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Lu J, Xu D, Wan Q, Chen H. Pregnancy outcomes and risk factors analysis in patients with systemic lupus erythematous. BMC Pregnancy Childbirth 2024; 24:495. [PMID: 39039448 PMCID: PMC11265087 DOI: 10.1186/s12884-024-06701-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/15/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND The management of systemic lupus erythematosus (SLE) during pregnancy remains a challenge currently. Identifying early predictors of adverse pregnancy outcomes in SLE patients can help to develop treatment plan and improve prognosis. The aim of this study is to explore the clinical and laboratory variables in the early pregnancy that can predict adverse neonatal and maternal outcomes, thereby facilitating the grading management of SLE. METHODS A retrospective analysis was conducted on 126 pregnant women with SLE who were admitted to Zhongnan Hospital of Wuhan University between January 2017 and December 2022. All enrolled patients were diagnosed (including newly diagnosed and previously diagnosed) during first trimester of pregnancy and their clinical records, laboratory results and pregnancy outcomes were reviewed. The association between the clinical and laboratory characteristics of patients at 12 gestational age and the adverse neonatal (ANOs) as well as maternal outcomes (AMOs) were analyzed. RESULTS A total of 117 live births (92.8%) were recorded in the study. ANOs occurred in 59 (46.8%) cases, including fetal loss in 9 cases (7.1%), preterm birth in 40 cases (31.7%), small for gestational (SGA) in 15 cases (11.9%), and complete heart block in 2 cases (1.5%). Univariate analysis showed that disease activity index (P < 0.0001), lupus nephritis (P = 0.0195), anti-SSB positivity (P = 0.0074) and hypocomplementemia (P = 0.0466) were related to ANOs. However, multivariate analysis showed that only disease activity during early pregnancy was an independent predictor for ANOs (OR = 7.053, 95% CI: 1.882 to 26.291, P = 0.004). In addition, 48 patients experienced AMOs during subsequent trimester, including 24 (19.0%) patients with disease flare and 23 (18.3%) patients with pre-eclampsia. Unplanned pregnancy (P = 0.010), active disease (P = 0.0004), new onset SLE (P = 0.0044) and lupus nephritis (P = 0.0009) were associated with AMOs in univariate analysis, while disease activity was identified as an independent risk factor for AMOs (OR = 2.553, 95% CI: 1.012-6.440, P = 0.047). CONCLUSION Active disease in early pregnancy is associated with adverse pregnancy outcomes. For patients with high risk factor for ANOs and AMOs, more intensive treatment and follow-up should be a wise measure. Especially for those who suffer from active disease, they should be fully informed and given the option to terminate or continue their pregnancy.
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Affiliation(s)
- Jing Lu
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Clinical Medicine Research Centre of Prenatal Diagnosis and Birth Health in Hubei Province, Wuhan, 430071, China
| | - Dan Xu
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Clinical Medicine Research Centre of Prenatal Diagnosis and Birth Health in Hubei Province, Wuhan, 430071, China
| | - Qianqian Wan
- Department of Rheumatology and Immunology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Huijun Chen
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
- Clinical Medicine Research Centre of Prenatal Diagnosis and Birth Health in Hubei Province, Wuhan, 430071, China.
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Ramnarain A, Liam C, Milea D, Morand E, Kent J, Kandane-Rathnayake R. Predictors of Organ Damage in Systemic Lupus Erythematosus in the Asia Pacific Region: A Systematic Review. Arthritis Care Res (Hoboken) 2024; 76:720-732. [PMID: 38191962 DOI: 10.1002/acr.25291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/21/2023] [Accepted: 01/04/2024] [Indexed: 01/10/2024]
Abstract
OBJECTIVE Irreversible organ damage is common in patients with systemic lupus erythematosus (SLE). Despite evidence of increased prevalence and severity of SLE in Asia Pacific, organ damage is less well studied in this region. This systematic review aims to identify predictors of organ damage in SLE in the Asia Pacific region. METHODS We searched Medline, PubMed, Embase, and Web of Science for observational studies on organ damage in adult patients with SLE in Asia Pacific from August 31, to September 5, 2022. Study selection and data extraction were completed by two independent reviewers using Covidence systematic review software. Risk of bias was assessed using the Newcastle-Ottawa Scale and Joanna Briggs Institute tool. Significant results from univariable and multivariable analyses were synthesized from included studies. RESULTS Thirty-eight eligible studies were selected from 1999 to 2022; 22 (58%) of these reported organ damage at study enrollment and 19 (50%) reported damage accrual, as measured by the Systemic Lupus International Collaborating Clinic/American College of Rheumatology Damage Index. Factors predictive of organ damage included older age, glucocorticoid use, longer disease duration, and disease activity. Lupus nephritis was a risk factor for renal and overall damage accrual. Hydroxychloroquine was protective against overall organ damage. CONCLUSION Predictors of organ damage in SLE in Asia Pacific are similar to other regions. Although glucocorticoid use is a modifiable risk factor for organ damage, the impact of immunosuppressives and biologic therapies needs further investigation. Effective strategies in early disease are needed to minimize initial organ damage as it predicts subsequent damage accrual.
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Affiliation(s)
- Arushi Ramnarain
- Monash University and Monash Health, Melbourne, Victoria, Australia
| | | | | | - Eric Morand
- Monash University and Monash Health, Melbourne, Victoria, Australia
| | - Joanna Kent
- Monash Health, Melbourne, Victoria, Australia
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Meng L, Gao CR, Wang HC, Yasin R, Huang RJ, Zhao YX, Ma XH, Wen YY. Positive psychological capital, post-traumatic growth, social support, and quality of life in patients with systemic lupus erythematosus: A cross-sectional study. Lupus 2024; 33:470-480. [PMID: 38442229 DOI: 10.1177/09612033241238051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
OBJECTIVE This study aimed to investigate the correlation between positive psychological capital, post-traumatic growth, social support, and quality of life (QOL) in patients with systemic lupus erythematosus (SLE). METHODS A cross-sectional study was conducted at the First Affiliated Hospital of Xinjiang Medical University from October 2022 to May 2023. A sample of 330 hospitalized SLE patients was selected for this study. The collected data included demographic information, the SLE disease activity index, the Positive Mental Capital Questionnaire, the Chinese version of the Post-Traumatic Growth Scale, the Social Support Rating Scale, and the Chinese version of the Lupus Quality of Life Scale. RESULTS The QOL score among the 330 SLE patients was measured as M(P25, P75) of 105 (83.00,124.00). Positive psychological capital, post-traumatic growth, and social support demonstrated significant positive correlations with the QOL in SLE patients (p < 0.05). Multiple linear regression analysis revealed that literacy, disease level, disease duration, occupation, marital status, psychological capital, social support, and post-traumatic growth were influential factors associated with the QOL in SLE patients. CONCLUSION Medical professionals should be attentive to the psychological well-being of SLE patients and should consider implementing early psychological interventions. These interventions are crucial for enhancing the QOL for individuals diagnosed with SLE.
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Affiliation(s)
- Lyu Meng
- Nursing School, Xinjiang Medical University, Urumqi, China
| | - Cui-Rong Gao
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hui-Cai Wang
- Department of Undergraduate Educational Management ,The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Raxida Yasin
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Rui-Jie Huang
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yu-Xin Zhao
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiao-Hui Ma
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yuan-Yuan Wen
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Suh CH, Lee Y, Yoo SB, Quasny H, Navarro Rojas AA, Hammer A, Song YW, Kang YM, Cho CS, Park W, Kwok SK, Lee SG, Chung WT, Bae SC. Efficacy and safety of intravenous belimumab in a subgroup of South Korean patients with systemic lupus erythematosus enrolled into a Phase 3, randomized, placebo-controlled trial in North East Asia. Int J Rheum Dis 2024; 27:e14997. [PMID: 38140854 DOI: 10.1111/1756-185x.14997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 10/23/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023]
Abstract
AIM This post hoc analysis evaluated the efficacy and safety of intravenous belimumab 10 mg/kg in the South Korean subgroup of patients with systemic lupus erythematosus (SLE) enrolled in the North East Asia (NEA) study (GSK Study BEL113750; NCT01345253). METHODS NEA was a double-blind, placebo-controlled, randomized Phase 3 trial. Patients with active, autoantibody-positive SLE were randomized 2:1 to belimumab or placebo plus standard therapy administered on Days 0, 14, and 28, and then every 28 days up to Week 48. The primary efficacy endpoint in this analysis was SLE Responder Index 4 (SRI-4) response rate at Week 52, defined as the proportion of patients achieving a ≥4-point reduction in Safety of Estrogens in Lupus Erythematosus National Assessment-SLE Disease Activity Index (SELENA-SLEDAI) score, no worsening (<0.3 increase from baseline) in Physician Global Assessment, no new British Isles Lupus Assessment Group (BILAG) A domain and <2 new BILAG B domain scores. RESULTS Among 100 South Korean patients enrolled in NEA, 54/66 (81.8%) belimumab- and 24/34 (70.6%) placebo-treated patients completed the double-blind phase. Significantly more belimumab- than placebo-treated patients achieved SRI-4 response at Week 52 (n = 35/66, 53.0% vs. n = 8/34, 23.5%; odds ratio [OR; 95% confidence interval (CI)]: 3.67 [1.45, 9.28]; p = .0061). The proportion of patients experiencing ≥1 adverse event was similar between groups (belimumab: n = 60/66, 90.9% vs. placebo: n = 31/34, 91.2%). No new safety signals emerged in this subgroup analysis. CONCLUSION Belimumab was efficacious for the treatment of SLE and well tolerated among the South Korean subgroup of patients from the NEA study.
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Affiliation(s)
- Chang-Hee Suh
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | | | | | - Holly Quasny
- Clinical Sciences, GSK, Durham, North Carolina, USA
| | | | - Anne Hammer
- Immunology Biostatistics, GSK, Collegeville, Pennsylvania, USA
| | - Yeong-Wook Song
- Division of Rheumatology, Seoul National University Hospital, Seoul, Korea
- Medical Research Center, Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea
| | - Young Mo Kang
- Division of Rheumatology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Chul-Soo Cho
- Division of Rheumatology, Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Won Park
- Medicine/Rheumatology, School of Medicine, IN-HA University, Incheon, Korea
| | - Seung-Ki Kwok
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung-Geun Lee
- Division of Rheumatology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Won Tae Chung
- Division of Rheumatology, Department of Internal Medicine, Dong-A University Hospital, Busan, Korea
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Hanyang University Institute for Rheumatology and Hanyang University Institute of Bioscience and Biotechnology, Seoul, Korea
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Rice C, Ayyala DN, Shi H, Madera-Acosta A, Bell S, Qureshi A, Carbone LD, Coughlin SS, Elam RE. Sex and Racial Differences in Systemic Lupus Erythematosus Among US Adults in the All of Us Research Program. Arthritis Care Res (Hoboken) 2023; 75:2096-2106. [PMID: 36705447 PMCID: PMC10372192 DOI: 10.1002/acr.25093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/28/2022] [Accepted: 01/24/2023] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Men with systemic lupus erythematosus (SLE) are an understudied population. The present study characterized differences between men and women with SLE. METHODS We examined cross-sectionally participants with SLE in the All of Us Research Program, a US cohort with a participant survey at enrollment (May 2018 to June 2022) and linked electronic health record (EHR) data. We described and compared characteristics of men and women with SLE encompassing disease manifestations and prescribed medications from EHR data and socioeconomic factors, including health literacy and health care access and utilization, from surveys. We reported racial variations stratified by sex. RESULTS Of 1,462 participants with SLE, 126 (9%) were male. Men reported lower educational attainment and less fatigue than women. Myocardial infarction was significantly more common in men. Men had significantly less confidence in completing medical forms than women and exhibited a trend toward requiring more help in reading health-related materials. Barriers to health care access and utilization were common in both men and women (40% versus 47%, respectively, reporting some reason for delay in care; P = 0.35). Women of race other than Black or African American or White more often reported delaying care due to cultural differences between patient and provider. CONCLUSION Our study demonstrated major clinical and health literacy differences in men and women with SLE. Socioeconomic factors were significant barriers to health care in both sexes. Our study suggests men have disproportionately poorer health literacy, which may exacerbate preexisting disparities. Further large prospective studies, focusing on recruiting men, are needed to better characterize racial differences in men with SLE.
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Affiliation(s)
| | - Deepak Nag Ayyala
- Division of Biostatistics and Data Science, Department of Population Health Sciences, Augusta University, Augusta, GA, USA
| | - Hong Shi
- Division of Rheumatology, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Adria Madera-Acosta
- Division of Rheumatology, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
| | - Stephen Bell
- Division of Rheumatology, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
| | - Anam Qureshi
- Division of Rheumatology, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
| | - Laura D. Carbone
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
- J. Harold Harrison, MD, Distinguished University Chair in Rheumatology, Division of Rheumatology, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Steven S. Coughlin
- Division of Epidemiology, Department of Population Health Sciences, Augusta University, Augusta, GA, USA
| | - Rachel E. Elam
- Division of Rheumatology, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
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Petri M, Fang C, Goldman DW. East-Asian lupus nephritis in the Hopkins Lupus Cohort. RHEUMATOLOGY AND IMMUNOLOGY RESEARCH 2023; 4:157-161. [PMID: 37781683 PMCID: PMC10538617 DOI: 10.2478/rir-2023-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/13/2023] [Indexed: 10/03/2023]
Abstract
Background and Objective East Asian systemic lupus erythematosus (SLE) is under represented in lupus cohorts outside of East Asia. We asked whether lupus nephritis was more common and more severe in East Asians than in other ethnicities in a large United States SLE cohort. Methods The Hopkins Lupus Cohort, a longitudinal cohort of 2802 patients (53.5% Caucasian, 39.2% African-American, 3.2% East Asian) was studied. The SLICC/ACR Damage Index was used to assess renal outcomes. Results: East Asian patients had the same prevalence of lupus nephritis as African-Americans and both were higher than Caucasians. East Asians were not significantly different in frequency of end stage kidney disease compared with African-Americans. East Asians were more likely than Caucasians to have anti-Sm, low C3 and low C4. East Asians were more likely than African-Americans to have low C3 and low C4. Conclusion East Asians living in the United States were more likely to have lupus nephritis than Caucasians. Poor outcomes such as end stage kidney disease occurred at an equal frequency in East Asians as in African-Americans. Lupus nephritis was both more frequent and more severe in East Asians than in African-Americans.
