease remission should be pursued whenever possible. Fortunately, clinical remission is currently realistic for a greater number of patients than it was in the past, yet tight monitoring is required in order for patients to benefit from disease- and corticosteroid-free intervals, while minimizing the risk of disease flares. In everyday practice, patients should be brought to the lowest level of disease activity ensuring a significant benefit over a persistently active disease, being either clinical remission or low disease activity.
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Affiliation(s)
- A Doria
- Division of Rheumatology, Department of Medicine, University of Padova, Padova, Italy
| | - M Gatto
- Division of Rheumatology, Department of Medicine, University of Padova, Padova, Italy
| | - L Iaccarino
- Division of Rheumatology, Department of Medicine, University of Padova, Padova, Italy
| | - L Punzi
- Division of Rheumatology, Department of Medicine, University of Padova, Padova, Italy
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19
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Kay SD, Poulsen MK, Diederichsen ACP, Voss A. Coronary, Carotid, and Lower-extremity Atherosclerosis and Their Interrelationship in Danish Patients with Systemic Lupus Erythematosus. J Rheumatol 2015; 43:315-22. [PMID: 26628595 DOI: 10.3899/jrheum.150488] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Atherosclerosis is highly prevalent among patients with systemic lupus erythematosus (SLE), but has been demonstrated predominantly in non-European SLE cohorts and few investigations have included more than 1 imaging modality. We aimed to investigate the prevalence of atherosclerosis in 3 frequently affected vascular territories, the coronary, carotid, and lower-extremity arteries, in a Danish, predominantly population-based SLE cohort. METHODS Patients with SLE without prior cardiovascular disease (CVD; n = 103) were screened for coronary artery calcification, carotid intima-media thickening and plaque, and abnormal ankle-brachial index by means of cardiac computed tomography, ultrasound of the carotid arteries, and ankle systolic blood pressure. RESULTS In patients with SLE, the prevalence of atherosclerosis in any vascular territory was 41%. The distribution of the atherosclerotic manifestations showed an overlap with 45% of the patients having involvement in more than 1 vascular territory. However, more than one-third of the patients with SLE with coronary, carotid, or lower-extremity atherosclerosis exclusively demonstrated this particular manifestation. Based on a multiple logistic regression model, age (p < 0.001), current smoking (p = 0.009), and the Systemic Lupus International Collaborating Clinics (SLICC; p = 0.008) were significant independent risk factors for atherosclerosis at any vascular territory. CONCLUSION Atherosclerosis is highly prevalent among Danish patients with SLE without prior CVD. Screening for atherosclerosis in 1 vascular territory is insufficient in diagnosing atherosclerosis in patients with SLE. In Danish patients with SLE, the presence of atherosclerosis was not only assigned to traditional CV risk factors, but also associated with SLICC.
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Affiliation(s)
- Susan Due Kay
- From the Department of Rheumatology, and Department of Cardiology, Odense University Hospital, Odense, Denmark.S.D. Kay, MD, Department of Rheumatology, Odense University Hospital; M.K. Poulsen, PhD, Department of Cardiology, Odense University Hospital; A.C. Diederichsen, PhD, Department of Cardiology, Odense University Hospital; A. Voss, PhD, Department of Rheumatology, Odense University Hospital.
