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Kuchcinski G, Rumetshofer T, Zervides KA, Lopes R, Gautherot M, Pruvo JP, Bengtsson AA, Hansson O, Jönsen A, Sundgren PCM. MRI BrainAGE demonstrates increased brain aging in systemic lupus erythematosus patients. Front Aging Neurosci 2023; 15:1274061. [PMID: 37927336 PMCID: PMC10622955 DOI: 10.3389/fnagi.2023.1274061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disease affecting multiple organs in the human body, including the central nervous system. Recently, an artificial intelligence method called BrainAGE (Brain Age Gap Estimation), defined as predicted age minus chronological age, has been developed to measure the deviation of brain aging from a healthy population using MRI. Our aim was to evaluate brain aging in SLE patients using a deep-learning BrainAGE model. Methods Seventy female patients with a clinical diagnosis of SLE and 24 healthy age-matched control females, were included in this post-hoc analysis of prospectively acquired data. All subjects had previously undergone a 3 T MRI acquisition, a neuropsychological evaluation and a measurement of neurofilament light protein in plasma (NfL). A BrainAGE model with a 3D convolutional neural network architecture, pre-trained on the 3D-T1 images of 1,295 healthy female subjects to predict their chronological age, was applied on the images of SLE patients and controls in order to compute the BrainAGE. SLE patients were divided into 2 groups according to the BrainAGE distribution (high vs. low BrainAGE). Results BrainAGE z-score was significantly higher in SLE patients than in controls (+0.6 [±1.1] vs. 0 [±1.0], p = 0.02). In SLE patients, high BrainAGE was associated with longer reaction times (p = 0.02), lower psychomotor speed (p = 0.001) and cognitive flexibility (p = 0.04), as well as with higher NfL after adjusting for age (p = 0.001). Conclusion Using a deep-learning BrainAGE model, we provide evidence of increased brain aging in SLE patients, which reflected neuronal damage and cognitive impairment.
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Affiliation(s)
- Grégory Kuchcinski
- Division of Diagnostic Radiology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
- Lund University BioImaging Centre, Lund University, Lund, Sweden
- Inserm, CHU Lille, U1172 – LilNCog – Lille Neuroscience & Cognition, Univ. Lille, Lille, France
| | - Theodor Rumetshofer
- Division of Diagnostic Radiology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
- Division of Logopedics, Phoniatrics and Audiology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Kristoffer A. Zervides
- Division of Rheumatology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Renaud Lopes
- Inserm, CHU Lille, U1172 – LilNCog – Lille Neuroscience & Cognition, Univ. Lille, Lille, France
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Morgan Gautherot
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Jean-Pierre Pruvo
- Inserm, CHU Lille, U1172 – LilNCog – Lille Neuroscience & Cognition, Univ. Lille, Lille, France
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Anders A. Bengtsson
- Division of Rheumatology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Oskar Hansson
- Clinical Memory Research Unit, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Andreas Jönsen
- Division of Rheumatology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Pia C. Maly Sundgren
- Division of Diagnostic Radiology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
- Lund University BioImaging Centre, Lund University, Lund, Sweden
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Chung CP, Karakoc G, Dickson A, Liu G, Gamboa JL, Mosley JD, Cox NJ, Kawai VK. APOL1 and the risk of adverse renal outcomes in patients of African ancestry with systemic lupus erythematosus. Lupus 2023; 32:763-770. [PMID: 37105192 DOI: 10.1177/09612033231172660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) disproportionately affects individuals of African ancestry (AA) compared to European ancestry (EA). In the general population, high risk (HR) variants in the apolipoprotein L1 (APOL1) gene increase the risk of renal and hypertensive disorders in individuals of AA. Since SLE is characterized by an interferon signature and APOL1 expression is driven by interferon, we examined the hypothesis that APOL1 HR genotypes predominantly drive higher rates of renal and hypertensive-related comorbidities observed in SLE patients of AA versus those of EA. METHODS We performed a retrospective cohort study in patients with SLE of EA and AA using a genetic biobank linked to de-identified electronic health records. APOL1 HR genotypes were defined as G1/G1, G2/G2, or G1/G2 and low risk (LR) genotypes as 1 or 0 copies of the G1 and G2 alleles. To identify renal and hypertensive-related disorders that differed in prevalence by ancestry, we used a phenome-wide association approach. We then used logistic regression to compare the prevalence of renal and hypertensive-related disorders in EA and AA patients, both including and excluding patients with the APOL1 HR genotype. In a sensitivity analysis, we examined the association of end stage renal disease secondary to lupus nephritis (LN-related ESRD) with ancestry and the APOL1 genotype. RESULTS We studied 784 patients with SLE; 195 (24.9%) were of AA, of whom 27 (13.8%) had APOL1 HR genotypes. Eighteen renal and hypertensive-related phenotypes were more common in AA than EA patients (p-value ≤ 1.4E-4). All phenotypes remained significantly different after exclusion of patients with APOL1 HR genotypes, and most point odds ratios (ORs) decreased only slightly. Even among ORs with the greatest decrease, risk for AA patients without the APOL1 HR genotype remained significantly elevated compared to EA patients. In the sensitivity analysis, LN-related ESRD was more prevalent in SLE patients of AA versus EA and AA patients with the APOL1 HR genotype versus LR (p-value < .05 for both). CONCLUSION The higher prevalence of renal and hypertensive disorders in SLE patients of AA compared to those of EA is not fully explained by the presence of APOL1 high risk variants.