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Affiliation(s)
- Michelle Petri
- Johns Hopkins University School of Medicine, Department of Medicine, Division of Rheumatology, Baltimore, Maryland, USA
| | - Chenglong Fang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences& Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science& Technology; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing100730, China
| | - Daniel W. Goldman
- Johns Hopkins University School of Medicine, Department of Medicine, Division of Rheumatology, Baltimore, Maryland, USA
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Cheng C, Huang C, Chen Z, Zhan F, Duan X, Wang Y, Zhao C, Wu Z, Xu J, Li H, Yang M, Wu R, Zhao J, Zhang S, Wang Q, Leng X, Tian X, Li M, Zeng X. Risk factors for avascular necrosis in patients with systemic lupus erythematosus: a multi-center cohort study of Chinese SLE Treatment and Research Group (CSTAR) Registry XXII. Arthritis Res Ther 2023; 25:78. [PMID: 37173771 PMCID: PMC10176939 DOI: 10.1186/s13075-023-03061-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Avascular necrosis is a common organ damage in SLE patients, which can influence patients' life quality. Conflicting results exist in risk factors of AVN in SLE patients. The aim of this study was to illustrate risk factors predicting the occurrence of avascular necrosis (AVN), also known as osteonecrosis, in systemic lupus erythematosus (SLE) patients in Chinese SLE Treatment and Research Group (CSTAR), a multi-center cohort of Chinese SLE patients. METHODS SLE patients in CSTAR without existing AVN at registration were included. At least two follow-ups and an observation period of no less than 2 years for AVN event were required. Univariate and multivariate Cox regression analyses were used to evaluate risk factors for AVN in SLE patients. Coefficient B was transformed to risk score for the development of a risk stratification model. RESULTS One hundred six (2.59%) of 4091 SLE patients were diagnosed AVN during follow-ups of no less than 2 years. Multi-variate Cox regression analysis suggested that SLE onset age ≤ 30 (HR 1.616, p 0.023), arthritis (HR 1.642, p 0.018), existing organ damage (SDI ≥ 1) at registration (HR 2.610, p < 0.001), positive anti-RNP (HR 1.709, p 0.006), and high glucocorticoid maximum daily dose at registration (HR 1.747, p 0.02) were independent risk factors. A risk stratification system was developed according to the risk factors, and patients were divided into high risk (3-6) and low risk (0-2). The AUC of 0.692 indicated moderate discrimination. The calibration curve in internal validation was drawn. CONCLUSION Patients with SLE onset age ≤ 30, arthritis, existing organ damage (SDI ≥ 1) at registration, positive anti-RNP, and high glucocorticoid maximum daily dose at registration are at high risk for AVN and require attention.
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Grants
- 2021YFC2501300 Chinese National Key Technology R&D Program, Ministry of Science and Technology
- 2021YFC2501300 Chinese National Key Technology R&D Program, Ministry of Science and Technology
- No.Z201100005520022,23, 25-27 Beijing Municipal Science & Technology Commission
- No.Z201100005520022,23, 25-27 Beijing Municipal Science & Technology Commission
- 2021-I2M-1-005 CAMS Innovation Fund for Medical Sciences (CIFMS)
- 2021-I2M-1-005 CAMS Innovation Fund for Medical Sciences (CIFMS)
- 2022-PUMCH-B-013, C-002, D-009 National High Level Hospital Clinical Research Funding
- 2022-PUMCH-B-013, C-002, D-009 National High Level Hospital Clinical Research Funding
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Affiliation(s)
- Cheng Cheng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China
| | - Can Huang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China
| | - Zhen Chen
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Feng Zhan
- Department of Rheumatology, Hainan General Hospital, Haikou, China
| | - Xinwang Duan
- Department of Rheumatology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yongfu Wang
- Department of Rheumatology Institute of Immunology and Rheumatology Inner Mongolia Key Laboratory of Autoimmunity, The First Affiliated Hospital of Baotou Medical College, Baotou Medical College, Baotou, China
| | - Cheng Zhao
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhenbiao Wu
- Department of Clinical Immunology and Rheumatology, Xijing Hospital Affiliated to the Fourth Military Medical University, Xi'an, China
| | - Jian Xu
- Department of Rheumatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hongbin Li
- Department of Rheumatology, Affiliated Hospital of Inner Mongolia Medical College, Hohhot, China
| | - Min Yang
- Department of Rheumatology and Immunology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Rui Wu
- Department of Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jiuliang Zhao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China
| | - Shangzhu Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China
| | - Qian Wang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China
| | - Xiaomei Leng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China
| | - Xinping Tian
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China
| | - Mengtao Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China.
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China.
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8
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Raghunath S, Glikmann-Johnston Y, Golder V, Kandane-Rathnayake R, Morand EF, Stout JC, Hoi A. Clinical associations of cognitive dysfunction in systemic lupus erythematosus. Lupus Sci Med 2023; 10:10/1/e000835. [PMID: 36854540 PMCID: PMC9980376 DOI: 10.1136/lupus-2022-000835] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/10/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE Cognitive dysfunction in SLE is common, but clinical risk factors are poorly understood. This study aims to explore the associations of cognitive dysfunction in SLE with disease activity, organ damage, biomarkers and medications. METHODS We performed cross-sectional cognitive assessment using a conventional neuropsychological test battery, with normative values derived from demographically matched healthy subjects. Endpoints included two binary definitions of cognitive dysfunction and seven individual cognitive domain scores. Clinical parameters included disease activity (SLEDAI-2K) and organ damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index). We performed regression analyses to determine associations between clinical parameters and cognitive endpoints. RESULTS 89 patients with SLE were studied, with median age of 45 and disease duration of 15 years. Organ damage was significantly associated with severe cognitive dysfunction (OR 1.49, CI 1.01-2.22) and worse cognitive test performance in three of the seven individual cognitive domains. In contrast, no significant associations were found between SLEDAI-2K at the time of cognitive assessment and any cognitive endpoints on multivariate analysis. Higher time-adjusted mean SLEDAI-2K was associated with better verbal memory scores but had no significant associations with other cognitive endpoints. The presence of anti-dsDNA antibodies and high IFN gene signature were negatively associated with severe cognitive dysfunction; there were no significant associations with the other autoantibodies studied or any medications. Substance use was significantly associated with lower psychomotor speed. Only 8% of patients who had cognitive dysfunction on testing had been recognised by clinicians on their SDI score. CONCLUSIONS In SLE, cognitive dysfunction was positively associated with organ damage, but not associated with disease activity, and serological activity and high IFN signature were negatively associated. Cognitive dysfunction was poorly captured by clinicians. These findings have implications for preventative strategies addressing cognitive dysfunction in SLE.
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Affiliation(s)
- Sudha Raghunath
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia .,Rheumatology Department, Monash Health, Melbourne, Victoria, Australia
| | - Yifat Glikmann-Johnston
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Vera Golder
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.,Rheumatology Department, Monash Health, Melbourne, Victoria, Australia
| | - Rangi Kandane-Rathnayake
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Eric F Morand
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.,Rheumatology Department, Monash Health, Melbourne, Victoria, Australia
| | - Julie C Stout
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Alberta Hoi
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.,Rheumatology Department, Monash Health, Melbourne, Victoria, Australia
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Aguirre A, Izadi Z, Trupin L, Barbour KE, Greenlund KJ, Katz P, Lanata C, Criswell L, Dall’Era M, Yazdany J. Race, Ethnicity, and Disparities in the Risk of End-Organ Lupus Manifestations Following a Systemic Lupus Erythematosus Diagnosis in a Multiethnic Cohort. Arthritis Care Res (Hoboken) 2023; 75:34-43. [PMID: 35452566 PMCID: PMC9587136 DOI: 10.1002/acr.24892] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/22/2022] [Accepted: 04/07/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Data on the onset of lupus manifestations across multiple organ domains and in diverse populations are limited. The objective was to analyze racial and ethnic differences in the risk of end-organ lupus manifestations following systemic lupus erythematosus (SLE) diagnosis in a multiethnic cohort. METHODS The California Lupus Epidemiology Study (CLUES) is a longitudinal study of SLE. Data on major end-organ lupus manifestations were collected and categorized by organ system: renal, hematologic, neurologic, cardiovascular, and pulmonary. Multiorgan disease was defined as manifestations in ≥2 of these distinct organ systems. Kaplan-Meier curves assessed end-organ disease-free survival, and Cox proportional hazards regression estimated the rate of end-organ disease following SLE diagnosis, adjusting for age at diagnosis, sex, and self-reported race and ethnicity (White, Hispanic, Black, and Asian). RESULTS Of 326 participants, 89% were female; the mean age was 45 years. Self-reported race and ethnicity were 30% White, 23% Hispanic, 11% Black, and 36% Asian. Multiorgan disease occurred in 29%. Compared to White participants, Hispanic and Asian participants had higher rates, respectively, of renal (hazard ratio [HR] 2.9 [95% confidence interval (95% CI) 1.8-4.7], HR 2.9 [95% CI 1.9-4.6]); hematologic (HR 2.7 [95% CI 1.3-5.7], HR 2.1 [95% CI 1.0-4.2]); and multiorgan disease (HR 3.3 [95% CI 1.8-5.9], HR 2.5 [95% CI 1.4-4.4]) following SLE diagnosis. CONCLUSION We found heightened risks of developing renal, hematologic, and multiorgan disease following SLE diagnosis among Hispanic and Asian patients with SLE, as well as a high burden of multiorgan disease among CLUES participants.
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Affiliation(s)
- Alfredo Aguirre
- University of California, San Francisco, Division of Rheumatology, Department of Medicine
| | - Zara Izadi
- University of California, San Francisco, Division of Rheumatology, Department of Medicine
| | - Laura Trupin
- University of California, San Francisco, Division of Rheumatology, Department of Medicine
| | | | | | - Patti Katz
- University of California, San Francisco, Division of Rheumatology, Department of Medicine
| | - Cristina Lanata
- National Human Genome Research Institute, National Institutes of Health
| | - Lindsey Criswell
- National Human Genome Research Institute, National Institutes of Health
| | - Maria Dall’Era
- University of California, San Francisco, Division of Rheumatology, Department of Medicine
| | - Jinoos Yazdany
- University of California, San Francisco, Division of Rheumatology, Department of Medicine
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10
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Hasan B, Fike A, Hasni S. Health disparities in systemic lupus erythematosus-a narrative review. Clin Rheumatol 2022; 41:3299-3311. [PMID: 35907971 PMCID: PMC9340727 DOI: 10.1007/s10067-022-06268-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/21/2022] [Accepted: 06/26/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To describe root causes of health disparities by reviewing studies on incidence and outcomes of systemic lupus erythematosus (SLE) related to ethnic, race, gender, or socioeconomic differences and to propose solutions. RECENT FINDINGS SLE outcomes have steadily improved over the past 40 years but are not uniformly distributed across various racial and ethnic groups. Belonging to racial and ethnic minority has been cited as a risk factor for more severe disease and poor outcome in SLE. Population-based registries have demonstrated that Black patients with SLE have significantly lower life expectancy compared to White patients. Lower socioeconomic status has been shown to be one of the strongest predictors of progression to end stage renal disease in lupus nephritis. An association between patient experiences of racial discrimination, increased SLE activity, and damage has also been described. The lack of representation of marginalized communities in lupus clinical trials further perpetuates these disparities. To that end, the goal of a rheumatology workforce that resembles the patients it treats has emerged as one of many solutions to current shortfalls in care. Disparities in SLE incidence, treatment, and outcomes have now been well established. The root causes of these disparities are multifactorial including genetic, epigenetic, and socioeconomic. The underrepresentation of marginalized communities in lupus clinical trials further worsen these disparities. Efforts have been made recently to address disparities in a more comprehensive manner, but systemic causes of disparities must be acknowledged and political will is required for a sustained positive change.
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Affiliation(s)
- Bilal Hasan
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, MD USA
| | - Alice Fike
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, MD USA
| | - Sarfaraz Hasni
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, MD USA
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11
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Sreedharan S, Li N, Littlejohn G, Buchanan R, Nikpour M, Morand E, Hoi A, Golder V. Association of clinic setting with quality indicator performance in systemic lupus erythematosus: a cross-sectional study. Arthritis Res Ther 2022; 24:150. [PMID: 35733186 PMCID: PMC9214991 DOI: 10.1186/s13075-022-02823-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 05/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare quality for systemic lupus erythematosus (SLE) is a modifiable target for improving patient outcomes. We aimed to assess the quality of care processes in different clinic settings, comparing a subspecialty lupus clinic with hospital-based and private general rheumatology clinics. METHODS Patients with SLE (n = 258) were recruited in 2016 from a subspecialty lupus clinic (n = 147), two hospital general rheumatology clinics (n = 56) and two private rheumatology clinics (n = 55). Data were collected from medical records and patient questionnaires. Quality of care was assessed using 31 validated SLE quality indicators (QI) encompassing diagnostic work-up, disease and comorbidity assessments, drug monitoring, preventative care and reproductive health. Per-QI performance was measured as a percentage of patients that met the QI relative to the number of patients eligible. Per-patient QI performance was calculated as a percentage of QIs met relative to the number of eligible QIs for each patient. Per-QI and per-patient QI performance were compared between the three clinic settings, and multiple regression performed to adjust for sociodemographic, disease and healthcare factors. RESULTS Per-QI performance was generally high across all clinic settings for diagnostic work-up, comorbidity assessment, lupus nephritis, drug monitoring, prednisolone taper, osteoporosis and pregnancy care. Median [IQR] per-patient performance on eligible QIs was higher in the subspeciality lupus clinic (66.7% [57.1-74.1]) than the hospital general rheumatology (52.7% [47.5-58.1]) and private rheumatology (50.0% [42.9-60.9]) clinics (p <0.001) and the difference remained significant after multivariable adjustment. The subspecialty lupus clinic recorded higher per-QI performance for documentation of disease activity, disease damage, cardiovascular risk factor and drug toxicity assessments, pre-immunosuppression hepatitis and tuberculosis screening, new medication counselling, vaccinations, sun avoidance education and contraception counselling. CONCLUSIONS SLE patients managed in a subspecialty lupus clinic recorded higher per-patient QI performance compared to hospital general rheumatology and private rheumatology clinics, in part related to better documentation on certain QIs.
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Affiliation(s)
- Sidha Sreedharan
- Monash University, Melbourne, Australia. .,Monash Health, Melbourne, Australia.
| | - Ning Li
- Monash University, Melbourne, Australia
| | | | | | - Mandana Nikpour
- The University of Melbourne at St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Eric Morand
- Monash University, Melbourne, Australia.,Monash Health, Melbourne, Australia
| | - Alberta Hoi
- Monash University, Melbourne, Australia.,Monash Health, Melbourne, Australia
| | - Vera Golder
- Monash University, Melbourne, Australia.,Monash Health, Melbourne, Australia
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12
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Tay SH, Cho J, Lateef A, Mak A. Reply on: A Meta-Analysis of Clinical Manifestations in Asian Systemic Lupus Erythematous: The Effects of Ancestry, Ethnicity and Gender. Semin Arthritis Rheum 2022; 55:152009. [DOI: 10.1016/j.semarthrit.2022.152009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/30/2022]
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13
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Lee MH, Koh JWH, Ng CH, Lim SHH, Cho J, Lateef A, Mak A, Tay SH. A meta-analysis of clinical manifestations in asian systemic lupus erythematous: The effects of ancestry, ethnicity and gender. Semin Arthritis Rheum 2021; 52:151932. [PMID: 34996626 DOI: 10.1016/j.semarthrit.2021.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 11/17/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Systemic lupus erythematosus (SLE) in Asians is a unique patient group that has been thought to present with more severe organ involvement in comparison to their non-Asian counterparts. We set out to perform a meta-analysis to compare clinical manifestations between ancestries, with a focus on Southeast Asian ethnicities and gender. MATERIALS AND METHODS A cross-sectional study was performed in conjunction with a meta-analysis to identify differences in prevalences of SLE clinical manifestations. Searches were conducted on Medline for articles comparing between: (i) Asian and non-Asian ancestry; (ii) Southeast Asian ethnicities (Chinese, Malay and Indian); and (iii) male and female Asians. Using random effects model, effect sizes as odd ratios were pooled with DerSimonian and Laird's model. RESULTS A total of 13 articles were identified and pooled together with our study for this meta-analysis. Comparing among patients of Asian with Non-Asian/European ancestries, no significance difference was found in severe organ manifestations such as renal and neurological involvement [odds ratio (OR): 1.398, p= 0.320 and OR: 1.224, p= 0.526 respectively]. There was significantly greater proportion of Asian SLE patients with thrombocytopenia compared to non-Asian SLE. Chinese SLE patients were less likely to have oral ulcers compared to Indian SLE patients. Lastly, Asian male SLE patients had greater incidence of renal involvement and thrombocytopenia compared to Asian female SLE patients. CONCLUSIONS Severe SLE manifestations such as renal and neurological involvement were not significantly more frequent in Asian SLE compared to non-Asian/European SLE in this analysis.