| | - Mikael Kjaer Poulsen
- From the Department of Rheumatology, and Department of Cardiology, Odense University Hospital, Odense, Denmark.S.D. Kay, MD, Department of Rheumatology, Odense University Hospital; M.K. Poulsen, PhD, Department of Cardiology, Odense University Hospital; A.C. Diederichsen, PhD, Department of Cardiology, Odense University Hospital; A. Voss, PhD, Department of Rheumatology, Odense University Hospital
| | - Axel Cosmus Pyndt Diederichsen
- From the Department of Rheumatology, and Department of Cardiology, Odense University Hospital, Odense, Denmark.S.D. Kay, MD, Department of Rheumatology, Odense University Hospital; M.K. Poulsen, PhD, Department of Cardiology, Odense University Hospital; A.C. Diederichsen, PhD, Department of Cardiology, Odense University Hospital; A. Voss, PhD, Department of Rheumatology, Odense University Hospital
| | - Anne Voss
- From the Department of Rheumatology, and Department of Cardiology, Odense University Hospital, Odense, Denmark.S.D. Kay, MD, Department of Rheumatology, Odense University Hospital; M.K. Poulsen, PhD, Department of Cardiology, Odense University Hospital; A.C. Diederichsen, PhD, Department of Cardiology, Odense University Hospital; A. Voss, PhD, Department of Rheumatology, Odense University Hospital
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Sato JO, Corrente JE, Saad-Magalhães C. Chronic active disease pattern predicts early damage in juvenile systemic lupus erythematosus. Lupus 2015; 24:1421-8. [PMID: 26253073 DOI: 10.1177/0961203315599449] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 07/08/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The objective of this article is to assess disease activity patterns and their relationship to damage, death and growth failure in a cohort of juvenile lupus. METHODS Chronic active, relapsing-remitting and long quiescent activity patterns were retrospectively classified according to longitudinal scores of both the Modified SLEDAI-2K and ECLAM. The Pediatric SLICC/ACR Damage Index (Ped-SDI) was scored at the last visit in patients followed more than six months. Survival analysis was performed considering death, damage and growth failure, and stratified according to disease activity patterns. Cox model analysis identified predictors for damage and growth failure among onset clinical variables. RESULTS Thirty-seven patients with 11 years mean age at diagnosis and 3.2 years mean follow-up were studied. According to the Modified SLEDAI-2K, activity pattern was 67.5% relapsing-remitting, 29.8% chronic active and 2.7% long quiescent and by ECLAM, 45.9%, 48.7% and 5.4%, respectively. The five-year survival was 90%. Damage accrued in 62.5% and growth failure in 31.3%. Chronic active cases progressed to damage earlier than relapsing-remitting (log-rank test, p < 0.05). Damage was associated with disease duration (p < 0.0001), thrombocytopenia (p < 0.05) and alopecia (p < 0.004). Growth failure was associated with disease duration (p < 0.007) and renal failure (p < 0.007). CONCLUSION Damage was observed in nearly two-thirds of patients, and occurred earlier in the chronic active pattern. Disease duration, thrombocytopenia and alopecia at onset predicted damage.
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Affiliation(s)
- J O Sato
- Departamento de Pediatria, Faculdade de Medicina de Botucatu, UNESP - Universidade Estadual Paulista, São Paulo, Brasil
| | - J E Corrente
- Departamento de Bioestatística, Instituto de Biociências, Campus de Botucatu, UNESP - Universidade Estadual Paulista, São Paulo, Brasil
| | - C Saad-Magalhães
- Departamento de Pediatria, Faculdade de Medicina de Botucatu, UNESP - Universidade Estadual Paulista, São Paulo, Brasil
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Zen M, Iaccarino L, Gatto M, Bettio S, Nalotto L, Ghirardello A, Punzi L, Doria A. Prolonged remission in Caucasian patients with SLE: prevalence and outcomes. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-207347] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
AimTo assess the prevalence of prolonged remission in Caucasian patients affected with systemic lupus erythematosus (SLE) and its relationship with damage accrual.MethodsCaucasian patients diagnosed with SLE between 1990 and 2009 and quarterly seen from 2009 to 2013 were included in the study. We defined remission as prolonged when lasting ≥5 consecutive years. Three levels of remission were defined using the SLE Disease Activity Index-2000 (SLEDAI-2K): complete remission: no disease activity in corticosteroid-free and immunosuppressant-free patients; clinical remission off corticosteroids: serologically active clinical quiescent (SACQ) disease in corticosteroid-free patients and clinical remission on corticosteroids: SACQ disease in patients taking prednisone 1–5 mg/day. Damage was measured by the SLICC/American College of Rheumatology Damage Index (SDI).Results224 patients fulfilled inclusion criteria: 196 (87.5%) were women, mean±SD disease duration 11.2±6.8 years. During the 5-year follow-up, 16 patients (7.1%) achieved prolonged complete remission, 33 (14.7%) prolonged clinical remission off corticosteroids and 35 (15.6%) prolonged clinical remission on corticosteroids. At the multivariate analysis, vasculitis (OR 4.95), glomerulonephritis (OR 2.38) and haematological manifestations (OR 2.19) over the patients’ disease course were associated with an unremitted disease. SDI increased more frequently in unremitted (72/140, 51.4%) than in remitted patients (22/84, 26.2%; p=0.001); SDI median increase was higher in unremitted than in remitted patients: 1 (0–3) vs 0 (0–2), respectively (p<0.001). At multivariate analysis, unremitted disease (OR 2.52) and high-dose corticosteroid intake (OR 2.35) were risk factors for damage accrual.ConclusionsThirty-seven percent of our Caucasian patients achieved a prolonged remission, which was associated with a better outcome in terms of damage accrual.