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Affiliation(s)
- Cecilia P Chung
- Division of Rheumatology and Immunology, Department of Medicine Vanderbilt University Medical Center, Nashville, TN, USA
- Tennessee Valley Healthcare System - Nashville Campus, Nashville, TN, USA
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Rheumatology, University of Miami, Miami, FL, USA
- Miami VA Healthcare System, Miami, FL, USA
| | - Gul Karakoc
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alyson Dickson
- Division of Rheumatology and Immunology, Department of Medicine Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ge Liu
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jorge L Gamboa
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonathan D Mosley
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Nancy J Cox
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Vivian K Kawai
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
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Williams EM, Nelson J, Francis D, Corbin K, Link G, Caldwell T, Gilkeson G. Formative research to promote lupus awareness and early screening at Historically Black College and University (HBCU) communities in South Carolina. BMC Rheumatol 2022; 6:92. [PMID: 36585733 PMCID: PMC9805239 DOI: 10.1186/s41927-022-00323-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 12/01/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Systemic lupus erythematosus or lupus is a severe chronic autoimmune disorder that disproportionately impacts young African Americans. Increasing lupus awareness in this high-risk group may be an effective approach to ultimately improving lupus outcomes. To begin to address this disparity, this report describes qualitative data to be utilized in the development of a campaign to enhance awareness of lupus on Historically Black Colleges and University (HBCU) campuses. METHODS Two focus groups (N = 14) were held with African American students in the network of HBCU's in South Carolina to examine perspectives of focus group participants on knowledge, awareness, and experiences with lupus. RESULTS Five key emergent themes included: (1) Lupus Knowledge and Awareness, (2) Barriers for Not Seeking Healthcare, (3) Fatalism for Disease Burden, (4) Lifestyle Debilitation, and (5) Elevation of Education and Advocacy for Lupus. Additionally, five key recommendations emerged to improve lupus awareness and support, including: (1) remaining positive, (2) developing a supportive network, (3) the importance of increasing advocacy efficacy, and (4) messaging strategies around lupus, and (5) providing education to foster knowledge around the clinical impacts of lupus. CONCLUSION Participants in our study stressed the necessity of lupus education and awareness among African American youth and expressed the desire for resources that would enable them to advocate for themselves and their families. Given the early age of onset for lupus, it is therefore vital to include African American youth in increasing education and awareness about lupus.
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Affiliation(s)
- Edith M. Williams
- Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd, CU 420708, Rochester, NY 14642 USA
| | - Joni Nelson
- James B. Edwards College of Dental Medicine, Medical University of South Carolina, 73 Ashley Ave, BSB 127, Charleston, SC 29425 USA
| | - Diane Francis
- Department of Communication, University of Kentucky, 343 S. Martin Luther King Blvd, Lexington, KY 40506 USA
| | - Keesha Corbin
- James B. Edwards College of Dental Medicine, Medical University of South Carolina, 73 Ashley Ave, BSB 127, Charleston, SC 29425 USA
| | - Gary Link
- Division of Rheumatology and Immunology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425 USA
| | - Tomika Caldwell
- Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd, CU 420708, Rochester, NY 14642 USA
| | - Gary Gilkeson
- Division of Rheumatology and Immunology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425 USA
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Orefice V, Ceccarelli F, Pirone C, Galoppi P, Spinelli FR, Alessandri C, Brunelli R, Perrone G, Conti F. Breastfeeding in women affected by systemic lupus erythematosus: Rate, duration and associated factors. Lupus 2021; 30:913-920. [PMID: 33611966 DOI: 10.1177/0961203321995263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Breastfeeding is a crucial moment for both mothers and child, providing a beneficial effect on child survival, nutrition, development and on maternal health. Despite the prevalent involvement of childbearing women in systemic lupus erythematosus (SLE), breastfeeding is still a neglected topic. The objective of this study was to evaluate breastfeeding frequency, duration and associated factors in SLE women. METHODS We consecutively enrolled SLE pregnant women reporting demographic, clinical, serological, gynaecological and obstetric data. Breastfeeding experience was evaluated by using a specific questionnaire. Disease activity was assessed before and during pregnancy as well as during postpartum. RESULTS A total of 57 pregnancies in 43 SLE women were included in the present study. In almost all the pregnancies, mothers planned to breastfeed their child (96.5%) and forty-one (71.9%) actually did breastfeed. The median time of breastfeeding was 3 months (IQR 7). Non-breastfeeding women showed a more frequent caesarean section (p = 0.0001), IUGR occurrence (p = 0.004) and disease relapse (p = 0.0001) after pregnancy. When comparing patients according with breastfeeding duration (cut-off 6 months), we found a significant more frequent smoking habitus (p = 0.02), caesarean section (p = 0.009), and joint involvement during postpartum (p = 0.0001) in women breastfeeding for less than or equal to 6 months, together with higher median BMI (p = 0.0001). Moreover, breastfeeding duration was positively associated with disease duration and hydroxychloroquine (HCQ) treatment during disease history, pregnancy and postpartum. CONCLUSIONS SLE women didn't show lower breastfeeding rate in comparison with general population but they presented higher prevalence of early discontinuation within three months. Early interruption was positively associated with smoking, BMI, joint involvement; meanwhile disease duration and HCQ treatment during postpartum were positively associated with a longer breastfeeding duration.