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Affiliation(s)
- Ming Hui Lee
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore
| | - Jeffery Wei Heng Koh
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sandy H H Lim
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore
| | - Jiacai Cho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Rheumatology, Department of Medicine, National University Hospital, Singapore
| | - Aisha Lateef
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Rheumatology, Department of Medicine, National University Hospital, Singapore; Department of Medicine, Woodlands Health Campus, Singapore
| | - Anselm Mak
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Rheumatology, Department of Medicine, National University Hospital, Singapore
| | - Sen Hee Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Rheumatology, Department of Medicine, National University Hospital, Singapore.
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14
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Meng X, Wang Q, Wu S, Pu D, Zhang A, Fang S, Zhou X, Lu H. Pharmacokinetics and Safety of Intravenous and Subcutaneous Auto-injector Single-dose Belimumab in Healthy Chinese Volunteers: A phase 1, Randomized, Open-label Study. Rheumatol Ther 2021; 8:1711-1724. [PMID: 34554352 PMCID: PMC8572285 DOI: 10.1007/s40744-021-00366-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Belimumab is a recombinant human immunoglobulin G1λ monoclonal antibody indicated as an intravenous (IV) 10 mg/kg and subcutaneous (SC) 200-mg dose for the treatment of systemic lupus erythematosus (SLE). Belimumab 10 mg/kg IV has been approved for the treatment of patients with SLE in China. This phase 1 study investigated the pharmacokinetics (PK), safety, and tolerability of belimumab 200 mg SC and the approved IV formulation in a healthy Chinese population. Methods This was a 13-week open-label, randomized, parallel-group study in healthy Chinese volunteers. Eligible volunteers were randomized (1:2) to receive a single dose of IV or SC (via auto-injector) belimumab 200 mg. PK and safety endpoints were evaluated using descriptive statistics. Results Thirty-six healthy Chinese volunteers were enrolled and all completed the study. Concentration–time profiles were as expected for both formulations. Overall, 130 adverse events (AEs) were reported, with 28 AEs reported in 11 (91.7%) volunteers in the IV group and 102 AEs in 24 (100%) volunteers in the SC group. Of the 130 AEs, 104 (80.0%) were considered to be treatment-related (27 [20.8% of total AEs] treatment-related AEs in the IV group; 77 [59.2% of total AEs] in the SC group). Although the occurrence of AEs was higher in the SC group, most volunteers (91.7%) experienced AEs of mild intensity. The most frequently reported AEs included injection site pain (n = 19 [79.2%]) and oropharyngeal pain (n = 5 [20.8%]) in the SC group, and positive bacterial test, upper respiratory tract infection, blood uric acid increase, white blood cell count increase, asthenia, and diarrhea (n = 2 [16.7%], each) in the IV group. Conclusions PK profiles of 200 mg SC and IV belimumab administrations were similar to previous studies, and safety profiles were acceptable, supporting the use of the SC dose in Chinese patients with SLE. Trial registration NCT04136145. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00366-0. Systemic lupus erythematosus (SLE) is a long-term autoimmune disease that affects patients’ quality of life. Belimumab is an antibody used in several countries in combination with standard therapy to treat patients with SLE. Belimumab can be given monthly either via a vein (intravenous, IV) or weekly under the skin (subcutaneous, SC). In China, only the IV belimumab has been approved for the treatment of patients with SLE. Therefore, we carried out a study in healthy Chinese volunteers to compare the concentration of a single dose of IV or SC belimumab in the body over time, and to investigate the safety of SC belimumab to assist its approval in China. In our study, the concentration and safety of both administration methods were similar; however, more volunteers from the SC treatment group had urinalysis-related side effects compared with the IV treatment group. All of these side effects were of mild intensity and did not require treatment. These results suggest that SC belimumab could be used for the treatment of Chinese patients with SLE.
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Affiliation(s)
- Xianmin Meng
- Department of Pharmacy, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Qianqian Wang
- Department of Internal Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | | | - Di Pu
- R&D, GlaxoSmithKline, Shanghai, China
| | | | - Sun Fang
- R&D, GlaxoSmithKline, Shanghai, China
| | - Xuan Zhou
- Clinical Pharmacology Modelling and Simulation, GlaxoSmithKline, Shanghai, China
| | - Hongzhou Lu
- Department of Infectious Diseases and Immunology, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Rd, Jinshan District, Shanghai, China.
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15
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Zeng X, Zheng L, Rui H, Kang R, Chen J, Chen H, Liu J. Risk factors for the flare of systemic lupus erythematosus and its influence on prognosis: a single-center retrospective analysis. Adv Rheumatol 2021; 61:43. [PMID: 34215349 DOI: 10.1186/s42358-021-00202-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 06/22/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To explore the risk factors for systemic lupus erythematosus (SLE) flare and their impact on prognosis. METHODS The clinical characteristics, laboratory results, and treatment plans of 121 patients with SLE flare were retrospectively analyzed. Ninety-eight SLE outpatients with sustained remission during the same period were selected as controls. Logistic multivariate regression analysis was employed to screen for risk factors for SLE flare. RESULTS Infection, thrombocytopenia, arthritis, anti-nucleosome antibodies positive, anti-β2-glycoprotein I (IgG) antibodies positive, and patient's self-discontinuation of medicine maintenance therapy might be risk factors for SLE flare. Patients who discontinued medicine maintenance therapy by themselves had a significantly higher rate of severe SLE flare than patients with regular medicine maintenance therapy (P = 0.033). The incidence of anemia associated with SLE (P = 0.001), serositis (P = 0.005), and pulmonary hypertension (P = 0.003) in patients who discontinued medicine maintenance therapy were significantly higher than patients with regular medicine maintenance therapy. SLE patients with regular medicine maintenance therapy for less than 3 years had a higher risk of pulmonary hypertension than those with regular medicine maintenance therapy longer than 3 years (P = 0.034). CONCLUSIONS The accompanying thrombocytopenia, arthritis, anti-nucleosome antibodies positive and anti-β2-glycoprotein I (IgG) antibodies positive at the onset of SLE may affect the prognosis of SLE. Patient's self-discontinuation of medicine maintenance therapy is the main cause of SLE flare, which may induce severe flare in SLE patients and lead to a significantly higher incidence of pulmonary hypertension.
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Affiliation(s)
- Xiaohong Zeng
- Department of Rheumatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, Fujian, China.
| | - Ling Zheng
- Department of Rheumatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, Fujian, China
| | - Hongbing Rui
- Department of Rheumatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, Fujian, China
| | - Rihui Kang
- Department of Rheumatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, Fujian, China
| | - Junmin Chen
- Department of Rheumatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, Fujian, China
| | - Huaning Chen
- Department of Rheumatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, Fujian, China
| | - Jizan Liu
- Department of Rheumatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, Fujian, China
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16
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Shaharir SS, Chua SH, Mohd R, Mustafar R, Noh MM, Shahril NS, Said MSM, Rajalingham S. Risk factors for symptomatic Avascular Necrosis (AVN) in a multi-ethnic Systemic Lupus Erythematosus (SLE) cohort. PLoS One 2021; 16:e0248845. [PMID: 33739994 PMCID: PMC7978335 DOI: 10.1371/journal.pone.0248845] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/06/2021] [Indexed: 12/30/2022] Open
Abstract
Avascular necrosis of bone (AVN) is increasingly being recognized as a complication of SLE and causes significant disability due to pain and mobility limitations. We studied the prevalence and factors associated with avascular necrosis (AVN) in a multiethnic SLE cohort. SLE patients who visited the outpatient clinic from October 2017 to April 2019 were considered eligible. Their medical records were reviewed to identify patients who developed symptomatic AVN, as confirmed by either magnetic resonance imaging or plain radiography. Subsequently, their SLE disease characteristics and treatment were compared with the characteristics of patients who did not have AVN. Multivariable logistic regression analyses were performed to determine the independent factors associated with AVN among the multiethnic SLE cohort. A total of 390 patients were recruited, and the majority of them were females (92.6%); the patients were predominantly of Malay ethnicity (59.5%), followed by Chinese (35.9%) and Indian (4.6%). The prevalence of symptomatic AVN was 14.1%, and the mean age of AVN diagnosis was 37.6 ± 14.4 years. Both univariate and multivariable logistic regression analyses revealed that a longer disease duration, high LDL-C (low density lipoprotein cholesterol), positive anti-cardiolipin (aCL) IgG and anti-dsDNA results, a history of an oral prednisolone dose of more than 30 mg daily for at least 4 weeks and osteoporotic fractures were significantly associated with AVN. On the other hand, hydroxychloroquin (HCQ), mycophenolate mofetil (MMF) and bisphosphonate use were associated with a lower risk of AVN. No associations with ethnicity were found. In conclusion, several modifiable risk factors were found to be associated with AVN, and these factors may be used to identify patients who are at high risk of developing such complications. The potential protective effects of HCQ, MMF and bisphosphonates warrant additional studies.
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Affiliation(s)
- Syahrul Sazliyana Shaharir
- Rheumatology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
- * E-mail: ,
| | - Siew Huoy Chua
- Department of Internal Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Rozita Mohd
- Nephrology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - Ruslinda Mustafar
- Nephrology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - Malehah Mohd Noh
- Department of Medicine, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | | | - Mohd Shahrir Mohamed Said
- Rheumatology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - Sakthiswary Rajalingham
- Rheumatology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
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17
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DeQuattro K, Trupin L, Murphy LB, Rush S, Criswell LA, Lanata CM, Dall'Era M, Katz P, Yazdany J. High Disease Severity Among Asians in a US Multiethnic Cohort of Individuals with Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2020; 74:896-903. [PMID: 33337580 DOI: 10.1002/acr.24544] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/15/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Knowledge about systemic lupus erythematosus (SLE) outcomes among US Asians is lacking. We examined SLE disease activity, severity, and damage among Asians of primarily Chinese and Filipino descent in a multiethnic cohort. METHODS California Lupus Epidemiology Study (CLUES, n=328) data were analyzed. Data were collected in English, Cantonese, Mandarin or Spanish, using validated instruments for disease activity (Systemic Lupus Erythematosus Disease Activity Index), disease severity (Lupus Severity Index [LSI]) and disease damage (Systemic Lupus International Collaborating Clinics Damage Index). We assessed differences in SLE outcomes among racial/ethnic groups using multivariable linear regression including interaction terms for age at diagnosis and race/ethnicity. RESULTS Asians were the largest racial/ethnic group (38%; [Chinese=22%; Filipino=9%; Other=7%]). Average age at diagnosis (years) was younger among Asians (27.9), particularly Filipinos (22.2), compared with Whites (29.4) and Blacks (34.0). After adjustment, disease activity and damage were not significantly different across groups. Disease severity among Asians was significantly higher than Whites (LSI 7.1 vs 6.5; p<0.05) but similar to Blacks and Hispanics. Early age at diagnosis was associated with greater organ damage among Asians, Blacks, and Hispanics, but not Whites. CONCLUSIONS SLE was more severe among US Asians compared to Whites. Filipinos were affected at strikingly young ages. Asians and non-White groups with younger age at diagnosis had greater organ damage than Whites. Such racial/ethnic distinctions suggest the need for heightened clinical awareness to improve health outcomes among Asians with SLE. Further study of SLE outcomes across a range of US Asian subgroups is important.
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Affiliation(s)
- Kimberly DeQuattro
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Laura Trupin
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Louise B Murphy
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia, USA
| | - Stephanie Rush
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Lindsey A Criswell
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Cristina M Lanata
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Maria Dall'Era
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Patricia Katz
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
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18
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Chanprapaph K, Ploydaeng M, Pakornphadungsit K, Mekwilaiphan T, Vachiramon V, Kanokrungsee S. The behavior, attitude, and knowledge towards photoprotection in patients with cutaneous/systemic lupus erythematosus: a comparative study with 526 patients and healthy controls. Photochem Photobiol Sci 2020; 19:1201-1210. [PMID: 32935699 DOI: 10.1039/d0pp00073f] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the attitude, knowledge, and behavior towards the sun protection in systemic lupus erythematosus (SLE) patients with and without cutaneous involvement (CLE) compared to non-photosensitive controls and to determine influential factors for photoprotective practices in SLE patients. METHODS A case-control study was performed. Patients and controls completed a self-reported questionnaire. For SLE patients, the presence of organ involvement, disease activity and laboratory data were acquired from their physical examination and medical records. RESULTS A total of 263 SLE patients and 263 healthy controls were recruited. SLE patients had statistically significant better photoprotective practices than controls, i.e. exposure to sunlight <1 hour per day (76.1% vs. 48.3%, OR, 3.40; 95% CI, 2.34-4.93, p < 0.001), less outdoor activities (9.8% vs. 19.1%, OR, 0.44; 95% CI, 0.26-0.71, p = 0.003), wore long-sleeved shirts (57.0% vs. 32.7%, OR, 2.73; 95% CI, 1.92-3.89, p < 0.001) and hats (43.8% vs. 26.6%, OR 2.14; 95% CI, 1.49-3.09, p < 0.001). SLE with CLE subgroup had the highest percentage for regular practice in almost all sun protective means compared to SLE without CLE and controls. SLE with CLE patients had more diligent sunscreen application with higher percentage of consistent use (93.7% vs. 59.3%, OR, 11.66; 95% CI, 2.57-52.89, p = 0.001) and adequate application (58.1% vs. 24.6%, OR, 4.24; 95% CI, 1.93-9.30, p < 0.001) compared to those without CLE. Previous and current CLE were influential factors for adherence to photoprotective methods, while the extracutaneous involvement was not. The majority of SLE patients were well acquainted with the harm of sunlight to their diseases (91.6%). However, 40.1% of them did not perceive that sunlight could escalate their internal flare, which may have led to inferior photoprotective practices in patients with extracutaneous involvement. CONCLUSION SLE patients had good awareness and practiced better photoprotection than controls. The cutaneous sign is a predictor for superior photoprotective behavior. Education regarding the harms of sunlight and the importance of appropriate photoprotection should be emphasized, especially in SLE cases without cutaneous involvement.