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Ceccarelli F, Perricone C, Massaro L, Cipriano E, Alessandri C, Spinelli FR, Valesini G, Conti F. Assessment of disease activity in Systemic Lupus Erythematosus: Lights and shadows. Autoimmun Rev 2015; 14:601-8. [PMID: 25742757 DOI: 10.1016/j.autrev.2015.02.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 02/24/2015] [Indexed: 01/24/2023]
Abstract
The assessment of disease activity in patients affected by Systemic Lupus Erythematosus (SLE) represents an important issue, as recommended by the European League Against Rheumatism (EULAR). Two main types of disease activity measure have been proposed: the global score systems, providing an overall measure of activity, and the individual organ/system assessment scales, assessing disease activity in different organs. All the activity indices included both clinical and laboratory items, related to the disease manifestations. However, there is no gold standard to measure disease activity in patients affected by SLE. In this review, we will analyze the lights and shadows of the disease activity indices, by means of a critical approach. In particular, we will focus on SLE Disease Activity Index (SLEDAI) and British Isles Lupus Assessment Group (BILAG), the most frequently used in randomized controlled trials and observational studies. The evaluation of data from the literature underlined some limitations of these indices, making their application in clinical practice difficult and suggesting the possible use of specific tools in the different subset of SLE patients, in order to capture all the disease features.
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Affiliation(s)
- Fulvia Ceccarelli
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e specialità Mediche, Sapienza Università di Roma, Italy.
| | - Carlo Perricone
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e specialità Mediche, Sapienza Università di Roma, Italy
| | - Laura Massaro
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e specialità Mediche, Sapienza Università di Roma, Italy
| | - Enrica Cipriano
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e specialità Mediche, Sapienza Università di Roma, Italy
| | - Cristiano Alessandri
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e specialità Mediche, Sapienza Università di Roma, Italy
| | - Francesca Romana Spinelli
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e specialità Mediche, Sapienza Università di Roma, Italy
| | - Guido Valesini
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e specialità Mediche, Sapienza Università di Roma, Italy
| | - Fabrizio Conti
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e specialità Mediche, Sapienza Università di Roma, Italy
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Chen Z, Li MT, Xu D, Leng XM, Wang Q, Tian XP, Zhang SZ, Zhao Y, Zeng XF. Organ damage in patients with incomplete lupus syndromes: from a Chinese academic center. Clin Rheumatol 2015; 34:1383-9. [PMID: 25687983 DOI: 10.1007/s10067-015-2884-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 01/06/2015] [Accepted: 01/22/2015] [Indexed: 11/24/2022]
Abstract
With this study, we provide insight into the clinical characteristics, laboratory characteristics, and organ damage associated with incomplete lupus syndromes (ILE) and search for predictors of organ damage in ILE. A retrospective chart review was performed on 77 hospitalized patients with ILE. The control patient group comprised 2104 systemic lupus erythematosus (SLE) patients who were entered into the Chinese SLE Treatment and Research group (CSTAR). The Systemic Lupus International Collaborating Clinics (SLICC)/ACR Damage Index (SDI) was used to classify damage features. Based on their SDI score, ILE patients were divided into SDI > 0 and SDI = 0 groups. The percentages of anti-SSA-seropositive (54.5 %) and anti-RNP-seropositive (24.7 %) patients with ILE were higher than those found among the SLE patients from CSTAR (p < 0.001). The mean SDI score was 0.66 (range 0-2), and a damage score greater than 0 was present in 41 (53.3 %) patients. The most prevalent damage category was pulmonary damage, present in 17 (22.1 %) patients. Peripheral vascular damage occurred in individuals who were significantly older than those who had musculoskeletal damage (p = 0.031). The subgroup with SDI > 0 had a higher mean age (36.8 ± 2.04 years) than those with SDI = 0 (30.8 ± 2.08 years; p = 0.044). The mean SLEDAI score in the SDI > 0 patient group (8.2 ± 0.74) was higher than that of the SDI = 0 group (4.8 ± 0.54; p = 0.001). ILE patients may include a subset that is likely to experience progressive organ damage. Organ damage was more common in patients of older age and with high SLEDAI scores.