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Affiliation(s)
- Valeria Orefice
- Lupus Clinic, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza University of Rome, Rome, Italy
| | - Fulvia Ceccarelli
- Lupus Clinic, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza University of Rome, Rome, Italy
| | - Carmelo Pirone
- Lupus Clinic, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza University of Rome, Rome, Italy
| | - Paola Galoppi
- Dipartimento di Scienze Ginecologiche-Ostetriche e Urologiche, Sapienza University of Rome, Rome, Italy
| | - Francesca Romana Spinelli
- Lupus Clinic, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza University of Rome, Rome, Italy
| | - Cristiano Alessandri
- Lupus Clinic, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza University of Rome, Rome, Italy
| | - Roberto Brunelli
- Dipartimento di Scienze Ginecologiche-Ostetriche e Urologiche, Sapienza University of Rome, Rome, Italy
| | - Giuseppina Perrone
- Dipartimento di Scienze Ginecologiche-Ostetriche e Urologiche, Sapienza University of Rome, Rome, Italy
| | - Fabrizio Conti
- Lupus Clinic, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza University of Rome, Rome, Italy
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Signorini V, Tani C, Elefante E, Carli L, Stagnaro C, Zucchi D, Parma A, Vagelli R, Ferro F, Mosca M. How do systemic lupus erythematosus patients with very-long disease duration present? Analysis of a monocentric cohort. Lupus 2021; 30:439-447. [PMID: 33413007 DOI: 10.1177/0961203320984230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE to describe the disease path and the very long-term outcome in a monocentric cohort of patients with Systemic Lupus Erythematosus (SLE). METHODS SLE patients with a disease duration of at least 15 years from diagnosis were enrolled. The number of hospitalizations, the disease flares occurred over the disease course and the organ damage accumulation were evaluated at 1, 2, 3, 4, 5, 10 years from diagnosis and at last observation in 2019 as well. Disease state, ongoing therapies and quality of life measures were also assessed at last visit. RESULTS 126 Caucasian SLE patients were included in the analysis (95% female, median age 47.5 IQR 41-53, median disease duration 21 IQR19-26). At last visit, the majority of the patients (78.6%) was on LLDAS (remission included), 53.4% were on GC treatment and 35.7% on immunosuppressant. Furthermore, 53.2% had at least one organ damage. The majority of patients (66.7%) presented a relapsing-remitting course, for a total of 158 flares during the disease course (incidence rate: 0.79/patient-year); moreover, 84.9% of the cohort experienced at least one hospital admission, amounting to a total of 328 hospitalizations (incidence rate: 0.85/patient-year). The main reason for admission was disease activity, while the percentage of hospitalizations due to other causes has been growing over the 10 years of follow-up. CONCLUSION after a very long period of disease, most of the patients with SLE are in remission and are not taking GC therapy; however, the risk of incurring in disease flare remains a real problem.
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Affiliation(s)
- Viola Signorini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chiara Tani
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elena Elefante
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Linda Carli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chiara Stagnaro
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Dina Zucchi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alice Parma
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Roberta Vagelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesco Ferro
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marta Mosca
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Eldeiry D, Zandy M, Tayer-Shifman OE, Kwan A, Marzouk S, Su J, Bingham K, Touma Z. Association between depression and anxiety with skin and musculoskeletal clinical phenotypes in systemic lupus erythematosus. Rheumatology (Oxford) 2020; 59:3211-3220. [DOI: 10.1093/rheumatology/keaa098] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
Abstract
Objectives
To study the clinical phenotypes, determined based on cumulative disease activity manifestations, and sociodemographic factors associated with depression and anxiety in SLE.
Methods
Patients attending a single centre were assessed for depression and anxiety. SLE clinical phenotypes were based on the organ systems of cumulative 10-year SLE Disease Activity Index 2000 (SLEDAI-2K), prior to visit. Multivariable logistic regression analyses for depression, anxiety, and coexisting anxiety and depression were performed to study associated SLE clinical phenotypes and other factors.
Results
Among 341 patients, the prevalence of anxiety and depression was 34% and 27%, respectively, while 21% had coexisting anxiety and depression. Patients with skin involvement had significantly higher likelihood of anxiety compared with patients with no skin involvement [adjusted odds ratio (aOR) = 1.8; 95% CI: 1.1, 3.0]. Patients with skin involvement also had higher likelihood of having coexisting anxiety and depression (aOR = 2.0, 95% CI: 1.2, 3.9). Patients with musculoskeletal (MSK) (aOR = 1.9; 95% CI: 1.1, 3.5) and skin system (aOR = 1.8; 95% CI: 1.04, 3.2) involvement had higher likelihood of depression compared with patients without skin or musculoskeletal involvement. Employment status and fibromyalgia at the time of the visit, and inception status were significantly associated with anxiety, depression, and coexisting anxiety and depression, respectively.