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Affiliation(s)
- Kumutnart Chanprapaph
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama IV Rd, 10400, Bangkok, Thailand
| | - Monthanat Ploydaeng
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama IV Rd, 10400, Bangkok, Thailand
| | - Kallapan Pakornphadungsit
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama IV Rd, 10400, Bangkok, Thailand
| | - Thiraphong Mekwilaiphan
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama IV Rd, 10400, Bangkok, Thailand
| | - Vasanop Vachiramon
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama IV Rd, 10400, Bangkok, Thailand
| | - Silada Kanokrungsee
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama IV Rd, 10400, Bangkok, Thailand.,Skin Center Srinakharinwirot University, 114 Sukhumvit 21, 10110, Bangkok, Thailand
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Su Z, Niu Q, Huang Z, Yang B, Zhang J. Association of nucleotide-binding oligomerization domain-like receptor family pyrin domain-containing protein 3 polymorphisms with systemic lupus erythematosus disease activity and biomarker levels: A case-control study in Chinese population. Medicine (Baltimore) 2020; 99:e21888. [PMID: 32871918 PMCID: PMC7458188 DOI: 10.1097/md.0000000000021888] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/11/2020] [Accepted: 07/20/2020] [Indexed: 02/05/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is a prototypic autoimmune disease with considerable genetic predisposition. Nucleotide-binding oligomerization domain-like receptor family pyrin domain-containing protein 3 (NLRP3) is crucial for the innate immunity and implicated in SLE pathogenesis. Accordingly, we conducted a case-control study to find the association of NLRP3 variations with SLE susceptibility and disease activity.Three single nucleotide polymorphisms of NLRP3 (rs3806268, rs4612666, and rs10754558) were genotyped in 400 SLE patients and 400 healthy controls; the patients were further divided into mild-to-moderate or high disease activity subgroup. Serum cytokines, complements, and autoantibodies were also detected.We found that rs4612666 TT genotype conferred a higher risk of severe disease activity with adjusted odds ratio = 2.08, P = .02 and adjusted odds ratio = 2.34, P = .01 in the codominant and recessive model, respectively. Nevertheless, there was no association between the 3 single nucleotide polymorphisms of NLRP3 gene and SLE susceptibility. In addition, C4 decreased significantly in rs3806268 GG (P < .001) and rs4612666 TT genotype carriers (P = .03). A higher trend of interleukin-1β and interleukin-γ release were identified in rs3806268 AA and rs10754558 CC genotype carriers, respectively.NLRP3 polymorphisms are associated with SLE disease activity and hypocomplementemia. Interleukin-1β and interleukin-γ levels in SLE patients are correlated with NLRP3 variants as well.
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20
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Tanaka Y, O'Neill S, Li M, Tsai IC, Yang YW. Systemic Lupus Erythematosus: Targeted literature review of the epidemiology, current treatment and disease burden in the Asia Pacific region. Arthritis Care Res (Hoboken) 2020; 74:187-198. [PMID: 32841537 DOI: 10.1002/acr.24431] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/09/2020] [Accepted: 08/18/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To understand the epidemiology, current treatment and disease burden of systemic lupus erythematosus (SLE) in the Asia Pacific region (APAC). METHODS A targeted literature review of published evidence on SLE in APAC was conducted, using the MEDLINE® database (2008-2018), conference proceedings and other supplementary sources. RESULTS The review identified 70 studies conducted in China (n=15), Japan (n=13), Taiwan (n=12), Korea (n=9), Australia (n=7), Hong Kong (n=6), Singapore (n=4), and multiple places within the APAC region (n=4). Incidence rates (per 100,000 per year) ranged from 0.9-8.4, while prevalence rates ranged from 3.7-127 (per 100,000); however, recent data was limited. Asian SLE patients were reported to have higher disease severity, activity (higher SLE disease activity index scores) and organ damage accrual; along with increased morbidity, mortality, and susceptibility to renal involvement compared with other ethnicities in APAC. The risk of developing SLE is higher in the Asian population. Routinely used SLE therapies included belimumab, hydroxychloroquine, cyclophosphamide, tacrolimus, azathioprine, mycophenolate mofetil, and corticosteroids; however, prescribing patterns varied across the region. Increased disease activity was associated with high economic burden and poor quality of life for SLE patients in APAC. CONCLUSION SLE remains a disease with a significant unmet medical need for an innovative therapy that is well-tolerated and effective for patients in APAC. Further evidence is required to better characterize the disease and fully capture the burden and impact of SLE in APAC. This review has highlighted where there is a paucity of data from patients across the APAC region.
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Affiliation(s)
- Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Sean O'Neill
- Department of Rheumatology, Royal North Shore Hospital, Northern Clinical School, University of Sydney, St Leonards, New South Wales, Australia
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, National Clinical Research Center for Immunologic Diseases, Ministry of Science & Technology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - I-Ching Tsai
- Janssen: Pharmaceutical Companies of Johnson & Johnson, 11F, No.2, Sec.3, Minsheng East Rd, Taipei City, Taiwan
| | - Ya-Wen Yang
- Janssen Global Services, LLC, Horsham, PA, USA
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21
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Kither H, Heazell A, Bruce IN, Tower C, Crocker I. Adverse pregnancy outcomes and subsequent development of connective tissue disease in the UK: an epidemiological study. BJOG 2020; 127:941-949. [PMID: 32128978 DOI: 10.1111/1471-0528.16191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study assessed prevalence of connective tissue disease (CTDs), systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS) and antiphospholipid antibodies (aPL) in women with previous adverse pregnancy outcome compared with uncomplicated livebirths. DESIGN Retrospective case-control study. SETTING UK Primary Care. POPULATION OR SAMPLE Records of women, 18 years and older, within the Clinical Practice Research Datalink (CPRD) (1 January 2000-31 December 2013). METHODS Clinical Practice Research Datalink was searched for pregnancy terms to identify adverse pregnancy outcome. Each identified case was matched to five livebirths. MAIN OUTCOME MEASURES Diagnosis of SLE, CTD, APS or autoimmune antibodies. Poisson regression was performed to calculate relative risk ratios (RR), comparing adverse pregnancy outcome with livebirth cohorts. RESULTS Clinical Practice Research Datalink identified 20 123 adverse pregnancy outcomes matched to 97 323 livebirths, with a total of 875 590 person-years follow up. Median follow up from study entry was 7.29 years (SD 4.39). Compared with women with an uncomplicated livebirth, women with adverse pregnancy outcome had an increased risk of developing CTD or autoimmune antibodies (RR 3.20, 95% CI 2.90-3.51). Risk was greatest following a stillbirth (RR 5.82, 95% CI 4.97-6.81). For CTD and SLE, the risk was greatest within the first 5 years of adverse pregnancy outcome. Risk for aPL and APS diagnosis was highest ≥5 years from adverse pregnancy outcome. CONCLUSIONS Adverse pregnancy outcome is associated with increased risk of developing maternal CTD, including SLE. Either immunological factors predispose women to adverse pregnancy outcome and subsequent CTD diagnosis or, alternatively, adverse pregnancy outcome initiates autoimmune events which culminate in CTD in later life. TWEETABLE ABSTRACT Stillbirth is associated with increased maternal risk of developing systemic lupus erythematosus (SLE).
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Affiliation(s)
- H Kither
- Faculty of Biological, Medical and Human Sciences, School of Medical Sciences, Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Saint Mary's Hospital, Manchester, UK
| | - A Heazell
- Faculty of Biological, Medical and Human Sciences, School of Medical Sciences, Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Saint Mary's Hospital, Manchester, UK
| | - I N Bruce
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, School of Biological Sciences, Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester, UK
| | - C Tower
- Faculty of Biological, Medical and Human Sciences, School of Medical Sciences, Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Saint Mary's Hospital, Manchester, UK
| | - I Crocker
- Faculty of Biological, Medical and Human Sciences, School of Medical Sciences, Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Saint Mary's Hospital, Manchester, UK
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22
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Cho J, Lahiri M, Teoh LK, Dhanasekaran P, Cheung PP, Lateef A. Predicting flares in patients with stable systemic lupus erythematosus. Semin Arthritis Rheum 2019; 49:91-97. [PMID: 30660381 DOI: 10.1016/j.semarthrit.2019.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/12/2018] [Accepted: 01/02/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Data on flares in Asian patients with systemic lupus erythematosus (SLE) are scarce. Here, we aim to identify the baseline predictors of flares in a cohort of Southeast Asian patients with SLE. METHODS Consecutive adult patients with prevalent SLE according to the 1997 ACR or 2012 SLICC criteria were enrolled and followed three-monthly. Clinical and laboratory data were collected at every visit using a standardised protocol. Flares were defined using the SELENA-SLEDAI Flare Index (SFI). Baseline predictors of flare in patients with stable disease (SLE Disease Activity Index-2K (SLEDAI-2K) of ≤ 4) were determined using Cox proportional hazards. RESULTS Of the 210 patients recruited, 148 (70.5%) were Chinese. The median (IQR) SLEDAI-2K at entry was 2 (0-4) and the median (IQR) disease duration was 10 (4.4-16.4) years. At baseline, 152 (72.4%) patients had stable disease. After a median (IQR) follow-up of 31.5 (24.1-36.3) months, 109 (51.9%) flared. Stable patients who flared tended to be in the lowest tertile of age (HR 3.08, 95% CI 1.72-5.48, p < 0.01), had thrombocytopenia (HR 5.01, 95% CI 1.32-18.99, p = 0.02), hypocomplementemia (HR 3.35, 95% CI 1.54-7.30, p < 0.01) and had the highest baseline prednisolone doses (HR 2.39, 95% CI 1.28-4.46, p = 0.01). Conversely, patients in the lowest tertile of disease duration tended not to flare (HR 0.41, 95% CI 0.21-0.80, p = 0.01). CONCLUSION Flares are common in Asian SLE patients with initial stable disease. Close monitoring is needed for patients who are younger, with longer disease duration, thrombocytopenia, hypocomplementemia, or who required a higher baseline prednisolone dose.
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Affiliation(s)
- Jiacai Cho
- Division of Rheumatology, Department of Medicine, National University Hospital of Singapore, Level 10, NUHS Tower Block, 1E Kent Ridge Road, 119228, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Manjari Lahiri
- Division of Rheumatology, Department of Medicine, National University Hospital of Singapore, Level 10, NUHS Tower Block, 1E Kent Ridge Road, 119228, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lay Kheng Teoh
- Division of Rheumatology, Department of Medicine, National University Hospital of Singapore, Level 10, NUHS Tower Block, 1E Kent Ridge Road, 119228, Singapore
| | - Preeti Dhanasekaran
- Division of Rheumatology, Department of Medicine, National University Hospital of Singapore, Level 10, NUHS Tower Block, 1E Kent Ridge Road, 119228, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Peter P Cheung
- Division of Rheumatology, Department of Medicine, National University Hospital of Singapore, Level 10, NUHS Tower Block, 1E Kent Ridge Road, 119228, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Aisha Lateef
- Division of Rheumatology, Department of Medicine, National University Hospital of Singapore, Level 10, NUHS Tower Block, 1E Kent Ridge Road, 119228, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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23
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Nim HT, Connelly K, Vincent FB, Petitjean F, Hoi A, Koelmeyer R, Boyd SE, Morand EF. Novel Methods of Incorporating Time in Longitudinal Multivariate Analysis Reveals Hidden Associations With Disease Activity in Systemic Lupus Erythematosus. Front Immunol 2019; 10:1649. [PMID: 31379847 PMCID: PMC6653068 DOI: 10.3389/fimmu.2019.01649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/02/2019] [Indexed: 12/27/2022] Open
Abstract
Objective: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease. SLE is characterized by high inter-patient variability, including fluctuations over time, a factor which most biomarker studies omit from consideration. We investigated relationships between disease activity and biomarker expression in SLE, using novel methods to control for time-dependent variability, in a proof-of-concept study to evaluate whether doing so revealed additional information. Methods: We measured 4 serum biomarkers (MIF, CCL2, CCL19, and CXCL10) and 13 routine clinical laboratory parameters, alongside disease activity measured by the SLE disease activity index-2k (SLEDAI-2k), collected longitudinally. We analyzed these data with unsupervised learning methods via ensemble clustering, incorporating temporal relationships using dynamic time warping for distance metric calculation. Results: Data from 843 visits in 110 patients (median age 47, 83% female) demonstrated highly heterogeneous time-dependent relationships between disease activity and biomarkers. Unbiased magnitude-based hierarchical clustering of biomarker expression levels isolated a patient subset (n = 9) with distinctively heterogeneous expression of the 17 biological parameters, and who had MIF, CCL2, CCL19, and CXCL10 levels that were higher and more strongly associated with disease activity, based on leave-one-out cross-validated regression analysis. In the remaining subgroup, a time-dependent regression model revealed significantly stronger predictive power of biomarkers for disease activity, compared to a time-agnostic regression model. Despite no significant difference in simple magnitude, using dynamic time warping analysis to align longitudinal profiles revealed a large subset (n = 69) with significantly stronger associations between biological parameters and disease activity. This subgroup had significantly lower flare rates, disease activity and damage scores, suggesting this clustering is clinically meaningful. Conclusions: These results suggest associations between biological parameters and disease activity in SLE exist in a multi-dimensional time-dependent pattern, with implications for the analysis of biomarkers in SLE often used to identify therapeutic targets. Novel methods to analyse high-dimensional data and control for time-dependent variability may have broad utility in the study complex relationships between clinical and biological parameters.
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Affiliation(s)
- Hieu T Nim
- Data Science & AI, Faculty of Information Technology, Monash University, Clayton, VIC, Australia.,Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Kathryn Connelly
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Fabien B Vincent
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - François Petitjean
- Data Science & AI, Faculty of Information Technology, Monash University, Clayton, VIC, Australia
| | - Alberta Hoi
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Rachel Koelmeyer
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Sarah E Boyd
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Eric F Morand
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
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24
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Yo JH, Barbour TD, Nicholls K. Management of refractory lupus nephritis: challenges and solutions. Open Access Rheumatol 2019; 11:179-188. [PMID: 31372070 PMCID: PMC6636187 DOI: 10.2147/oarrr.s166303] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/13/2019] [Indexed: 12/15/2022] Open
Abstract
Refractory lupus nephritis, broadly defined as failure to attain clinical remission after appropriate induction immunosuppressive therapy, is associated with an increased risk of progression to end-stage kidney disease and mortality. This is a challenging issue in clinical practice, as modern induction therapy despite proven efficacy can still be associated with treatment failure. Moreover, newer therapies have failed in recent years to displace or even match existing protocols for effective induction of remission. Refractory disease is generally assessed on the basis of clinical parameters, which may be unreliable, and renal biopsy, which is often not performed in a standard or timely fashion. Persisting histological inflammation in 30%–50% of patients who have attained clinical remission highlights the disparity between clinical and immunological response to therapy. The lack of an international consensus regarding what constitutes refractory lupus nephritis compounds clinician indecision regarding optimal management for these patients. Moreover, non-adherence to prescribed therapy versus primary treatment failure can be challenging to discriminate, and the time point at which non-response becomes treatment failure is unclear. In this review, we assess the key published evidence for the treatment of refractory lupus nephritis and provide practical recommendations based around the use of adjunctive therapies. These agents include rituximab and calcineurin inhibitors, with evidence consisting largely of observational or uncontrolled studies, as well as some of the biologic therapies currently under investigation through prospective clinical trials. The poor prognosis of refractory lupus nephritis demands regular review of patient response and the flexibility to switch or augment therapy.