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Affiliation(s)
- Zhen Chen
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, People's Republic China
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Preclinical features of lupus. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00125-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
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Arnaud L, Fagot JP, Mathian A, Paita M, Fagot-Campagna A, Amoura Z. Prevalence and incidence of systemic lupus erythematosus in France: A 2010 nation-wide population-based study. Autoimmun Rev 2014; 13:1082-9. [DOI: 10.1016/j.autrev.2014.08.034] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 06/15/2014] [Indexed: 12/16/2022]
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Abstract
Preclinical lupus encompasses a spectrum from enhanced SLE risk without clinical symptoms to individuals with autoantibodies and some SLE clinical features without meeting ACR classification. Studies have identified antibody and serological biomarkers years before disease onset. Incomplete lupus and undifferentiated connective tissue disease may occur during preclinical disease periods, but only 10-20% of these individuals transition to SLE and many have a mild disease course. Further studies are warranted to characterize biomarkers of early disease, identify individuals in need of close monitoring or preventive interventions, and elucidate mechanisms of disease pathogenesis without confounding factors of immunosuppressive medications or organ damage.
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Affiliation(s)
- Julie M Robertson
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, 825 Northeast 13th Street, Oklahoma City, OK 73104, USA
| | - Judith A James
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, 825 Northeast 13th Street, Oklahoma City, OK 73104, USA; Department of Medicine, University of Oklahoma Health Sciences Center, 1200 N. Phillips Avenue, Oklahoma City, OK 73104, USA; Department of Pathology, University of Oklahoma Health Sciences Center, 1200 N. Phillips Avenue, Oklahoma City, OK 73104, USA; Oklahoma Clinical and Translational Science Institute, University of Oklahoma Health Sciences Center, 1000 N. Lincoln Boulevard, Suite 2100, Oklahoma City, OK 73104, USA.
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Chan PC, Yu CH, Yeh KW, Horng JT, Huang JL. Comorbidities of pediatric systemic lupus erythematosus: A 6-year nationwide population-based study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014; 49:257-63. [PMID: 25066707 DOI: 10.1016/j.jmii.2014.05.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 04/14/2014] [Accepted: 05/09/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Systemic lupus erythematous (SLE) is a systemic and complex disease that can involve multiple organs. To clarify the risk of developing associated comorbidities after a diagnosis of SLE in children, we used the National Health Insurance Research Database (NHIRD) in Taiwan to investigate diseases experienced in these patients. This is the first nationwide population-based study of the comorbidities of pediatric SLE patients. METHODS The study was based on data from the NHIRD in Taiwan. Children were enrolled who were below the age of 18 years and whose disease corresponded to the International Classification of Disease, Ninth Revision Clinical Modification (ICD-9-CM) diagnostic code of 710.0 (SLE). The comorbidities associated with SLE were defined by the ICD-9-CM codes of diseases that presented after the SLE diagnosis. We analyzed the common diseases in SLE patients and compared the frequency of these diseases between pediatric SLE patients and the non-SLE population. RESULTS From January 1, 2003 to December 31, 2008, we enrolled 904 SLE patients (774 females, 130 males). Infection (86.36%) was the most common comorbidity in pediatric SLE. Other comorbidities were musculoskeletal diseases (16.7%), cardiovascular diseases (16.37%), ocular diseases (10.73%), and renal diseases (6.75%). Children with SLE had a higher risk of heart failure, hypertension, osteoporosis, cataracts, glaucoma, dyslipidemia, seizures, encephalopathy, and malignant changes, compared to non-SLE populations. CONCLUSION The population-based cohort demonstrated several systemic and/or chronic diseases in pediatric SLE patients in Taiwan. Children with SLE were more susceptible to these diseases, including malignancy, compared to the non-SLE population.
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Affiliation(s)
- Pei-Chun Chan
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chong-Hua Yu
- Department of Computer Science and Information Engineering, National Central University, Taoyuan, Taiwan
| | - Kuo-Wei Yeh
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Jorng-Tzong Horng
- Department of Computer Science and Information Engineering, National Central University, Taoyuan, Taiwan.
| | - Jing-Long Huang
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
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Economic burden of systemic lupus erythematosus flares and comorbidities in a commercially insured population in the United States. J Occup Environ Med 2014; 55:1262-70. [PMID: 24202242 DOI: 10.1097/jom.0000000000000008] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the medical and productivity-related cost burden of systemic lupus erythematosus (SLE) flares and comorbidities in a commercially insured population. METHODS Using administrative data, annual medical costs and indirect costs because of work loss were calculated for adult SLE patients, including flare severity and SLE-related comorbidity subsets, and a matched control group without SLE. RESULTS Adjusted annualized medical costs were $18,952, $4305, $914, and $441 greater for SLE patients with severe, moderate, mild, and no flares, respectively, during follow-up than those of the matched controls. Medical costs also varied by SLE-related comorbidity. Adjusted annualized indirect costs of work loss because of absence and short-term disability were $1867 and $1602 greater, respectively, for SLE patients than for controls. CONCLUSIONS SLE imposes a substantial cost burden to both patients and their employers.