Conclusion
SLE clinical phenotypes, specifically skin or MSK systems, along with fibromyalgia, employment and shorter disease duration were associated with anxiety or depression. Routine patient screening, especially among patients with shorter disease duration, for these associations may facilitate the diagnosis of these mental health disorders, and allow for more timely diagnosis.
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Affiliation(s)
- David Eldeiry
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Medicine, Division of Rheumatology, University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital
| | - Moe Zandy
- Department of Medicine, Division of Rheumatology, University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital
| | - Oshrat E Tayer-Shifman
- Department of Medicine, Division of Rheumatology, University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital
| | - Andrew Kwan
- Department of Medicine, Division of Rheumatology, University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital
| | | | - Jiandong Su
- Department of Medicine, Division of Rheumatology, University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital
| | - Kathleen Bingham
- Centre for Mental Health, Psychiatry Department, University Health Network, Toronto General Hospital
| | - Zahi Touma
- Department of Medicine, Division of Rheumatology, University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital
- Institute of Health Policy, University of Toronto, Toronto, Ontario, Canada
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González LA, Pons-Estel GJ, Toloza SMA, Ugarte-Gil MF, Alarcón GS. Understanding Risk Factors for Poor Outcomes in a Multiethnic Longitudinal Cohort: The LUMINA (Lupus in Minorities: Nature vs. Nurture) Experience (LUMINA LXXXII). Rheum Dis Clin North Am 2020; 47:55-64. [PMID: 34042054 DOI: 10.1016/j.rdc.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Lupus in Minorities: Nature Vs Nurture (LUMINA) cohort has placed Hispanics on the lupus map in the United States. Texan Hispanic and African American patients experience, overall, worse outcomes than the Caucasian and Puerto Rican Hispanic patients. The genetic component of ethnicity is important early in the disease course whereas socioeconomic factors become more important subsequently. The role of hydroxychloroquine in preventing damage accrual and reducing mortality in lupus patients is a major contribution of LUMINA.
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Affiliation(s)
- Luis Alonso González
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Universidad de Antioquia, Hospital Universitario de San Vicente Fundación, Medellín, Colombia
| | - Guillermo J Pons-Estel
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR). Rosario, Argentina; Rheumatology Department, Hospital Provincial de Rosario, Rosario, Argentina
| | - Sergio M A Toloza
- Department of Medicine, Rheumatology Unit, Hospital San Juan Bautista, San Fernando del Valle de Catamarca, Catamarca, Argentina
| | - Manuel Francisco Ugarte-Gil
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú; Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Perú
| | - Graciela S Alarcón
- Division of Clinical Immunology and Rheumatology, Department of Medicine, School of Medicine, The University of Alabama at Birmingham, USA; Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia. Lima, Perú.
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Babaoğlu H, Li J, Goldman D, Magder LS, Petri M. Time to Lupus Low Disease Activity State in the Hopkins Lupus Cohort: Role of African American Ethnicity. Arthritis Care Res (Hoboken) 2020; 72:225-232. [PMID: 31507071 DOI: 10.1002/acr.24063] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/03/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Lupus low disease activity state (LLDAS) is a potential treat-to-target goal in systemic lupus erythematosus (SLE). This study determined predictors of time to reach LLDAS in a longitudinal cohort. METHODS Patients were grouped according to LLDAS status at cohort entry. Those who did not satisfy LLDAS at cohort entry were analyzed prospectively. The Kaplan-Meier approach was used to estimate the time to LLDAS. Cox regression was used to identify patient characteristics that were associated with time to LLDAS. RESULTS The probability of LLDAS attainment within 1 year was 52% for Caucasians, 36% for African Americans, and 33% for SLE patients with renal involvement. The median time to LLDAS was 1.1 years. In multivariable models, African American ethnicity, baseline prednisone >10 mg daily, hypocomplementemia, baseline damage, and baseline renal activity remained significant predictors of longer time to attain LLDAS, while disease duration <1 year and cutaneous activity were associated with earlier attainment. CONCLUSION LLDAS is potentially attainable in the majority of SLE patients. The time to LLDAS was found to be longer in African American patients with SLE. Characteristics of African American patients with SLE, such as renal activity and hypocomplementemia, were also independent predictors of slower attainment of LLDAS. These findings point to the need to include African American patients with SLE in both clinical and pharmaceutical research.