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Affiliation(s)
- J H Yo
- Department of Nephrology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - T D Barbour
- Department of Nephrology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - K Nicholls
- Department of Nephrology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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25
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Nasonov E, Soloviev S, Davidson JE, Lila A, Togizbayev G, Ivanova R, Baimukhamedov C, Omarbekova Z, Iaremenko O, Gnylorybov A, Shevchuk S, Vasylyev A, Makarova J, Tariq L. Systemic lupus erythematosus and associated healthcare resource consumption in selected cities from the Russian Federation, Republic of Kazakhstan and Ukraine: the ESSENCE study. J Med Econ 2018; 21:1006-1015. [PMID: 29992845 DOI: 10.1080/13696998.2018.1499518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To evaluate healthcare resource (HR) consumption associated with Systemic Lupus Erythematosus (SLE) management in adult patients with active autoantibody positive disease in the Russian Federation, Republic of Kazakhstan, and Ukraine. METHODS The ESSENCE was a retrospective, observational study, and included data on patients' clinical characteristics and SLE-related HR use (laboratory, biopsy, imaging tests, medications, visits to specialists, outpatient visits, hospitalizations) during 2010 from the 12 specialized rheumatologic centers. RESULTS A total of 436 SLE patients were included in the analyses, with 232 patients being enrolled in Russia, 110 in Kazakhstan, and 94 in Ukraine. The mean age was 36-42 years and median SLE duration was 3-6.8 years across the countries. Extrapolation to total country population showed that, in 2010, visits to specialists (who assign treatment for organs involved/damaged by SLE) were the most frequently used HR (from 13,439 visits in Kazakhstan to 23,510 in Russia), followed by hospitalizations (from 2,950 in Kazakhstan to 6,267 in Russia) and outpatient visits (from 1,654 visits in Russia to 8,064 in Kazakhstan). Compared to chronic active patients (SLE persistent during last year), patients with relapsing-remitting SLE (at least one flare alternated by one remission per year) had a higher rate of visits to specialists (100% vs 60.8%, p < .001) and hospitalizations (98.9% vs 60.8%, p < .001). Compared to patients without flares, patients experiencing flares had a higher rate of unplanned visits to specialists (86.2% vs 6.3%, p < .001), were more often hospitalized (both ICU and non-ICU) (100.0% vs 50.0%, p < .001), and had a longer duration of ICU hospitalization (25.9 days vs 17.5 days, p < .001). CONCLUSIONS Specialist visits are the most frequently consumed SLE-related healthcare recourse in the Commonwealth of Independent States (CIS) countries. A relapsing-remitting SLE profile and the occurrence of flares significantly raise healthcare resource consumption.
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Affiliation(s)
- E Nasonov
- a Institute of Rheumatology at Russian Academy of Medical Science , Moscow , Russia
| | - S Soloviev
- a Institute of Rheumatology at Russian Academy of Medical Science , Moscow , Russia
| | - J E Davidson
- b Worldwide Epidemiology, GlaxoSmithKline R&D , Stockley Park , UK
| | - A Lila
- c North-Western Medical University named after I.I. Mechnikov , St. Petersburg , Russia
| | - G Togizbayev
- d Institute of Advanced Education "Asyl Clinic" , Almaty , Kazakhstan
| | - R Ivanova
- e Semey State Medical University , Internal Medicine Department , Semey , Kazakhstan
| | - Ch Baimukhamedov
- d Institute of Advanced Education "Asyl Clinic" , Almaty , Kazakhstan
| | - Zh Omarbekova
- d Institute of Advanced Education "Asyl Clinic" , Almaty , Kazakhstan
| | - O Iaremenko
- f National Medical University named after O.O. Bogomolets , Kyiv , Ukraine
| | - A Gnylorybov
- g Institute of Urgent and Recovery Surgery named after V.K. Gusak, National Academy of Medical Sciences of Ukraine , Kyiv , Ukraine
| | - S Shevchuk
- h Scientific Research Institute of Rehabilitation of Disabled, Vinnytsya National Medical University named after M.I. Pirogov , Vinnitsya , Ukraine
| | | | | | - L Tariq
- k GlaxoSmithKline , Dubai , United Arab Emirates
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26
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Mende R, Vincent FB, Kandane-Rathnayake R, Koelmeyer R, Lin E, Chang J, Hoi AY, Morand EF, Harris J, Lang T. Analysis of Serum Interleukin (IL)-1β and IL-18 in Systemic Lupus Erythematosus. Front Immunol 2018; 9:1250. [PMID: 29930551 PMCID: PMC5999794 DOI: 10.3389/fimmu.2018.01250] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 05/18/2018] [Indexed: 12/13/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease characterized by biological and clinical heterogeneity. The interleukin (IL)-1 superfamily is a group of innate cytokines that contribute to pathogenesis in many autoimmune diseases. IL-1β and IL-18 are two members that have been shown to play a role in murine lupus-like models, but their role in human SLE remains poorly understood. Here, IL-1β and IL-18 were quantified by enzyme-linked immunosorbent assay in the serum of healthy controls (HCs) and SLE patients from a prospectively followed cohort. Disease activity and organ damage were assessed using SLE disease activity index 2000 (SLEDAI-2K) and SLE damage index scores (SDI), respectively. 184 SLE patients (mean age 44.9 years, 91% female, 56% double-stranded deoxyribonucleic acid positive) were compared to 52 HC. SLE patients had median [IQR] SLEDAI-2K of 4 [2,6], and SDI of 1 [0–2]. Serum IL-18 levels were statistically significantly higher in SLE patients compared to HCs. Univariable linear regression analyses showed that patients with active renal disease or irreversible organ damage had statistically significantly elevated serum IL-18 levels. The association between serum IL-18 and active renal disease was confirmed in multivariable analysis after adjusting for ethnicity and organ damage. High baseline serum IL-18 levels were associated with organ damage at the subsequent visit. Serum IL-1β levels were not significantly elevated in SLE patients when compared to HCs and had no association with overall or organ-specific disease activity or organ damage in cross-sectional and longitudinal analyses. Our data suggest that serum IL-18 and IL-1β have different clinical implications in SLE, with IL-18 being potentially associated with active renal disease.
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Affiliation(s)
- Rachel Mende
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Fabien B Vincent
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Rangi Kandane-Rathnayake
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Rachel Koelmeyer
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Emily Lin
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Janet Chang
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Alberta Y Hoi
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Eric F Morand
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - James Harris
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Tali Lang
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
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Abdul Kadir WD, Jamil A, Shaharir SS, Md Nor N, Abdul Gafor AH. Photoprotection awareness and practices among patients with systemic lupus erythematosus and its association with disease activity and severity. Lupus 2018; 27:1287-1295. [PMID: 29665756 DOI: 10.1177/0961203318770016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective The objective of this paper is to determine photoprotection awareness, knowledge, practices, and its relationship with disease activity and damage in patients with systemic lupus erythematosus (SLE). Methods A cross-sectional study was performed. Data were acquired from in-person interviews and medical records. Results A total of 199 (89.6%) females and 23 (10.4%) males were recruited. Median age was 39.00 (interquartile range (IQR) 18) years, disease duration 12.12 (IQR 8) years, Fitzpatrick skin phototype III 119 (53.6%) and IV 81 (36.5%). Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2 K) was 2.95 (IQR 4) while Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC-ACR DI) was 1.20 (IQR 2). The majority 205 (92.3%) were aware of sun exposure effects on SLE. Photoprotection methods were shade seeking 209 (94.1%), sun avoidance 212 (95.5%), long pants 168 (75.7%), long sleeves 155 (69.8%), sunscreen 116 (52.3%), sunglasses 114 (51.4%) and head cover 103 (46.4%). Significantly higher photoprotection practice scores (PPS) were observed in females, Malays, and individuals with higher education level and internet accessibility. PPS were not significantly correlated with SLICC-ACR DI and SLEDAI-2 K. Independent predictors for good photoprotection practice (GPP) were ethnicity (OR = 3.66, 95% CI 1.78-7.53), awareness (OR = 3.77, 95% CI 1.09-13.08) and cutaneous involvement (OR = 2.43, 95% CI 1.11-5.28). Photoprotection methods and GPP were not predictors for disease activity or damage. Conclusion Photoprotection awareness and knowledge was good. Shade seeking and sun avoidance were the common photoprotection methods practised. The use of sunscreen requires improvement. Photoprotection awareness and cutaneous manifestation were predictors for GPP. Neither photoprotection methods nor GPP were associated with disease activity or damage.
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Affiliation(s)
- W D Abdul Kadir
- 1 Department of Medicine, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - A Jamil
- 2 Department of Medicine, University Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - S Sazliyana Shaharir
- 2 Department of Medicine, University Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - N Md Nor
- 2 Department of Medicine, University Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - A H Abdul Gafor
- 2 Department of Medicine, University Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
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Tunnicliffe DJ, Singh-Grewal D, Craig JC, Jesudason S, Tugwell P, Lin MW, O'Neill SG, Sumpton D, Tong A. Perspectives of Medical Specialists From Different Disciplines on the Management of Systemic Lupus Erythematosus: An Interview Study. Arthritis Care Res (Hoboken) 2017; 70:1284-1293. [PMID: 29136338 DOI: 10.1002/acr.23469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 11/07/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) is a complex autoimmune disease that can affect multiple organ systems, with specialists from many disciplines often involved, which may lead to inconsistent care. We aimed to describe the attitudes and perspectives of specialists from different medical disciplines on the management of people with SLE. METHODS Face-to-face semistructured interviews were conducted with rheumatologists (n = 16), nephrologists (n = 16), and immunologists (n = 11) providing care to adults with SLE from 19 centers across Australia in 2015. All interviews were transcribed and analyzed thematically. RESULTS Five themes were identified: uncertainties in judgments (hampered by unknown and unclear etiology, inapplicable evidence, comprehending information dispersion), reflexive responses (anchoring to specialty training, anticipating outcomes, avoiding disaster, empathy for the vulnerable), overarching duty to patients (achieving patient priorities, maximizing adherence, controlling the disease, providing legitimate information, having adequate and relevant expertise), safeguarding professional opportunities (diversifying clinical skills, protecting colleagues' interests), and optimizing access to treatment (capitalizing on multidisciplinary care, acquiring breakthrough therapies). CONCLUSION Specialists strive to deliver evidence-informed patient-centered care, but recognize that they are anchored by their training. To overcome uncertainties in clinical management due to lack of high-quality evidence and specialty silo structures, specialists translated evidence from other disease settings and collaborated with other specialists in routine care. Developing robust evidence, tools to support evidence-informed decisions, and multidisciplinary shared-care pathways may improve the management of people with this complex disease.
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Affiliation(s)
- David J Tunnicliffe
- Sydney School of Public Health, University of Sydney, and Children's Hospital at Westmead, Sydney, Australia
| | - Davinder Singh-Grewal
- Sydney Medical School, Sydney Children's Hospital Network, and University of New South Wales, Sydney, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, and Children's Hospital at Westmead, Sydney, Australia
| | - Shilpanjali Jesudason
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
| | | | - Ming-Wei Lin
- Sydney Medical School, University of Sydney, and Westmead Hospital, Sydney, Australia
| | - Sean G O'Neill
- University of New South Wales, Liverpool Hospital, and Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Daniel Sumpton
- Sydney School of Public Health, University of Sydney, Children's Hospital at Westmead, Liverpool Hospital, Sydney, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, and Children's Hospital at Westmead, Sydney, Australia
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Oku K, Atsumi T, Akiyama Y, Amano H, Azuma N, Bohgaki T, Asanuma YF, Horita T, Hosoya T, Ichinose K, Kato M, Katsumata Y, Kawaguchi Y, Kawakami A, Koga T, Kohsaka H, Kondo Y, Kubo K, Kuwana M, Mimori A, Mimori T, Mimura T, Murakami K, Nakano K, Nakayamada S, Ogishima H, Ohmura K, Saito K, Sano H, Shibuya M, Takahashi Y, Takasaki Y, Takeuchi T, Tamura N, Tanaka Y, Tsuboi H, Tsunoda S, Yukawa N, Yamakawa N, Yamamoto K, Sumida T. Evaluation of the alternative classification criteria of systemic lupus erythematosus established by Systemic Lupus International Collaborating Clinics (SLICC). Mod Rheumatol 2017; 28:642-648. [PMID: 29120258 DOI: 10.1080/14397595.2017.1385154] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the performance of the 2012 Systemic Lupus International Collaborating Clinics criteria (SLICC-12) on classifying systemic lupus erythematosus (SLE) in an uncontrolled multi-centered study with real-life scenario of the patients in Japan. METHODS This study comprised 495 patients with SLE or non-SLE rheumatic diseases and allied conditions from 12 institutes in Japan. Chart review of each patient was performed by the 27 expert rheumatologists and diagnosis of 487 cases reached to the consensus. Value of the SLICC-12 on SLE classification was analyzed comparing with the 1997 revised American College of Rheumatology SLE classification criteria (ACR-97) employing the expert-consented diagnoses. RESULTS Compared to the ACR-97, the SLICC-12 had a higher sensitivity (ACR-97 vs. SLICC-12: 0.88 vs. 0.99, p < .01) and comparable specificity (0.85 vs. 0.80). The rate of misclassification (0.14 vs. 0.11) or the area under the receiver operating characteristic curves (0.863 vs. 0.894) was not statistically different. In the cases that diagnoses corresponded in high rates among experts, both criteria showed high accordance of SLE classification over 85% with the expert diagnoses. CONCLUSION Although employment of SLICC-12 for the classification for SLE should be carefully considered, the SLICC-12 showed the higher sensitivity on classifying SLE in Japanese population.