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Doria A, Gatto M, Zen M, Iaccarino L, Punzi L. Optimizing outcome in SLE: treating-to-target and definition of treatment goals. Autoimmun Rev 2014; 13:770-7. [DOI: 10.1016/j.autrev.2014.01.055] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 01/22/2014] [Indexed: 12/15/2022]
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Chehab G, Sander O, Richter J, Acar H, Vordenbäumen S, Brinks R, Schneider M, Fischer-Betz R. Validation and evaluation of the German Brief Index of Lupus Damage (BILD)--a self-reported instrument to record damage in systemic lupus erythematosus. Lupus 2014; 22:1050-5. [PMID: 23963433 DOI: 10.1177/0961203313500369] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Damage is a very important predictor for outcome in systemic lupus erythematosus (SLE) and should be routinely documented. Patient-reported assessments for damage are rare and neither the Lupus Damage Index Questionnaire (LDIQ) nor the Brief Index of Lupus Damage (BILD) is validated in German language. Our aim was to validate the BILD in German language and evaluate its use as a patient-administered instrument. METHOD We translated and adapted the BILD questionnaire to use it as a self-administered questionnaire for German-speaking SLE patients. It was applied to SLE outpatients at an academic centre and compared to the SLICC/SDI and other lupus outcome parameters. RESULTS The German BILD showed as strong a correlation with the SLICC/SDI as the original version of the BILD and a superior correlation compared to the LDIQ. It scored significantly higher with an increase of age, disease duration or disease activity, with a lower functional status or overall health and a higher probability of receiving an incapacity pension. CONCLUSION The German version of the BILD shows a comparable validity to the original BILD with even higher correlation to physician-reported damage even when used as a self-administered questionnaire. Hence it represents a promising instrument to survey damage in clinical routine as well as in clinical and epidemiological studies.
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Affiliation(s)
- G Chehab
- Rheumatology, Heinrich-Heine-University, Duesseldorf, Germany.
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van Vollenhoven RF, Mosca M, Bertsias G, Isenberg D, Kuhn A, Lerstrøm K, Aringer M, Bootsma H, Boumpas D, Bruce IN, Cervera R, Clarke A, Costedoat-Chalumeau N, Czirják L, Derksen R, Dörner T, Gordon C, Graninger W, Houssiau F, Inanc M, Jacobsen S, Jayne D, Jedryka-Goral A, Levitsky A, Levy R, Mariette X, Morand E, Navarra S, Neumann I, Rahman A, Rovenský J, Smolen J, Vasconcelos C, Voskuyl A, Voss A, Zakharova H, Zoma A, Schneider M. Treat-to-target in systemic lupus erythematosus: recommendations from an international task force. Ann Rheum Dis 2014; 73:958-67. [DOI: 10.1136/annrheumdis-2013-205139] [Citation(s) in RCA: 446] [Impact Index Per Article: 44.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Ugarte-Gil MF, Acevedo-Vásquez E, Alarcón GS, Pastor-Asurza CA, Alfaro-Lozano JL, Cucho-Venegas JM, Segami MI, Wojdyla D, Soriano ER, Drenkard C, Brenol JC, de Oliveira e Silva Montandon AC, Costallat LTL, Massardo L, Molina-Restrepo JF, Guibert-Toledano M, Silveira LH, Amigo MC, Barile-Fabris LA, Chacón-Díaz R, Esteva-Spinetti MH, Pons-Estel GJ, McGwin G, Pons-Estel BA. The number of flares patients experience impacts on damage accrual in systemic lupus erythematosus: data from a multiethnic Latin American cohort. Ann Rheum Dis 2014; 74:1019-23. [PMID: 24525909 DOI: 10.1136/annrheumdis-2013-204620] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 01/24/2014] [Indexed: 01/27/2023]
Abstract
PURPOSE To determine the association between the number of flares systemic lupus erythematosus (SLE) patients experience and damage accrual, independently of other known risk factors. METHODS SLE patients (34 centres, nine Latin American countries) with a recent diagnosis (≤2 years) and ≥3 evaluations were studied. Disease activity was ascertained with the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and damage with the SLICC/ACR Damage Index (SDI). Flare was defined as an increase ≥4 points in the SLEDAI between two study visits. An ambidirectional case- crossover design was used to determine the association between the number of flares and damage accrual. RESULTS 901 patients were eligible for the study; 500 of them (55.5%) experienced at least one flare, being the mean number of flares 0.9 (SD: 1.0). 574 intervals from 251 patients were included in the case-crossover design since they have case and control intervals, whereas, the remaining patients did not. Their mean age at diagnosis was 27.9 years (SD: 11.1), 213 (84.9%) were women. The mean baseline SDI and SLEDAI were 1.3 (1.3) and 13.6 (8.1), respectively. Other features were comparable to those of the entire sample. After adjusting for possible confounding variables, the number of flares, regardless of their severity, was associated with damage accrual (SDI) OR 2.05, 95% CI 1.43 to 2.94, p<0.001 (OR 2.62, 95% CI 1.31 to 5.24, p=0.006 for severe and OR 1.91, 95% CI 1.28 to 2.83, p=0.001 for mild-moderate). CONCLUSIONS The number of flares patients experience, regardless of their severity, increases the risk of damage accrual, independently of other known risk factors.