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Affiliation(s)
- Hakan Babaoğlu
- Johns Hopkins University School of Medicine, Baltimore, Maryland, and Gazi University School of Medicine, Ankara, Turkey
| | - Jessica Li
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel Goldman
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Babaoglu H, Li J, Goldman D, Magder LS, Petri M. Predictors of predominant Lupus Low Disease Activity State (LLDAS-50). Lupus 2019; 28:1648-1655. [PMID: 31694446 DOI: 10.1177/0961203319886028] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM The Lupus Low Disease Activity State (LLDAS) is a potential treat to target goal in systemic lupus erythematosus (SLE). SLE patients in LLDAS for more than half of the observation time have about a 50% lower risk of new organ damage and have reduced mortality. We identified predictors of being in LLDAS ≥50% of the observation time. METHODS A total of 2228 SLE patients who had at least three clinical visits were included. Percentage of time in LLDAS was calculated based on the proportion of days under observation. LLDAS-50 was defined as being in LLDAS for ≥50% of the observation time. We used the stepwise selection procedure in logistic regression to identify predictors of LLDAS-50. RESULTS A total of 1169 (52.5%) SLE patients, but only 37.6% of African Americans, achieved LLDAS-50. In the multivariable model, African American ethnicity, hypocomplementemia, serositis, renal activity, arthritis, anti-RNP, anti-dsDNA, vasculitis, malar rash, discoid rash, thrombocytopenia, and immunosuppressive use were negative predictors of LLDAS-50. Older age at diagnosis, longer disease duration, higher education level, and greater percentage of time taking hydroxychloroquine remained positive predictors of LLDAS-50. CONCLUSION In this large cohort, only 52.5% achieved LLDAS-50. This proportion was even less in African Americans. A higher percentage of time taking hydroxychloroquine was a modifiable positive predictor of LLDAS-50. Anti-RNP, anti-dsDNA, and low complement were negatively associated with LLDAS-50. Our findings further emphasize the importance of inclusion of African Americans in clinical trials and hydroxychloroquine adherence in both clinical practice and clinical trials.
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Affiliation(s)
- H Babaoglu
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Division of Rheumatology, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - J Li
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - D Goldman
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - L S Magder
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland, USA
| | - M Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Peschken CA, Wang Y, Abrahamowicz M, Pope J, Silverman E, Sayani A, Iczkovitz S, Ross J, Zummer M, Tucker L, Pineau C, Levy D, Hudson M, Hitchon CA, Huber AM, Smith CD, Avina-Zubieta A, Arbillaga H, Chédeville G, Wynant W, Fortin PR. Persistent Disease Activity Remains a Burden for Patients with Systemic Lupus Erythematosus. J Rheumatol 2018; 46:166-175. [DOI: 10.3899/jrheum.171454] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2018] [Indexed: 12/26/2022]
Abstract
Objective.Persistent systemic lupus erythematosus (SLE) disease activity is associated with increased morbidity and mortality. In a multicenter cohort of patients with prevalent SLE, we described persistence, patterns, and predictors of change in disease activity over time.Methods.Based on SLE Disease Activity Index (SLEDAI)-2K scores at cohort entry, patients were classified into 4 groups: low (score < 4; LOW), moderate (4 to < 6; MOD), moderately high (6 to ≤ 10; MHIGH), and very high (> 10; VHIGH). Multivariable linear and longitudinal mixed linear regression models were used to identify predictors of change over time in SLEDAI-2K.Results.There were 2019 participants, with declining followup data over 5 years (1326, 580, 274, 186, and 148 patients, respectively). At cohort entry, mean (± SD) age was 42 (± 17) years, disease duration 11 (± 10) years, and 90% were female. The 4 groups included 44% LOW (n = 891), 20% MOD (n = 400), 22% MHIGH (n = 442), and 14% VHIGH (n = 286); therefore, 36% had clinically important SLE activity. The proportion of patients in the LOW group at entry who moved to a higher activity level varied from 30% (167/557) at 1 year, to 49% (41/83) at 3 years, and 54% (30/56) at 5 years. Among 181 patients with MOD to VHIGH entry activity and 3 years of followup, 116 (64.1%) remained active. In all analyses, only higher SLEDAI-2K at cohort entry remained a significant predictor of higher SLEDAI-2K in subsequent years.Conclusion.Higher SLEDAI-2K at study entry was the single major independent predictor of higher SLEDAI-2K over time, reflecting frequent persistence of active disease, even in patients with longstanding disease. This highlights gaps in the optimal treatment of SLE.
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Lewis MJ, Jawad AS. The effect of ethnicity and genetic ancestry on the epidemiology, clinical features and outcome of systemic lupus erythematosus. Rheumatology (Oxford) 2017; 56:i67-i77. [PMID: 27940583 DOI: 10.1093/rheumatology/kew399] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Indexed: 01/03/2023] Open
Abstract
In this in-depth review, we examine the worldwide epidemiology of SLE and summarize current knowledge on the influence of race/ethnicity on clinical manifestations, disease activity, damage accumulation and outcome in SLE. Susceptibility to SLE has a strong genetic component, and trans-ancestral genetic studies have revealed a substantial commonality of shared genetic risk variants across different genetic ancestries that predispose to the development of SLE. The highest increased risk of developing SLE is observed in black individuals (incidence 5- to 9-fold increased, prevalence 2- to 3-fold increased), with an increased risk also observed in South Asians, East Asians and other non-white groups, compared with white individuals. Black, East Asian, South Asian and Hispanic individuals with SLE tend to develop more severe disease with a greater number of manifestations and accumulate damage from lupus more rapidly. Increased genetic risk burden in these populations, associated with increased autoantibody reactivity in non-white individuals with SLE, may explain the more severe lupus phenotype. Even after taking into account socio-economic factors, race/ethnicity remains a key determinant of poor outcome, such as end-stage renal failure and mortality, in SLE. Community measures to expedite diagnosis through increased awareness in at-risk racial/ethnic populations and ethnically personalized treatment algorithms may help in future to improve long-term outcomes in SLE.