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Affiliation(s)
- Kenji Oku
- a Division of Rheumatology, Endocrinology and Nephrology , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Tatsuya Atsumi
- a Division of Rheumatology, Endocrinology and Nephrology , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Yuji Akiyama
- b Department of Rheumatology and Applied Immunology , Saitama Medical University , Saitama , Japan
| | - Hirofumi Amano
- c Department of Internal Medicine and Rheumatology, Faculty of Medicine , Juntendo University , Tokyo , Japan
| | - Naoto Azuma
- d Division of Rheumatology, Department of Internal Medicine , Hyogo College of Medicine , Nishinomiya , Japan
| | - Toshiyuki Bohgaki
- a Division of Rheumatology, Endocrinology and Nephrology , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Yu Funakubo Asanuma
- b Department of Rheumatology and Applied Immunology , Saitama Medical University , Saitama , Japan
| | - Tetsuya Horita
- a Division of Rheumatology, Endocrinology and Nephrology , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Tadashi Hosoya
- e Department of Rheumatology, Graduate School of Medical and Dental Sciences , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
| | - Kunihiro Ichinose
- f Department of Immunology and Rheumatology , Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Masaru Kato
- a Division of Rheumatology, Endocrinology and Nephrology , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Yasuhiro Katsumata
- g Institute of Rheumatology , Tokyo Women's Medical University , Tokyo , Japan
| | - Yasushi Kawaguchi
- g Institute of Rheumatology , Tokyo Women's Medical University , Tokyo , Japan
| | - Atsushi Kawakami
- f Department of Immunology and Rheumatology , Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Tomohiro Koga
- f Department of Immunology and Rheumatology , Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Hitoshi Kohsaka
- e Department of Rheumatology, Graduate School of Medical and Dental Sciences , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
| | - Yuya Kondo
- h Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine , University of Tsukuba , Tsukuba , Japan
| | - Kanae Kubo
- i Department of Allergy and Rheumatology, Faculty of Medical Sciences , The University of Tokyo , Tokyo , Japan
| | - Masataka Kuwana
- j Department of Allergy and Rheumatology , Nippon Medical School , Tokyo , Japan
| | - Akio Mimori
- k Division of Rheumatic Diseases , National Center for Global Health and Medicine , Tokyo , Japan
| | - Tsuneyo Mimori
- l Department of Rheumatology and Clinical Immunology , Kyoto University , Kyoto , Japan
| | - Toshihide Mimura
- b Department of Rheumatology and Applied Immunology , Saitama Medical University , Saitama , Japan
| | - Kosaku Murakami
- l Department of Rheumatology and Clinical Immunology , Kyoto University , Kyoto , Japan
| | - Kazuhisa Nakano
- m The First Department of Internal Medicine, School of Medicine , University of Occupational and Environmental Health , Kitakyushu , Japan
| | - Shingo Nakayamada
- m The First Department of Internal Medicine, School of Medicine , University of Occupational and Environmental Health , Kitakyushu , Japan
| | - Hiroshi Ogishima
- h Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine , University of Tsukuba , Tsukuba , Japan
| | - Kazumasa Ohmura
- a Division of Rheumatology, Endocrinology and Nephrology , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Kazuyoshi Saito
- m The First Department of Internal Medicine, School of Medicine , University of Occupational and Environmental Health , Kitakyushu , Japan
| | - Hajime Sano
- d Division of Rheumatology, Department of Internal Medicine , Hyogo College of Medicine , Nishinomiya , Japan
| | - Mihoko Shibuya
- i Department of Allergy and Rheumatology, Faculty of Medical Sciences , The University of Tokyo , Tokyo , Japan
| | - Yuko Takahashi
- k Division of Rheumatic Diseases , National Center for Global Health and Medicine , Tokyo , Japan
| | - Yoshinari Takasaki
- c Department of Internal Medicine and Rheumatology, Faculty of Medicine , Juntendo University , Tokyo , Japan
| | - Tsutomu Takeuchi
- n Department of Internal Medicine , Keio University School of Medicine , Tokyo , Japan
| | - Naoto Tamura
- c Department of Internal Medicine and Rheumatology, Faculty of Medicine , Juntendo University , Tokyo , Japan
| | - Yoshiya Tanaka
- m The First Department of Internal Medicine, School of Medicine , University of Occupational and Environmental Health , Kitakyushu , Japan
| | - Hiroto Tsuboi
- h Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine , University of Tsukuba , Tsukuba , Japan
| | - Shinichiro Tsunoda
- d Division of Rheumatology, Department of Internal Medicine , Hyogo College of Medicine , Nishinomiya , Japan
| | - Naoichiro Yukawa
- l Department of Rheumatology and Clinical Immunology , Kyoto University , Kyoto , Japan
| | - Noriyuki Yamakawa
- l Department of Rheumatology and Clinical Immunology , Kyoto University , Kyoto , Japan.,o Department of Rheumatology , Kyoto-Katsura Hospital , Kyoto , Japan
| | - Kazuhiko Yamamoto
- i Department of Allergy and Rheumatology, Faculty of Medical Sciences , The University of Tokyo , Tokyo , Japan
| | - Takayuki Sumida
- h Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine , University of Tsukuba , Tsukuba , Japan
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Dall'Era M, Cisternas MG, Snipes K, Herrinton LJ, Gordon C, Helmick CG. The Incidence and Prevalence of Systemic Lupus Erythematosus in San Francisco County, California: The California Lupus Surveillance Project. Arthritis Rheumatol 2017; 69:1996-2005. [PMID: 28891237 DOI: 10.1002/art.40191] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 06/22/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Estimates of the incidence and prevalence of systemic lupus erythematosus (SLE) in the US have varied widely. The purpose of this study was to conduct the California Lupus Surveillance Project (CLSP) to determine credible estimates of SLE incidence and prevalence, with a special focus on Hispanics and Asians. METHODS The CLSP, which is funded by the Centers for Disease Control and Prevention, is a population-based registry of individuals with SLE residing in San Francisco County, CA, from January 1, 2007 through December 31, 2009. Data sources included hospitals, rheumatologists, nephrologists, commercial laboratories, and a state hospital discharge database. We abstracted medical records to ascertain SLE cases, which we defined as patients who met ≥4 of the 11 American College of Rheumatology classification criteria for SLE. We estimated crude and age-standardized incidence and prevalence, which were stratified by sex and race/ethnicity. RESULTS The overall age-standardized annual incidence rate was 4.6 per 100,000 person-years. The average annual period prevalence was 84.8 per 100,000 persons. The age-standardized incidence rate in women and men was 8.6 and 0.7 per 100,000 person-years, respectively. This rate was highest among black women (30.5), followed by Hispanic women (8.9), Asian women (7.2), and white women (5.3). The age-standardized prevalence in women per 100,000 persons was 458.1 in blacks, 177.9 in Hispanics, 149.7 in Asians, and 109.8 in whites. Capture-recapture modeling estimated 33 additional incident cases and 147 additional prevalent cases. CONCLUSION Comprehensive methods that include intensive case-finding provide more credible estimates of SLE in Hispanics and Asians, and confirm racial and ethnic disparities in SLE. The disease burden of SLE is highest in black women, followed by Hispanic women, Asian women, and white women.
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Affiliation(s)
| | | | - Kurt Snipes
- California Department of Public Health, Sacramento
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31
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Affiliation(s)
- Philip H. Li
- Division of Rheumatology and Clinical Immunology; Department of Medicine; Queen Mary Hospital; University of Hong Kong; Hong Kong Hong Kong
| | - Chak-Sing Lau
- Division of Rheumatology and Clinical Immunology; Department of Medicine; Queen Mary Hospital; University of Hong Kong; Hong Kong Hong Kong
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32
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Zaman GS. Introduction and Physiology of Lupus. Lupus 2017. [DOI: 10.5772/intechopen.68635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Golder V, Hoi A. Systemic lupus erythematosus: an update. Med J Aust 2017; 206:215-220. [PMID: 28301792 DOI: 10.5694/mja16.01229] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/12/2016] [Indexed: 12/25/2022]
Abstract
Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease predominantly affecting women of childbearing age. New classification criteria for SLE have greater sensitivity and therefore improve the diagnostic certainty for some patients, especially those who may previously have been labelled as having undifferentiated symptoms. Uncontrolled disease activity leads to irreversible end-organ damage, which in turn increases the risk of premature death; early and sustained control of disease activity can usually be achieved by conventional immunosuppressant therapy. The development of biological therapy lags behind that for other rheumatic diseases, with belimumab being the only targeted therapy approved by the Therapeutic Goods Administration. "Treat-to-target" concepts are changing trial design and clinical practice, with evidence-based definition of response criteria in the form of remission and low disease activity now on the horizon. While new therapies are awaited, research should also focus on optimising the use of current therapy and improving the quality of care of patients with SLE.
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Golder V, Kandane-Rathnayake R, Hoi AYB, Huq M, Louthrenoo W, An Y, Li ZG, Luo SF, Sockalingam S, Lau CS, Mok MY, Lateef A, Franklyn K, Morton S, Navarra STV, Zamora L, Wu YJ, Hamijoyo L, Chan M, O'Neill S, Goldblatt F, Nikpour M, Morand EF. Association of the lupus low disease activity state (LLDAS) with health-related quality of life in a multinational prospective study. Arthritis Res Ther 2017; 19:62. [PMID: 28320433 PMCID: PMC5359963 DOI: 10.1186/s13075-017-1256-6] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 02/09/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is associated with significant impairment of health-related quality of life (HR-QoL). Recently, meeting a definition of a lupus low disease activity state (LLDAS), analogous to low disease activity in rheumatoid arthritis, was preliminarily validated as associated with protection from damage accrual. The LLDAS definition has not been previously evaluated for association with patient-reported outcomes. The objective of this study was to determine whether LLDAS is associated with better HR-QoL, and examine predictors of HR-QoL, in a large multiethnic, multinational cohort of patients with SLE. METHODS HR-QoL was measured using the Medical Outcomes Study 36-item short form health survey (SF-36v2) in a prospective study of 1422 patients. Disease status was measured using the SLE disease activity index (SLEDAI-2 K), physician global assessment (PGA) and LLDAS. RESULTS Significant differences in SF-36 domain scores were found between patients stratified by ethnic group, education level and damage score, and with the presence of active musculoskeletal or cutaneous manifestations. In multiple linear regression analysis, Asian ethnicity (p < 0.001), a higher level of education (p < 0.001), younger age (p < 0.001) and shorter disease duration (p < 0.01) remained significantly associated with better physical component scores (PCS). Musculoskeletal disease activity (p < 0.001) was negatively associated with PCS, and cutaneous activity (p = 0.04) was negatively associated with mental component scores (MCS). Patients in LLDAS had better PCS (p < 0.001) and MCS (p < 0.001) scores and significantly better scores in multiple individual SF-36 domain scores. Disease damage was associated with worse PCS (p < 0.001), but not MCS scores. CONCLUSIONS Ethnicity, education, disease damage and specific organ involvement impacts HR-QoL in SLE. Attainment of LLDAS is associated with better HR-QoL.
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Affiliation(s)
- Vera Golder
- Monash University School of Clinical Sciences at Monash Health, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Melbourne, Australia.
| | - Rangi Kandane-Rathnayake
- Monash University School of Clinical Sciences at Monash Health, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Melbourne, Australia
| | - Alberta Yik-Bun Hoi
- Monash University School of Clinical Sciences at Monash Health, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Melbourne, Australia
| | - Molla Huq
- The University of Melbourne, Melbourne, Australia
| | | | - Yuan An
- People's Hospital Peking University Health Sciences Center, Beijing, China
| | - Zhan Guo Li
- People's Hospital Peking University Health Sciences Center, Beijing, China
| | - Shue Fen Luo
- Chang Gung Memorial Hospital, Guishan Township, Taiwan
| | | | | | - Mo Yin Mok
- University of Hong Kong, Pokfulam, Hong Kong
| | - Aisha Lateef
- National University Hospital, Singapore, Republic of Singapore
| | - Kate Franklyn
- Monash University School of Clinical Sciences at Monash Health, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Melbourne, Australia
| | | | | | - Leonid Zamora
- University of Santo Tomas Hospital, Manila, Philippines
| | - Yeong-Jian Wu
- Chang Gung Memorial Hospital, Guishan Township, Taiwan
| | | | - Madelynn Chan
- Tan Tock Seng Hospital, Singapore, Republic of Singapore
| | - Sean O'Neill
- University of New South Wales, Sydney, Australia
| | | | | | - Eric Francis Morand
- Monash University School of Clinical Sciences at Monash Health, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Melbourne, Australia
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Tunnicliffe DJ, Singh-Grewal D, Craig JC, Howell M, Tugwell P, Mackie F, Lin MW, O'Neill SG, Ralph AF, Tong A. Healthcare and Research Priorities of Adolescents and Young Adults with Systemic Lupus Erythematosus: A Mixed-methods Study. J Rheumatol 2017; 44:444-451. [PMID: 28250139 DOI: 10.3899/jrheum.160720] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Managing juvenile-onset systemic lupus erythematosus (SLE) is particularly challenging. The disease may be severe, adolescent patients have complex medical and psychosocial needs, and patients must navigate the transition to adult services. To inform patient-centered care, we aimed to identify the healthcare and research priorities of young patients with SLE and describe the reasons underpinning their priorities. METHODS Face-to-face, semistructured interviews and focus groups were conducted with patients with SLE, aged from 14 to 26 years, from 5 centers in Australia. For each of the 5 allocation exercises, participants allocated 10 votes to (1) research topics; research questions on (2) medical management, (3) prevention and diagnosis, (4) lifestyle and psychosocial; and (5) healthcare specialties, and discussed the reasons for their choices. Descriptive statistics were calculated for votes and qualitative data were analyzed thematically. RESULTS The 26 participants prioritized research that alleviated the psychological burden of SLE. They allocated their votes toward medical and mental health specialties in the management of SLE, while fewer votes were given to physiotherapy/occupational therapy and dietetics. The following 7 themes underpinned the participants' priorities: improving service shortfalls, strengthening well-being, ensuring cost efficiency, minimizing family/community burden, severity of comorbidity or complications, reducing lifestyle disruption, and fulfilling future goals. CONCLUSION Young patients with SLE value comprehensive care with greater coordination among specialties. They prioritized research focused on alleviating poor psychological outcomes. The healthcare and research agenda for patients with SLE should include everyone involved, to ensure that the agenda aligns with patient priorities, needs, and values.
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Affiliation(s)
- David J Tunnicliffe
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada. .,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead.
| | - Davinder Singh-Grewal
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada.,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead
| | - Jonathan C Craig
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada.,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead
| | - Martin Howell
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada.,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead
| | - Peter Tugwell
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada.,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead
| | - Fiona Mackie
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada.,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead
| | - Ming-Wei Lin
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada.,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead
| | - Sean G O'Neill
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada.,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead
| | - Angelique F Ralph
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada.,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead
| | - Allison Tong
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada.,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead
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Factors predictive of high disease activity early in the course of SLE in patients from a Latin-American cohort. Semin Arthritis Rheum 2017; 47:199-203. [PMID: 28291583 DOI: 10.1016/j.semarthrit.2017.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 01/21/2017] [Accepted: 01/26/2017] [Indexed: 11/21/2022]
Abstract
AIMS To determine the factors predictive of disease activity early in the course of SLE (baseline visit). METHODS Patients from GLADEL, a multi-national, multi-ethnic, Latin-American lupus cohort were included. Disease activity was evaluated at baseline with the SLEDAI score. Demographic characteristics (age at diagnosis, gender, ethnicity, marital status, educational level, medical coverage and socioeconomic status) were assessed. Disease duration was defined as the time between the fourth ACR criterion and baseline. Time to criteria accrual was defined as the interval between the first and fourth ACR criterion. Use of glucocorticoids was recorded as the highest dose received before the baseline visit. Antimalarials and immunosuppressive drugs were recorded as use or not use. Univariable and multivariable analysis were performed. Model selection was based on backward elimination. RESULTS One thousand two hundred sixty-eight patients were included; 1136 (89.6%) of them were female. Mean age at diagnosis was 29.2 (SD: 12.3) years. Five hundred sixty-five (44.6%) were Mestizo, 539 (42.5%) were Caucasians and 164 (12.9%) were African-Latin-Americans. The mean SLEDAI at baseline was 10.9 (SD: 8.4). Longer time between first and fourth ACR criterion, medical coverage, a dose of prednisone between 15 and 60mg/d, and the use of antimalarials were factors protective of disease activity, while Mestizo and African-Latin-American ethnicities were predictive factors. CONCLUSIONS Mestizo and African-Latin-American ethnicities were predictive whereas antimalarial use, medical coverage, and longer time to criteria accrual were protective of higher disease activity early in the disease course.
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Defining biological subsets in systemic lupus erythematosus: progress toward personalized therapy. Pharmaceut Med 2017; 31:81-88. [PMID: 28827978 DOI: 10.1007/s40290-017-0178-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Systemic lupus erythematosus (SLE) is a heterogeneous disease with respect to disease severity, response to treatment, and organ damage. The pathogenesis of SLE includes immunological mechanisms which are driven by both genetic and environmental factors. There are clear differences in the pathogenesis of SLE between patients of different ancestral backgrounds, including differences in genetic risk factors, immunological parameters, and clinical manifestations. Patients with high vs. low levels of type I interferon (IFN) in circulation represents one major biological subset within SLE, and these two groups of patients are present in all ancestral backgrounds. Genetic factors, autoantibodies, and levels of other cytokines all differ between high and low IFN patients. This distinction has also been important in predicting response to treatment with anti-type I IFN therapies, providing a precedent in SLE for biological subsets predicting treatment response. This review will highlight some recent developments in defining biological subsets of SLE based on disease pathophysiology, and the idea that improved knowledge of disease heterogeneity will inform our efforts to personalize therapy in this disease.