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Affiliation(s)
- Manuel F Ugarte-Gil
- Servicio de Reumatología, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú. Universidad Científica del Sur, Lima, Perú
| | - Eduardo Acevedo-Vásquez
- Servicio de Reumatología, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú. Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Graciela S Alarcón
- Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Cesar A Pastor-Asurza
- Servicio de Reumatología, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú. Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - José L Alfaro-Lozano
- Servicio de Reumatología, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú
| | - Jorge M Cucho-Venegas
- Servicio de Reumatología, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú
| | - Maria I Segami
- Universidad Nacional Mayor de San Marcos, Lima, Perú Servicio de Reumatología, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Perú
| | | | - Enrique R Soriano
- Servicio de Reumatología, Hospital Italiano and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina
| | - Cristina Drenkard
- Division of Rheumatology, Emory University School of Medicine, Atlanta, USA
| | - João Carlos Brenol
- Hospital das Clinicas de Porto Alegre, Universidade Federal do, Rio Grande do Sul, Brazil
| | | | - Lilian T Lavras Costallat
- Divisao de Reumatologia, Faculdade de Ciencias Medicas, Universidade Estadual da Campinas, Campinas, Brazil
| | - Loreto Massardo
- Department of Clinical Immunology and Rheumatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - Luis H Silveira
- Departamento de Reumatología, Instituto Nacional de Cardiología Ignacio Chávez, México D.F., México
| | | | - Leonor A Barile-Fabris
- Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico D.F., Mexico
| | - Rosa Chacón-Díaz
- Servicio de Reumatología, Centro Nacional de Enfermedades Reumáticas, Hospital Universitario de Caracas, Caracas, Venezuela
| | | | - Guillermo J Pons-Estel
- Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA Department of Autoimmune Diseases, Institut Clinic de Medicina I Dermatologia, Hospital Clinic, Barcelona, Catalonia, Spain
| | - Gerald McGwin
- Department of Epidemiology, Schools of Medicine and Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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Voss A, Laustrup H, Hjelmborg J, Junker P. Survival in systemic lupus erythematosus, 1995–2010. A prospective study in a Danish community. Lupus 2013; 22:1185-91. [DOI: 10.1177/0961203313498796] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The objective of this paper is to investigate survival and causes of death in a Danish lupus population. Methods Two hundred and fifteen SLE patients (94% Caucasians) were followed prospectively for up to 16 years. Thirty-eight patients died. Survival rate and causes of death were analysed. Results Overall standardized mortality ratio (SMR) was 2.2. Peak values were recorded for patients aged 20–29 (SMR 21.1). Cumulated survival rates at one, five, 10 and 15 years were 98.6%, 93.6%, 86.5% and 73.0%, respectively. The most common causes of death were cardiovascular events (32%), respiratory system disease (16%) and malignancies (13%). Deaths due to infections and active SLE were rare and predominated within the first seven years after diagnosis and before age 40, while cardiovascular deaths prevailed after 20 years’ follow-up. Conclusion This study shows that despite progress in lupus management, including direct access to specialized hospital care and increased use of hydroxychloroquine, mortality in lupus patients is still increased. Main causes of death were active disease and infections among the young and newly diagnosed, while cardiovascular deaths prevailed in longstanding disease.