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Affiliation(s)
- Myles J Lewis
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ali S Jawad
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Abstract
INTRODUCTION Systemic lupus erythematosus (SLE) is a disease distributed worldwide, which occurs in both genders, and across racial/ethnic and age groups; however, higher rates are observed in adults, in women and in non-Caucasians. Genetic, environmental, sociodemographic and methodological issues are responsible not only for these differences but for the variable course and outcome of the disease. Non-Caucasians have a more severe disease with a higher risk for early mortality and damage accrual. Males also have a more severe disease; however, a negative impact of male gender on lupus outcomes has not been firmly established. Childhood-onset is associated with a more severe disease; moreover, it is also associated with higher damage and diminished survival; finally, late-onset lupus is mild but it is associated with higher damage accrual and a diminished survival. Areas covered: In this review, we discuss the incidence and prevalence of SLE, the impact of age, gender and race/ethnicity in SLE and in the survival of those affected. Expert commentary: Age, gender and race/ethnicity impact disease expression in SLE patients; despite improvements in survival, mortality in SLE remains almost three times higher than in the general population.
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Affiliation(s)
- Guillermo J Pons-Estel
- a Department of Autoimmune Diseases , Institut Clinic de Medicina I Dermatologia, Hospital Clinic , Barcelona , Catalonia , Spain.,b Division of Rheumatology and Autoimmune Diseases , Sanatorio Parque, Grupo Oroño , Rosario , Argentina
| | - Manuel F Ugarte-Gil
- c Servicio de Reumatología , Hospital Nacional Guillermo Almenara Irigoyen, EsSalud , Lima , Perú.,d School of Medicine , Universidad Científica del Sur , Lima , Perú
| | - Graciela S Alarcón
- e Division of Clinical Immunology and Rheumatology, School of Medicine , The University of Alabama at Birmingham , Birmingham , AL , USA.,f Department of Medicine, School of Medicine , Universidad Peruana Cayetano Heredia , Lima , Perú
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Plantinga L, Lim SS, Bowling CB, Drenkard C. Association of age with health-related quality of life in a cohort of patients with systemic lupus erythematosus: the Georgians Organized Against Lupus study. Lupus Sci Med 2016; 3:e000161. [PMID: 27547440 PMCID: PMC4964216 DOI: 10.1136/lupus-2016-000161] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/24/2016] [Accepted: 06/27/2016] [Indexed: 01/23/2023]
Abstract
Objective To examine whether older age was associated with lower health-related quality of life (HRQOL) among patients with systemic lupus erythematosus (SLE) and whether differential disease-related damage and activity explained these associations. Methods We used cross-sectional data on 684 patients with SLE aged ≥20 years from the Georgians Organized Against Lupus cohort to estimate the associations between age (categorised as 20–39, 40–59 and ≥60 years) and HRQOL (Short Form-12 norm-based domain and physical component summary (PCS) and mental component summary (MCS) scores), using multivariable linear regression. We then examined the effect of disease-related damage and activity on these associations. Results The mean age of the cohort was 48.2±13.1 years (range, 20–88 years), with 28.0%, 52.9% and 19.1% of participants being aged 20–39, 40–59 and ≥60 years, respectively; 79.0% were African-American and 93.7% were female. The mean PCS score was 39.3 (41.8, 38.7 and 37.4 among those aged 20–39, 40–59 and ≥60 years, respectively), while the mean MCS score was 44.3 (44.2, 43.8 and 46.1, respectively). In general, lower physical but not mental HRQOL scores were associated with older age. With adjustment, older ages (40–59 and ≥60, respectively, vs 20–39) remained associated (β (95% CI)) with lower PCS (−2.53 (−4.58 to −0.67) and −3.57 (−6.19 to −0.96)) but not MCS (0.47 (−1.46 to 2.41) and 1.20 (−1.52 to 3.92)) scores. Associations of age with HRQOL domain and summary scores were not substantially changed by further adjustment for disease-related damage and/or activity. Conclusions Nearly one in five participants in this large, predominantly African-American cohort of patients with SLE was at least 60 years old. The associations of older age with lower physical, but not mental, HRQOL were independent of accumulated SLE damage and current SLE activity. The results suggest that studies of important geriatric outcomes in the setting of SLE are needed to inform patient-centred clinical care of the ageing SLE population.