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Phatak S, Chaurasia S, Mishra SK, Gupta R, Agrawal V, Aggarwal A, Misra R. Urinary B cell activating factor (BAFF) and a proliferation-inducing ligand (APRIL): potential biomarkers of active lupus nephritis. Clin Exp Immunol 2016; 187:376-382. [PMID: 27804111 DOI: 10.1111/cei.12894] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2016] [Indexed: 12/23/2022] Open
Abstract
B cell activating factor (BAFF) and a proliferation-inducing ligand (APRIL) help in B cell activation, maintenance and plasma cell survival. B cell infiltration has been demonstrated in kidneys of patients with lupus nephritis (LN). Serum levels of BAFF and APRIL have shown inconsistent relationships with lupus disease activity. We evaluated urinary levels of BAFF and APRIL as biomarker for LN. Thirty-six patients with proliferative lupus nephritis (AN), 10 with active lupus without nephritis (AL) and 15 healthy controls (HC) were studied. APRIL and BAFF levels were measured in both serum and urine using enzyme-linked immunosorbent assay (ELISA). Urine levels were normalized for urinary creatinine excretion. Urine levels were correlated with conventional disease activity markers and histology. Levels were reassessed in 20 AN patients at 6 months after treatment with cyclophosphamide. Urinary APRIL (uAPRIL) and BAFF (uBAFF) levels were raised significantly in AN. uAPRIL, but not uBAFF, correlated moderately with renal Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) in AN (r = 0·36, P < 0·05). On receiver operator curve (ROC) analysis, uBAFF and uAPRIL showed an area under the curve (AUC) of 0·825 and 0·781, respectively, in differentiating between nephritis and non-nephritis, which performed better than low C3, C4 and raised anti-dsDNA antibodies. There was no correlation of serum levels with uBAFF (r = 0·187, P = 0·261) and uAPRIL (r = 0·114, P = 0·494). uAPRIL levels reduced after treatment (mean 125 pg/mg to 36 pg/mg, P < 0·05). uBAFF levels reduced in 16 responders while two of four non-responders had increase in levels. Thus, uBAFF and uAPRIL are potential biomarkers of proliferative lupus nephritis.
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Affiliation(s)
- S Phatak
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - S Chaurasia
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - S K Mishra
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - R Gupta
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - V Agrawal
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - A Aggarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - R Misra
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Apostolopoulos D, Kandane-Rathnayake R, Raghunath S, Hoi A, Nikpour M, Morand EF. Independent association of glucocorticoids with damage accrual in SLE. Lupus Sci Med 2016; 3:e000157. [PMID: 27933196 PMCID: PMC5133410 DOI: 10.1136/lupus-2016-000157] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 10/13/2016] [Accepted: 10/26/2016] [Indexed: 12/15/2022]
Abstract
Objectives To determine factors associated with damage accrual in a prospective cohort of patients with SLE. Methods Patients with SLE who attended the Lupus Clinic at Monash Health, Australia, between 2007 and 2013 were studied. Clinical variables included disease activity (Systemic Lupus Erythematosus Disease Activity Index-2K, SLEDAI-2K), time-adjusted mean SLEDAI, cumulative glucocorticoid dose and organ damage (Systemic Lupus International Collaborating Clinics Damage Index (SDI)). Multivariate logistic regression analyses were performed to identify factors associated with damage accrual. Results A total of 162 patients were observed over a median (IQR) 3.6 (2.0–4.7) years. Seventy-five per cent (n=121) of patients received glucocorticoids. Damage accrual was significantly more frequent in glucocorticoid-exposed patients (42% vs 15%, p<0.01). Higher glucocorticoid exposure was independently associated with overall damage accrual after controlling for factors including ethnicity and disease activity and was significant at time-adjusted mean doses above 4.42 mg prednisolone/day; the OR of damage accrual in patients in the highest quartile of cumulative glucocorticoid exposure was over 10. Glucocorticoid exposure was independently associated with damage accrual in glucocorticoid-related and non-glucocorticoid related domains of the SDI. Conclusions Glucocorticoid use is independently associated with the accrual of damage in SLE, including in non-glucocorticoid related domains.
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Affiliation(s)
- Diane Apostolopoulos
- School of Clinical Sciences at Monash Health, Monash University Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia; Department of Rheumatology, Monash Health, Melbourne, Australia
| | - Rangi Kandane-Rathnayake
- School of Clinical Sciences at Monash Health, Monash University Faculty of Medicine, Nursing and Health Sciences , Melbourne , Australia
| | - Sudha Raghunath
- Department of Rheumatology , Monash Health , Melbourne , Australia
| | - Alberta Hoi
- School of Clinical Sciences at Monash Health, Monash University Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia; Department of Rheumatology, Monash Health, Melbourne, Australia
| | - Mandana Nikpour
- Department of Medicine and Rheumatology , The University of Melbourne at St Vincent's Hospital , Melbourne , Australia
| | - Eric F Morand
- School of Clinical Sciences at Monash Health, Monash University Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia; Department of Rheumatology, Monash Health, Melbourne, Australia
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Shaharir SS, Hussein H, Rajalingham S, Mohamed Said MS, Abdul Gafor AH, Mohd R, Mustafar R. Damage in the Multiethnic Malaysian Systemic Lupus Erythematosus (SLE) Cohort: Comparison with Other Cohorts Worldwide. PLoS One 2016; 11:e0166270. [PMID: 27846298 PMCID: PMC5112785 DOI: 10.1371/journal.pone.0166270] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 10/25/2016] [Indexed: 11/19/2022] Open
Abstract
Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease and despite the improvement in the survival in the past few decades, the morbidity due to disease damage remains significant. The objectives of this study were to investigate the disease damagepattern and determine the associated factors of damage in the multi-ethnic Malaysian SLE patients. We consecutively 424SLE patients who attended a consistent follow-up at the National University of Malaysia Medical Centre and Putrajaya Hospital were recruited. Disease damage was assessed using the SLICC/ACR (Systemic Lupus International Collaborating Clinics/American College of Rheumatology) Damage Index (SDI) scores. Information on their demographics and disease characteristics were obtained from the clinical record. Univariate analysis was performed and the best model of independent predictors of disease damage was determined by multivariate logistic regression analysis. A total of 182 patients (42.9%) had disease damage (SDI ≥1). A significantly higher number of Indian patients had disease/organ damage and they predominantly developed steroid-induced diabetes mellitus (SDM). Patients with corticosteroid-induced osteoporosis (CIOP) were more likely to be Malayswhile majority of patients who developed malignancy were Chinese (p<0.05). In the univariate and multivariate analyses, disease damage was significantly associated with age, Indian ethnicity, lower mean cumulative C3 level, neuropsychiatry lupus (NPSLE), and antiphospholipid syndrome (APLS). Patients who had ever and early treatment with hydroxychloroquine(HCQ)were less likely to develop disease damage while more patients who had received oral prednisolone ≥1mg/kg daily over 2 weeks had disease damage (p<0.05). In conclusion, there were inter-ethnic differences in the damage pattern and risks among SLE patients.
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Affiliation(s)
- Syahrul Sazliyana Shaharir
- Department of Internal Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia (UKMMC), Jalan Yaacob Latiff, 56000 Kuala Lumpur, Malaysia
- * E-mail:
| | - Heselynn Hussein
- Department of Internal Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia (UKMMC), Jalan Yaacob Latiff, 56000 Kuala Lumpur, Malaysia
- Department of Medicine, Putrajaya Hospital, Jalan P9, Presint 7, 62250 Putrajaya, Malaysia
| | - Sakthiswary Rajalingham
- Department of Internal Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia (UKMMC), Jalan Yaacob Latiff, 56000 Kuala Lumpur, Malaysia
| | - Mohd Shahrir Mohamed Said
- Department of Internal Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia (UKMMC), Jalan Yaacob Latiff, 56000 Kuala Lumpur, Malaysia
| | - Abdul Halim Abdul Gafor
- Department of Internal Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia (UKMMC), Jalan Yaacob Latiff, 56000 Kuala Lumpur, Malaysia
| | - Rozita Mohd
- Department of Internal Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia (UKMMC), Jalan Yaacob Latiff, 56000 Kuala Lumpur, Malaysia
| | - Ruslinda Mustafar
- Department of Internal Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia (UKMMC), Jalan Yaacob Latiff, 56000 Kuala Lumpur, Malaysia
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Antony A, Kandane-Rathnayake RK, Ko T, Boulos D, Hoi AY, Jolly M, Morand EF. Validation of the Lupus Impact Tracker in an Australian patient cohort. Lupus 2016; 26:98-105. [PMID: 27516435 DOI: 10.1177/0961203316664593] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 07/25/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The objective of this article is to validate the Lupus Impact Tracker (LIT), a disease-specific patient-reported outcome (PRO) tool, in systemic lupus erythematosus (SLE) patients in a multi-ethnic Australian cohort. METHODS Patients attending the Monash Lupus Clinic were asked to complete the LIT, a 10-item PRO. Psychometric testing assessing criterion validity, construct validity, test-retest reliability (TRT) and internal consistency reliability (ICR) were performed. We compared the LIT scores across patient characteristics, and correlations between LIT scores and SLEDAI-2k, PGA, and SLICC-SDI were examined. RESULTS LIT data were obtained from 73 patients. Patients were 84% female with a median age of 41 years, and 34% were Asian. The cohort had mild-moderate disease activity with a median (IQR) Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2k) of 4 (IQR 2-6). The median LIT score was 32.5 (IQR 17.5-50). LIT demonstrated criterion validity against SLEDAI-2k and SDI. Construct validity assessed by confirmatory factor analysis demonstrated an excellent fit (Goodness of fit index 0.95, Comparative Fit Index 1, Root Mean Square Error of Approximation <0.0001). The LIT demonstrated TRT with an overall intraclass correlation coefficient of 0.986 (95% CI 0.968-0.995). ICR was demonstrated with a Cronbach's alpha of 0.838. Patients with disability, low socioeconomic status, or higher disease activity had significantly worse LIT scores. CONCLUSION The LIT demonstrated properties consistent with its being valid in this population. Lower socioeconomic status appears to have a significant impact on patient-reported health-related quality of life in SLE.
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Affiliation(s)
- A Antony
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - R K Kandane-Rathnayake
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - T Ko
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - D Boulos
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - A Y Hoi
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - M Jolly
- Rush University Medical Centre, Chicago, IL, USA
| | - E F Morand
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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Connelly KL, Kandane-Rathnayake R, Hoi A, Nikpour M, Morand EF. Association of MIF, but not type I interferon-induced chemokines, with increased disease activity in Asian patients with systemic lupus erythematosus. Sci Rep 2016; 6:29909. [PMID: 27453287 PMCID: PMC4958969 DOI: 10.1038/srep29909] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 06/24/2016] [Indexed: 11/18/2022] Open
Abstract
Ethnicity is a key factor impacting on disease severity in SLE, but molecular mechanisms of these associations are unknown. Type I IFN and MIF have each been associated with SLE pathogenesis. We investigated whether increased SLE severity in Asian patients is associated with either MIF or Type I IFN. SLE patients (n = 151) had prospective recording of disease variables. Serum MIF, and a validated composite score of three Type I IFN-inducible chemokines (IFNCK:CCL2, CXCL10, CCL19) were measured. Associations of MIF and IFNCK score with disease activity were assessed, with persistent active disease (PAD) used as a marker of high disease activity over a median 2.6 years follow up. In univariable analysis, MIF, IFNCK score and Asian ethnicity were significantly associated with PAD. Asian ethnicity was associated with higher MIF but not IFNCK score. In multivariable logistic regression analysis, MIF (OR3.62 (95% CI 1.14,11.5), p = 0.03) and Asian ethnicity (OR3.00 (95% CI 1.39,6.46), p < 0.01) but not IFNCK were significantly associated with PAD. These results potentially support an effect of MIF, but not Type I IFN, in heightened SLE disease severity in Asian SLE. The associations of MIF and Asian ethnicity with PAD are at least partly independent.
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Affiliation(s)
- K L Connelly
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - R Kandane-Rathnayake
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - A Hoi
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Mandana Nikpour
- Department of Medicine and Rheumatology, The University of Melbourne at St. Vincent's Hospital, Melbourne, Australia
| | - E F Morand
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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Morais SA, Isenberg DA. A study of the influence of ethnicity on serology and clinical features in lupus. Lupus 2016; 26:17-26. [PMID: 27216418 DOI: 10.1177/0961203316645204] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/24/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The objective of this study was to review the links between ethnicity, serology and clinical expression in systemic lupus erythematosus (SLE) in a single cohort that was followed over a 36-year period. PATIENTS AND METHODS Patients with SLE treated at the University College London Hospitals (UCLHs) between January 1978 and December 2013 formed the cohort. We assessed the demographic, clinical and serological data. Standard methods were used for laboratory testing. The Student t test and Mann-Whitney U test were used for the continuous variables; the Fisher's exact test was used for the categorical variables. RESULTS We studied 624 SLE patients: There were 571 women (91.5%), with a mean age at diagnosis of 29.0 ± 6.5 years; and 53 men (8.5%), with a mean age at diagnosis of 29.4 ± 15.3 years. Ethnically, 369 of the patients were European, 100 were Afro-Caribbean, 77 were East Asian, 56 were South Asian and 21 were of mixed ethnicity. The East Asian patients developed the disease at a younger age than the other ethnic groups (p < 0.0001). The Afro-Caribbean patients were less frequently associated with the presence of rash and photosensitivity, and the non-European patients were more likely to have alopecia and renal involvement. The South Asian patients were significantly associated with musculoskeletal and neurological involvement, serositis, Sicca syndrome and hematological features. The Afro-Caribbean patients had the highest prevalence of anti-Smith, anti-RNP, anti-Ro and anti-La antibodies. Anti-IgG anticardiolipin (aCL) antibodies were significantly associated with the non-East Asian groups; and hypocomplementemia was common in the East Asians. Rash, alopecia, mouth ulcers, serositis, neurological, joint and renal involvement were significantly associated with the presence of anti-Smith and anti-RNP antibodies in the Afro-Caribbean group. We also observed an association of joint involvement and the presence of anti-Ro and anti-La antibodies in this group. CONCLUSIONS The East Asian patients developed their SLE disease at a younger age than the other ethnic groups. Cutaneous involvement was more frequent in those who were not Afro-Caribbean. Serositis, joint and neurological involvement were more frequently diagnosed in the South Asian patients. Anti-ENA antibodies were frequently associated with the Afro-Caribbean patients.
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Affiliation(s)
- S A Morais
- Internal Medicine Department, Hospital Pedro Hispano, Matosinhos, Portugal
| | - D A Isenberg
- Centre for Rheumatology, University College London Hospitals, London, UK
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Jones SA, Toh AEJ, Odobasic D, Oudin MAV, Cheng Q, Lee JPW, White SJ, Russ BE, Infantino S, Light A, Tarlinton DM, Harris J, Morand EF. Glucocorticoid-induced leucine zipper (GILZ) inhibits B cell activation in systemic lupus erythematosus. Ann Rheum Dis 2015; 75:739-47. [PMID: 26612340 DOI: 10.1136/annrheumdis-2015-207744] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 11/01/2015] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Systemic lupus erythematosus (SLE) is a serious multisystem autoimmune disease, mediated by disrupted B cell quiescence and typically treated with glucocorticoids. We studied whether B cells in SLE are regulated by the glucocorticoid-induced leucine zipper (GILZ) protein, an endogenous mediator of anti-inflammatory effects of glucocorticoids. METHODS We conducted a study of GILZ expression in blood mononuclear cells of patients with SLE, performed in vitro analyses of GILZ function in mouse and human B cells, assessed the contributions of GILZ to autoimmunity in mice, and used the nitrophenol coupled to keyhole limpet haemocyanin model of immunisation in mice. RESULTS Reduced B cell GILZ was observed in patients with SLE and lupus-prone mice, and impaired induction of GILZ in patients with SLE receiving glucocorticoids was associated with increased disease activity. GILZ was downregulated in naïve B cells upon stimulation in vitro and in germinal centre B cells, which contained less enrichment of H3K4me3 at the GILZ promoter compared with naïve and memory B cells. Mice lacking GILZ spontaneously developed lupus-like autoimmunity, and GILZ deficiency resulted in excessive B cell responses to T-dependent stimulation. Accordingly, loss of GILZ in naïve B cells allowed upregulation of multiple genes that promote the germinal centre B cell phenotype, including lupus susceptibility genes and genes involved in cell survival and proliferation. Finally, treatment of human B cells with a cell-permeable GILZ fusion protein potently suppressed their responsiveness to T-dependent stimuli. CONCLUSIONS Our findings demonstrated that GILZ is a non-redundant regulator of B cell activity, with important potential clinical implications in SLE.