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Affiliation(s)
- A Voss
- Odense University Hospital, Denmark
| | | | | | - P Junker
- Odense University Hospital, Denmark
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Olsen NJ, Yousif M, Mutwally A, Cory M, Elmagboul N, Karp DR. Organ damage in high-risk patients with systemic and incomplete lupus syndromes. Rheumatol Int 2013; 33:2585-90. [PMID: 23715694 DOI: 10.1007/s00296-013-2783-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 05/16/2013] [Indexed: 01/19/2023]
Abstract
The objective of this study was to characterize organ damage in lupus patients enrolled in Dallas Regional Autoimmune Disease Registry (DRADR). Retrospective chart review was carried out on 99 patients with four or more diagnostic criteria for systemic lupus erythematosus (SLE) and 15 with less than four of these criteria, who were designated as having incomplete lupus erythematosus (ILE). The majority of patients (84 %) were African American or Hispanic/Latino; mean disease duration was 9.5 years. The mean damage score was 1.57 (range 0-8), and a damage score greater than 0 was present in 64 % of the patients. The ILE group had lower mean damage scores (0.67) than the SLE group (1.67; P = 0.04), explained in part by the shorter disease duration in the ILE patients (4.33 vs. 10.24 years; P = 0.003). The most prevalent damage category was renal, present in 24 % of patients. Malignancies occurred in individuals who were significantly older than those who had renal or peripheral vascular damage (P = 0.0007). The findings confirm clinical impressions that DRADR includes a high-risk lupus population. The ILE patients have less damage but also shorter disease duration, suggesting that this might represent an earlier disease stage. These results are consistent with the hypothesis that ILE patients include a subset that is likely to experience progressive organ damage. Longitudinal study of these patients has significant likelihood of tracking the changes that are correlated with disease progression to SLE.
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Affiliation(s)
- Nancy J Olsen
- Division of Rheumatology, Pennsylvania State University Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA,
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Alonso MD, Llorca J, Martinez-Vazquez F, Miranda-Filloy JA, Diaz de Teran T, Dierssen T, Vazquez-Rodriguez TR, Gomez-Acebo I, Blanco R, Gonzalez-Gay MA. Systemic lupus erythematosus in northwestern Spain: a 20-year epidemiologic study. Medicine (Baltimore) 2011; 90:350-358. [PMID: 21857367 DOI: 10.1097/md.0b013e31822edf7f] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
To further investigate the epidemiology of systemic lupus erythematosus (SLE) in southern Europe, we assessed the incidence, prevalence, clinical spectrum of the disease, flares, and survival of patients diagnosed with SLE in the Lugo region of northwestern Spain. Between January 1987 and December 2006, 150 Lugo residents were diagnosed as having SLE according to the 1982 American College of Rheumatology criteria for the classification of SLE. Women outnumbered men (127 [84.7%] vs. 23 [15.3%]). The mean age at the time of disease diagnosis was 46.1 ± 19.6 years. The mean follow-up from the time of disease diagnosis was 7.8 ± 4.5 years. The age- and sex-adjusted annual incidence rate over the 20-year study period was 3.6 (95% confidence interval [CI], 3.0-4.2) per 100,000 population aged 15 years and older. The overall annual incidence rate over the 20-year study period in women (5.9/100,000 population aged ≥ 15 yr; 95% CI, 4.9-7.0) was higher than in men (1.1/100,000 population aged ≥ 15 yr; 95% CI, 0.7-1.7) (p < 0.001). By December 31, 2006, the overall age-adjusted SLE prevalence in the Lugo region for patients who fulfilled at least 4 of 1982 American College of Rheumatology criteria was 17.5 per 100,000 population aged 15 years and older (95% CI, 12.6-24.1). Prevalence in women (29.2/100,000 population aged ≥ 15 yr; 95% CI, 20.0-40.7) was higher than in men (5.8/100,000 population aged ≥ 15 yr; 95% CI, 2.0-12.0). The most frequent clinical manifestation was arthritis. As reported in population-based studies on SLE patients of European descent, renal disease was observed in only 27.3% of the patients. The rate of flares was 0.084/year. A younger age and the presence of nephritis at the time of disease diagnosis were associated with the development of flares during the follow-up of Lugo patients. Compared with the general population the probability of survival in patients with SLE was significantly reduced (p = 0.04). In conclusion, the present study establishes a baseline estimate of the incidence and clinical spectrum of SLE in northwestern Spain. According to our results, the incidence of SLE in northwestern Spain is slightly higher than that reported in most European regions. Patients with SLE from northwestern Spain have a later average age onset and a lower frequency of nephritis than in the African-American population. However, our data show a reduced probability of survival in Spanish patients with SLE.