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Affiliation(s)
- Laura Plantinga
- Division of Renal Medicine, Emory University, Atlanta, Georgia, USA; Division of Geriatrics and General Medicine, Emory University, Atlanta, Georgia, USA
| | - S Sam Lim
- Division of Rheumatology, Department of Medicine , Emory University , Atlanta, Georgia , USA
| | - C Barrett Bowling
- Division of Geriatrics and General Medicine, Emory University, Atlanta, Georgia, USA; Birmingham/Atlanta VA Geriatrics Research and Clinical Center, Atlanta, Georgia, USA
| | - Cristina Drenkard
- Division of Rheumatology, Department of Medicine , Emory University , Atlanta, Georgia , USA
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Watson P, Brennan A, Birch H, Fang H, Petri M. An integrated extrapolation of long-term outcomes in systemic lupus erythematosus: analysis and simulation of the Hopkins lupus cohort. Rheumatology (Oxford) 2014; 54:623-32. [PMID: 25234659 DOI: 10.1093/rheumatology/keu375] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The aim of this study was to develop an SLE disease model that simulates long-term outcomes of SLE to estimate the long-term effectiveness and cost-effectiveness of SLE treatments. METHODS Longitudinal data from 1354 patients from the Hopkins Lupus Cohort were included in the analysis. Statistical models were created to estimate disease activity [Safety of Estrogen in Lupus Erythematosus National Assessment (SELENA) SLEDAI scale] and prednisone dose over time using linear regression. Survival models for organ damage and mortality were created. The models were combined in a predictive simulation of SLE organ damage and mortality. Predictions were assessed against the Hopkins Lupus Cohort data. RESULTS The analyses found that change in the annual average SLEDAI score was associated with the previous annual average SLEDAI score, renal involvement, age, male gender, African American ethnicity, anaemia, haematological involvement, increased DNA binding and low complement. The annual average prednisone dose increased for every unit increase in annual average SLEDAI. Organ damage and mortality modelling demonstrated that adjusted mean SLEDAI and binary SLEDAI organ involvement indicators predicted mortality, cardiovascular, renal, neuropsychiatric, pulmonary, gastrointestinal, ocular and skin damage. The cumulative average prednisone dose was associated with risk of cardiovascular, ocular, musculoskeletal, neuropsychiatric and gastrointestinal damage, gonadal failure and diabetes mellitus. The simulation reproduced mean SLEDAI and organ damage scores from the Hopkins Lupus Cohort. CONCLUSION Longitudinal modelling of an SLE cohort confirmed relationships between risk factors and long-term outcomes in SLE. The models serve to estimate the probability of SLE outcomes over time and can be used to estimate the effectiveness and cost-effectiveness of new treatments.
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Affiliation(s)
- Penny Watson
- School of Health and Related Research, University of Sheffield, Sheffield, UK, Global Health Outcomes, GlaxoSmithKline, Uxbridge, UK and Department of Medicine-Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, UK, Global Health Outcomes, GlaxoSmithKline, Uxbridge, UK and Department of Medicine-Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Helen Birch
- School of Health and Related Research, University of Sheffield, Sheffield, UK, Global Health Outcomes, GlaxoSmithKline, Uxbridge, UK and Department of Medicine-Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hong Fang
- School of Health and Related Research, University of Sheffield, Sheffield, UK, Global Health Outcomes, GlaxoSmithKline, Uxbridge, UK and Department of Medicine-Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michelle Petri
- School of Health and Related Research, University of Sheffield, Sheffield, UK, Global Health Outcomes, GlaxoSmithKline, Uxbridge, UK and Department of Medicine-Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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González LA, Toloza SMA, McGwin G, Alarcón GS. Ethnicity in systemic lupus erythematosus (SLE): its influence on susceptibility and outcomes. Lupus 2014; 22:1214-24. [PMID: 24097993 DOI: 10.1177/0961203313502571] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ethnicity is a biological and a social construct which encompasses ancestral genes, cultural, geographic and socioeconomic characteristics shared within a population. It is clear that no homogeneous racial groups exist within the human race as demonstrated when examining ancestry informative markers. Both the genetic and non-genetic components of ethnicity exert influence in the expression and outcome of systemic lupus erythematosus (SLE), including disease activity, damage accrual, work disability and mortality. Although it is difficult to determine the extent to which the differences observed in these parameters are caused by genetic or non-genetic factors, early in the disease genetic factors seem to play a more important role as determinants of the differences observed between SLE patients from various ethnic groups. Over the course of the disease, non-genetic factors seem to play a more important role. By and large, SLE is more frequent and more severe with higher disease activity and more damage accrual in non-Caucasian populations (Hispanics, African descendants and Asians) than in Caucasians. To overcome these differences it is necessary to optimize health care access to disadvantaged populations and use innovative tools to increase disease awareness and improve treatment adherence.