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Affiliation(s)
- Sarah A Jones
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Australia
| | - Andrew E J Toh
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Australia
| | - Dragana Odobasic
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Australia
| | - Marie-Anne Virginie Oudin
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Australia
| | - Qiang Cheng
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Australia
| | - Jacinta P W Lee
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Australia
| | - Stefan J White
- Department of Human Genetics, Leiden Genome Technology Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Brendan E Russ
- Department of Microbiology and Immunology, The Doherty Institute at The University of Melbourne, Parkville, Victoria, Australia
| | - Simona Infantino
- Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia Department of Experimental Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Amanda Light
- Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia Department of Experimental Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - David M Tarlinton
- Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia Department of Experimental Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - James Harris
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Australia
| | - Eric F Morand
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Australia
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Franklyn K, Lau CS, Navarra SV, Louthrenoo W, Lateef A, Hamijoyo L, Wahono CS, Chen SL, Jin O, Morton S, Hoi A, Huq M, Nikpour M, Morand EF. Definition and initial validation of a Lupus Low Disease Activity State (LLDAS). Ann Rheum Dis 2015; 75:1615-21. [DOI: 10.1136/annrheumdis-2015-207726] [Citation(s) in RCA: 288] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 09/20/2015] [Indexed: 12/15/2022]
Abstract
AimsTreating to low disease activity is routine in rheumatoid arthritis, but no comparable goal has been defined for systemic lupus erythematosus (SLE). We sought to define and validate a Lupus Low Disease Activity State (LLDAS).MethodsA consensus definition of LLDAS was generated using Delphi and nominal group techniques. Criterion validity was determined by measuring the ability of LLDAS attainment, in a single-centre SLE cohort, to predict non-accrual of irreversible organ damage, measured using the Systemic Lupus International Collaborating Clinics Damage Index (SDI).ResultsConsensus methodology led to the following definition of LLDAS: (1) SLE Disease Activity Index (SLEDAI)-2K ≤4, with no activity in major organ systems (renal, central nervous system (CNS), cardiopulmonary, vasculitis, fever) and no haemolytic anaemia or gastrointestinal activity; (2) no new lupus disease activity compared with the previous assessment; (3) a Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA)-SLEDAI physician global assessment (scale 0–3) ≤1; (4) a current prednisolone (or equivalent) dose ≤7.5 mg daily; and (5) well tolerated standard maintenance doses of immunosuppressive drugs and approved biological agents. Achievement of LLDAS was determined in 191 patients followed for a mean of 3.9 years. Patients who spent greater than 50% of their observed time in LLDAS had significantly reduced organ damage accrual compared with patients who spent less than 50% of their time in LLDAS (p=0.0007) and were significantly less likely to have an increase in SDI of ≥1 (relative risk 0.47, 95% CI 0.28 to 0.79, p=0.005).ConclusionsA definition of LLDAS has been generated, and preliminary validation demonstrates its attainment to be associated with improved outcomes in SLE.
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Nikpour M, Bridge JA, Richter S. A systematic review of prevalence, disease characteristics and management of systemic lupus erythematosus in Australia: identifying areas of unmet need. Intern Med J 2015; 44:1170-9. [PMID: 25169712 DOI: 10.1111/imj.12568] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 08/17/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Few epidemiological studies of systemic lupus erythematosus (SLE) have been conducted in Australia, and current management practice and levels of unmet need in this country are not well characterised. AIM To perform a systematic literature review to identify Australia-specific information on SLE, particularly areas of unmet need. METHODS MEDLINE, EMBASE and the Cochrane Library were searched (1 January 1990 to 29 November 2013). All articles on prevalence, disease characteristics, management and outcomes of SLE in Australia were included. RESULTS There is limited published information on SLE in Australia. Of 24 articles included, 18 described results from observational studies, three were narrative reviews, one was a clinical update, and two were medical education articles. In remote regions, SLE was reported to be more prevalent in Aboriginal Australians than non-Aboriginal Australians; information in urban populations is lacking. Asian Australians may be more affected by SLE than non-Asian Australians. Pregnancy outcomes may also be adversely affected. Many Australians with SLE may experience high levels of unmet need, including delayed diagnosis, ongoing symptoms, flares, depression/anxiety, sleeping difficulty and decreased quality of life. Published guidance on the SLE management in Australia is limited and dated. CONCLUSIONS Published information on SLE in Australia is limited, but suggests that ethnicity may affect the prevalence and disease characteristics and that many Australians with SLE have unmet needs. Improvements in diagnosis, treatment and management are needed to alleviate these needs. Up-to-date guidance on the management of SLE would benefit healthcare professionals and patients.
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Affiliation(s)
- M Nikpour
- Department of Medicine at St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia; Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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Mao S, Shen H, Zhang J. Systemic lupus erythematosus and malignancies risk. J Cancer Res Clin Oncol 2015; 142:253-62. [PMID: 26319223 DOI: 10.1007/s00432-015-2032-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 08/15/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the risk of site-specific and overall malignancies after SLE and explore the potential influencing factors. METHODS We searched electronic databases for articles that assessed the risk of malignancies after SLE through February 2015. We extracted the incidence rates (IRs) and corresponding 95 % confidence intervals (CIs). We used random effects models to calculate the pooled IRs and assessed the impact of study designs, region, gender, age and duration of follow-up. RESULTS Eighteen studies were included, giving a pooled IR of 1.44 (95 % CI 1.23-1.69). Europeans, Americans and Asians showed a IR of 1.56 (95 % CI 1.07-2.28), 1.18 (95 % CI 1.01-1.39) and 1.62 (95 % CI 1.38-1.89), respectively. Males and females (eight studies) demonstrated a IR of 1.34 (95 % CI 1.07-1.67) and 1.51 (95 % CI 1.20-1.90), respectively. Prospective and retrospective studies showed a IR of 1.55 (95 % CI 0.97-2.47) and 1.44 (95 % CI 1.21-1.73), respectively. An increment of 10 years of age conferred a decrease in IR of 0.6. An increment of 5 years of SLE duration conferred a decrease in IR of 2.5. An increased IR of malignancies was observed in NHL, vagina/vulva, hematology, head/neck, leukemia, thyroid, liver/gallbladder, kidney, anal, cervix, esophagus, lung and pancreas. A decreased IR of malignancies was observed in ovary and colon/rectum. CONCLUSIONS SLE patients had an increased risk of developing overall malignancies, particularly among Asians and females. Age and SLE duration are inversely associated with the risk of overall malignancies. SLE patients showed a different role in the onset of various site-specific malignancies.
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Affiliation(s)
- Song Mao
- Department of Pediatrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
| | - Hua Shen
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jianhua Zhang
- Department of Pediatrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
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Tesar V, Hruskova Z. Lupus Nephritis: A Different Disease in European Patients? KIDNEY DISEASES 2015; 1:110-8. [PMID: 27536671 DOI: 10.1159/000438844] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 07/17/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Lupus nephritis (LN) is still associated with significant mortality and substantial risk of progression to end-stage renal failure. Its outcome is related to the class and severity of LN and response to treatment, and it is poorer in patients with renal relapses. Ethnicity has a relatively well-defined impact on the outcome of the patients and their response to treatment and must always be taken into consideration in treatment decisions. SUMMARY In this article, we provide a review of the impact of ethnicity on the prevalence of systemic lupus erythematosus (SLE), the proportion of patients with SLE developing LN, outcomes of SLE and LN and response of LN to treatment. In European patients, the prevalence of SLE and the proportion of SLE patients with LN are lower and the outcome of LN is better than in nonwhite populations. European patients may respond better to some modes of treatment [e.g. cyclophosphamide (CYC) or rituximab] and may be less frequently refractory to treatment compared to black patients with LN. Although these differences may be largely genetically driven, socioeconomic factors (poverty, education, insurance, access to health care and adherence to treatment) may also play a significant role in some disadvantaged patients. KEY MESSAGE Treatment of LN may be different in patients with different ethnicity. Less aggressive disease in European patients may better respond to less aggressive treatment. Treatment of LN in nonwhite patients may require newer (more effective) therapeutic approaches, but targeting negative socioeconomic factors might be even more effective. FACTS FROM EAST AND WEST (1) The prevalence of SLE is lower among Caucasians than other ethnicities. A higher prevalence is observed among Asians and African Americans, while the highest prevalence is found in Caribbean people. The prevalence of LN in Asian SLE patients is much higher than in Caucasians as well. However, the 10-year renal outcome and renal survival rate appear to be better in Asians. (2) Polymorphisms of genes involved in the immune response, such as Fcγ receptor, integrin alpha M, TNF superfamily 4, myotubularin-related protein 3 and many others, might be partly responsible for the differences in prevalence between the different ethnic groups. European ancestry was shown to be associated with a decrease in the risk of LN even after adjustment for genes most associated with renal disease. (3) Access to health care is a key determinant of disease progression, treatment outcome and the management of complications such as infections, particularly in South Asia, and might also explain disparities between clinical outcomes. (4) The efficacy of low-dose CYC combined with corticosteroids for induction treatment of LN was proved in European Caucasian patients. This treatment is also used in Asia, although no formal evaluation of efficacy and safety in comparison with other treatment regimens exists in this population. The efficacy of mycophenolate mofetil (MMF) is similar to that of CYC, and similar between Asians and Caucasians. MMF may be more effective than CYC in inducing response in high-risk populations such as African American or Hispanic patients. MMF might cause less infection-related events in Asians, but its high cost prevents broader usage at present. (5) For maintenance therapy, corticosteroid combined with azathioprine (AZA) or MMF is used worldwide, with a broadly similar efficacy of both treatments, although there are data suggesting that in high-risk populations (e.g. African Americans) MMF may be more effective in preventing renal flares. AZA is often preferred in Asia due to economic constraints and because of its safety in pregnancy. (6) Alternative therapies under investigation include rituximab, which might be more efficient in Caucasians, as well as belimumab. Recent Japanese and Chinese studies have indicated a potential benefit of tacrolimus as a substitute for or in addition to CYC or MMF (dual or triple immunosuppression). Mizoribine is used in Japan exclusively.
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Affiliation(s)
- Vladimir Tesar
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Zdenka Hruskova
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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Croyle L, Hoi A, Morand EF. Characteristics of azathioprine use and cessation in a longitudinal lupus cohort. Lupus Sci Med 2015; 2:e000105. [PMID: 26322237 PMCID: PMC4548066 DOI: 10.1136/lupus-2015-000105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 07/14/2015] [Accepted: 07/30/2015] [Indexed: 11/05/2022]
Abstract
Objective Guidelines for azathioprine (AZA) use in systemic lupus erythematosus (SLE), including indications for initiation and cessation, are lacking. Clinical decision-making could be improved if reasons for cessation of AZA treatment were standardised. Methods We determined the characteristics of AZA use in a cohort of patients with SLE and evaluated reasons for AZA cessation. Patients with SLE in a single centre had longitudinal recording of disease activity (Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI)-2k), laboratory investigations and treatment from 2007 to 2012. Results Of 183 patients studied, 67 used AZA on at least one occasion. There was no significant difference between AZA users and non-users in age or American College of Rheumatology criteria. Compared with those not treated with AZA, patients treated with AZA had higher disease activity (time-adjusted mean SLEDAI 5.2±0.3 vs 3.8±0.3, p=0.0028) and damage (Systemic Lupus International Collaborating Clinics (SLICC)-SDI 1.6±0.3 vs 1.2±0.1, p=0.0445), and were more likely to have a positive dsDNA (p=0.0130) and receive glucocorticoids (p<0.0001). AZA therapy was ceased in 30/67 (45%) patients. The predominant reasons for cessation were treatment de-escalation 14 (47%), treatment failure 12 (40%) and toxicity 3 (10%). AZA was switched to mycophenolate mofetil (MMF) in 9/12 (75%) of treatment failures, and this choice was strongly associated with active lupus nephritis. Conclusions AZA toxicity was uncommon, and many patients ceased therapy in the context of treatment de-escalation. However, the frequent development of active lupus nephritis requiring MMF suggests the need to distinguish refractoriness, under-treatment and non-adherence to AZA in patients with SLE. These findings suggest that future studies of AZA metabolite measurement could prove valuable in the management of SLE.
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Affiliation(s)
- Lucy Croyle
- Centre for Inflammatory Diseases, Monash University School of Clinical Sciences, Monash Medical Centre , Melbourne , Australia
| | - Alberta Hoi
- Centre for Inflammatory Diseases, Monash University School of Clinical Sciences, Monash Medical Centre , Melbourne , Australia
| | - Eric F Morand
- Centre for Inflammatory Diseases, Monash University School of Clinical Sciences, Monash Medical Centre , Melbourne , Australia
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Matatiele P, Tikly M, Tarr G, Gulumian M. DNA methylation similarities in genes of black South Africans with systemic lupus erythematosus and systemic sclerosis. J Biomed Sci 2015; 22:34. [PMID: 25986394 PMCID: PMC4437745 DOI: 10.1186/s12929-015-0142-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 05/01/2015] [Indexed: 02/07/2023] Open
Abstract
Background Systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) are systemic autoimmune connective tissue diseases that share overlapping clinico-pathological features. It is highly probable that there is an overlap in epigenetic landscapes of both diseases. This study aimed to identify similarities in DNA methylation changes in genes involved in SLE and SSc. Global DNA methylation and twelve genes selected on the basis of their involvement in inflammation, autoimmunity and/or fibrosis were analyzed using PCR arrays in three groups, each of 30 Black South Africans with SLE and SSc, plus 40 healthy control subjects. Results Global methylation in both diseases was significantly lower (<25 %) than in healthy subjects (>30 %, p = 0.0000001). In comparison to healthy controls, a similar gene-specific methylation pattern was observed in both SLE and SSc. Three genes, namely; PRF1, ITGAL and FOXP3 were consistently hypermethylated while CDKN2A and CD70 were hypomethylated in both diseases. The other genes (SOCS1, CTGF, THY1, CXCR4, MT1-G, FLI1, and DNMT1) were generally hypomethylated in SLE whereas they were neither hyper- nor hypo-methylated in SSc. Conclusions SSc and SLE patients have a higher global hypomethylation than healthy subjects with specific genes being hypomethylated and others hypermethylated. The majority of genes studied were hypomethylated in SLE compared to SSc. In addition to the commonly known hypomethylated genes in SLE and SSc, there are other hypomethylated genes (such as MT-1G and THY-1) that have not previously been investigated in SLE and SSc though are known to be hypermethylated in cancer.
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Affiliation(s)
- Puleng Matatiele
- Toxicology & Biochemistry Research Section, National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa.
| | - Mohamed Tikly
- Division of Rheumatology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Gareth Tarr
- Division of Rheumatology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mary Gulumian
- Toxicology & Biochemistry Research Section, National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa. .,Division of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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