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Affiliation(s)
- Maria D Alonso
- From Divisions of Internal Medicine (MDA), Neurology (FM-V), and Rheumatology (JAM-F, TRV-R), Hospital Xeral-Calde, Lugo; Division of Preventive Medicine and Public Health, Division of Epidemiology and Computational Biology (IG-A, TD, JL), School of Medicine, University of Cantabria, Santander; CIBER Epidemiología y Salud Publica (CIBERESP), IFIMAV, Santander; and Divisions of Internal Medicine (TDdT) and Rheumatology (RB, MAG-G), Hospital Universitario Marques de Valdecilla, IFIMAV, Santander, Spain
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Varaprasad IR, Agrawal S, Prabu VNN, Rajasekhar L, Kanikannan MA, Narsimulu G. Posterior reversible encephalopathy syndrome in systemic lupus erythematosus. J Rheumatol 2011; 38:1607-11. [PMID: 21572160 DOI: 10.3899/jrheum.101308] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To study the clinical profile of posterior reversible encephalopathy syndrome (PRES) in patients with systemic lupus erythematosus (SLE) and analyze the risk factors and outcomes associated with it. METHODS We identified patients with SLE and PRES from January 2006 to October 2010. Data were collected on demographic details, lupus characteristics, PRES-related features, laboratory abnormalities, treatment details, and outcomes. RESULTS We studied 13 patients (all female) ages 14-37 years (median 23 yrs; 4 were aged < 18 yrs with juvenile SLE). Duration of lupus ranged from 1.5 to 36 months (median 6 mo). Six patients had PRES as a part of their initial presentation of lupus. All had active lupus and hypertension; 9 had nephritis. Four patients were on treatment with cyclophosphamide therapy when they developed PRES. Antihypertensives and antiepileptics were the mainstay of treatment along with supportive care. Immunosuppressive therapy was guided by lupus-related major organ manifestations. Two patients had focal neurological deficits; one had persistent hemiparesis at followup. One patient died. CONCLUSION PRES occurs in young lupus patients and in the early part of the disease. Focal deficits are not uncommon. It can be the presenting manifestation of lupus. Management is predominantly symptomatic. Immunosuppression is directed by other major organ manifestations. Early diagnosis and appropriate management is productive.
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Eilertsen GØ, Nikolaisen C, Becker-Merok A, Nossent JC. Interleukin-6 promotes arthritis and joint deformation in patients with systemic lupus erythematosus. Lupus 2011; 20:607-13. [DOI: 10.1177/0961203310392432] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The underlying mechanisms for the subsets of self-limiting, intermittent or chronic and deforming arthritis in systemic lupus erythematosus (SLE) are not well understood. We performed a cross-sectional analysis of pro-inflammatory cytokines (IL-1β, IL-2, IL-6, IL-8 and TNF-α) and joint status in 47 SLE patients (79% females, age 42 years, disease duration 8.6 years). All cytokines levels were significantly elevated in SLE patients compared with controls, but only IL-2 and IL-8 levels were higher than in patients with rheumatoid arthritis. SLE patients with ongoing synovitis (19%) and joint deformities (11%) had increased erythrocyte sedimentation rate (ESR), IL-6 and anti-dsDNA Ab levels. IL-6 levels correlated with ESR, anti-dsDNA Ab and haemoglobin, but not with C-reactive protein levels. Arthritis constitutes a considerable burden of disease in SLE over time, and joint deformations are associated with longstanding disease and arthritis flare rates. IL-6 is a potential biomarker and therapeutic target in the prevention of joint damage in SLE arthritis.
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Affiliation(s)
- GØ Eilertsen
- Department of Rheumatology, Institute of Clinical Medicine, University of Tromsø, Norway
| | - C Nikolaisen
- Department of Rheumatology, Institute of Clinical Medicine, University of Tromsø, Norway
| | - A Becker-Merok
- Department of Rheumatology, Institute of Clinical Medicine, University of Tromsø, Norway
| | - JC Nossent
- Department of Rheumatology, Institute of Clinical Medicine, University of Tromsø, Norway
- Department of Rheumatology, University Hospital Northern Norway, Tromsø, Norway
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