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Affiliation(s)
- L A González
- 1Division of Rheumatology, Universidad de Antioquia, Medellín, Colombia; Hospital San Juan Bautista, San Fernando del Valle de Catamarca, Argentina; Departments of Epidemiology and Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA; and Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
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Garcia MA, Alarcon GS, Boggio G, Hachuel L, Marcos AI, Marcos JC, Gentiletti S, Caeiro F, Sato EI, Borba EF, Brenol JCT, Massardo L, Molina-Restrepo JF, Vasquez G, Guibert-Toledano M, Barile-Fabris L, Amigo MC, Huerta-Yanez GF, Cucho-Venegas JM, Chacon-Diaz R, Pons-Estel BA. Primary cardiac disease in systemic lupus erythematosus patients: protective and risk factors--data from a multi-ethnic Latin American cohort. Rheumatology (Oxford) 2014; 53:1431-8. [DOI: 10.1093/rheumatology/keu011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Nuttall A, Isenberg DA. Assessment of disease activity, damage and quality of life in systemic lupus erythematosus: new aspects. Best Pract Res Clin Rheumatol 2013; 27:309-18. [PMID: 24238688 DOI: 10.1016/j.berh.2013.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Systemic lupus erythematosus (SLE) is a multisystem auto-immune disorder that results from a combination of genetic, environmental and hormonal factors. The heterogeneity of disease presentation and course in different individuals and the variability in the disease progression/fluctuations within the same patient have made finding a unifying assessment tool difficult. It is currently accepted that assessment of patients with SLE cannot be accomplished with a single index. Formal evaluation of three aspects of the disease, disease activity, disease damage and patient-related quality of life (QoL), is required. In the recent decade, the pathogenesis of SLE at the cellular and molecular levels has been the subject of much research. Robust assessment tools are needed to correlate the presence of various serological markers with disease activity. In addition, multiple clinical trials of new therapies have necessitated validated measures that can give a sensitive response index. This review focusses on the SLE assessment tools currently in use and their translational application in clinical research and trials.
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Furtado J, Isenberg DA. Reprint of: B cell elimination in systemic lupus erythematosus. Clin Immunol 2013; 148:344-58. [DOI: 10.1016/j.clim.2013.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 11/15/2012] [Indexed: 11/28/2022]
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Furtado J, Isenberg DA. B cell elimination in systemic lupus erythematosus. Clin Immunol 2012; 146:90-103. [PMID: 23280492 DOI: 10.1016/j.clim.2012.11.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 11/12/2012] [Accepted: 11/15/2012] [Indexed: 10/27/2022]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disorder with a worldwide distribution, potentially life-threatening with considerable morbidity. The elimination of pathogenic B cells has emerged as a rational therapeutic option. Many open label studies have reported encouraging results in which clinical and serological remission have invariably been described, often enabling the reduction of steroid and immunosuppressive treatment. However, the results from randomized controlled studies have been disappointing and several questions remain to be answered. In this review we will focus on results of B cell direct depletion in the treatment of patients with systemic lupus erythematosus.
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Affiliation(s)
- João Furtado
- Department of Internal Medicine, Egas Moniz Hospital, Lisbon, Portugal.
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Urowitz MB, Gladman DD, Ibañez D, Fortin PR, Bae SC, Gordon C, Clarke A, Bernatsky S, Hanly JG, Isenberg D, Rahman A, Sanchez-Guerrero J, Wallace DJ, Ginzler E, Alarcón GS, Merrill JT, Bruce IN, Sturfelt G, Nived O, Steinsson K, Khamashta M, Petri M, Manzi S, Ramsey-Goldman R, Dooley MA, van Vollenhoven RF, Ramos M, Stoll T, Zoma A, Kalunian K, Aranow C. Evolution of disease burden over five years in a multicenter inception systemic lupus erythematosus cohort. Arthritis Care Res (Hoboken) 2011; 64:132-7. [DOI: 10.1002/acr.20648] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Strand V, Chu AD. Measuring outcomes in systemic lupus erythematosus clinical trials. Expert Rev Pharmacoecon Outcomes Res 2011; 11:455-68. [PMID: 21831027 DOI: 10.1586/erp.11.38] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The recent approval of the biologic therapy, belimumab, for treatment of systemic lupus erythematosus (SLE) by the US FDA has shifted the developmental landscape of therapeutics for this autoimmune disease. Promising therapies are currently in development for the treatment of SLE, with trials designed to emphasize clinically relevant end points. This article will discuss outcome measures that have been utilized including disease activity indices, definitions of flare, measures of damage, global assessments of disease activity and measures of health-related quality of life. Application of these outcome measures in recent trials are highlighted as illustrative examples. Contributions to the recent success of randomized controlled trials in SLE have included use of evidence-based responder indices, clear definitions of treatment failure, predefined management strategies for use of immunosuppressive agents and corticosteroids, sufficient sample sizes and efforts to identify responsive patient populations. Each completed study in SLE promises to better inform trial design and offer further opportunities for success in a field with a continuing unmet therapeutic need.
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Affiliation(s)
- Vibeke Strand
- Division of Immunology and Rheumatology, Stanford University School of Medicine, 306 Ramona Road, Portola Valley, CA 94028, USA.
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Romero-Diaz J, Isenberg D, Ramsey-Goldman R. Measures of adult systemic lupus erythematosus: updated version of British Isles Lupus Assessment Group (BILAG 2004), European Consensus Lupus Activity Measurements (ECLAM), Systemic Lupus Activity Measure, Revised (SLAM-R), Systemic Lupus Activity Questionnaire for Population Studies (SLAQ), Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). Arthritis Care Res (Hoboken) 2011; 63 Suppl 11:S37-46. [PMID: 22588757 PMCID: PMC3812450 DOI: 10.1002/acr.20572] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Juanita Romero-Diaz
- Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
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Alarcón GS. Multiethnic lupus cohorts: what have they taught us? ACTA ACUST UNITED AC 2010; 7:3-6. [PMID: 21794772 DOI: 10.1016/j.reuma.2010.11.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 11/13/2010] [Indexed: 11/29/2022]
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