Homocysteine levels are independently associated with damage accrual in systemic lupus erythematosus patients from a Latin-American cohort

PurposeTo determine the association between the number of flares systemic lupus erythematosus (SLE) patients experience and damage accrual, independently of other known risk factors.MethodsSLE patients (34 centres, nine Latin American countries) with a recent diagnosis (≤2 years) and ≥3 evaluations were studied. Disease activity was ascertained with the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and damage with the SLICC/ACR Damage Index (SDI). Flare was defined as an increase ≥4 points in the SLEDAI between two study visits. An ambidirectional case- crossover design was used to determine the association between the number of flares and damage accrual.Results901 patients were eligible for the study; 500 of them (55.5%) experienced at least one flare, being the mean number of flares 0.9 (SD: 1.0). 574 intervals from 251 patients were included in the case-crossover design since they have case and control intervals, whereas, the remaining patients did not. Their mean age at diagnosis was 27.9 years (SD: 11.1), 213 (84.9%) were women. The mean baseline SDI and SLEDAI were 1.3 (1.3) and 13.6 (8.1), respectively. Other features were comparable to those of the entire sample. After adjusting for possible confounding variables, the number of flares, regardless of their severity, was associated with damage accrual (SDI) OR 2.05, 95% CI 1.43 to 2.94, p<0.001 (OR 2.62, 95% CI 1.31 to 5.24, p=0.006 for severe and OR 1.91, 95% CI 1.28 to 2.83, p=0.001for mild-moderate).ConclusionsThe number of flares patients experience, regardless of their severity, increases the risk of damage accrual, independently of other known risk factors.

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Correction to: Homocysteine levels are independently associated with damage accrual in systemic lupus erythematosus patients from a Latin-American cohort

Clinical Rheumatology ◽

10.1007/s10067-019-04558-6 ◽

2019 ◽

Vol 38 (6) ◽

pp. 1799-1799

Author(s):

Paola A. Zeña-Huancas ◽

Haydee Iparraguirre-López ◽

Rocío V. Gamboa-Cárdenas ◽

Cristina Reátegui-Sokolova ◽

Francisco Zevallos-Miranda ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Latin American ◽

Lupus Erythematosus ◽

Systemic Lupus ◽

Damage Accrual

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Factors predictive of serious infections over time in systemic lupus erythematosus patients: data from a multi-ethnic, multi-national, Latin American lupus cohort

Lupus ◽

10.1177/0961203319860579 ◽

2019 ◽

Vol 28 (9) ◽

pp. 1101-1110 ◽

Cited By ~ 14

Author(s):

V R Pimentel-Quiroz ◽

M F Ugarte-Gil ◽

GB Harvey ◽

D Wojdyla ◽

G J Pons-Estel ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Disease Activity ◽

Latin American ◽

Lupus Erythematosus ◽

Clinical Manifestations ◽

Hazard Ratio ◽

Systemic Lupus ◽

Serious Infections ◽

Damage Accrual ◽

Over Time

Aim The aim of this study was to identify factors predictive of serious infections over time in patients with systemic lupus erythematosus (SLE). Methods A multi-ethnic, multi-national Latin American SLE cohort was studied. Serious infection was defined as one that required hospitalization, occurred during a hospitalization or led to death. Potential predictors included were sociodemographic factors, clinical manifestations (per organ involved, lymphopenia and leukopenia, independently) and previous infections at baseline. Disease activity (SLEDAI), damage (SLICC/ACR Damage Index), non-serious infections, glucocorticoids, antimalarials (users and non-users), and immunosuppressive drugs use; the last six variables were examined as time-dependent covariates. Cox regression models were used to evaluate the predictors of serious infections using a backward elimination procedure. Univariable and multivariable analyses were performed. Results Of the 1243 patients included, 1116 (89.8%) were female. The median (interquartile range) age at diagnosis and follow-up time were 27 (20–37) years and 47.8 (17.9–68.6) months, respectively. The incidence rate of serious infections was 3.8 cases per 100 person-years. Antimalarial use (hazard ratio: 0.69; 95% confidence interval (CI): 0.48–0.99; p = 0.0440) was protective, while doses of prednisone >15 and ≤60 mg/day (hazard ratio: 4.18; 95 %CI: 1.69–10.31; p = 0.0019) and >60 mg/day (hazard ratio: 4.71; 95% CI: 1.35–16.49; p = 0.0153), use of methylprednisolone pulses (hazard ratio: 1.53; 95% CI: 1.10–2.13; p = 0.0124), increase in disease activity (hazard ratio: 1.03; 95% CI: 1.01–1.04; p = 0.0016) and damage accrual (hazard ratio: 1.22; 95% CI: 1.11–1.34; p < 0.0001) were predictive factors of serious infections. Conclusions Over time, prednisone doses higher than 15 mg/day, use of methylprednisolone pulses, increase in disease activity and damage accrual were predictive of infections, whereas antimalarial use was protective against them in SLE patients.

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Clinical features, damage accrual, and survival in patients with familial systemic lupus erythematosus: data from a multi-ethnic, multinational Latin American lupus cohort

Lupus ◽

10.1177/0961203320935184 ◽

2020 ◽

Vol 29 (9) ◽

pp. 1140-1145

Author(s):

Rosana Quintana ◽

Guillermo J Pons-Estel ◽

Karen Roberts ◽

Mónica Sacnún ◽

Rosa Serrano ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Disease Activity ◽

Clinical Features ◽

Latin American ◽

Lupus Erythematosus ◽

Activity Index ◽

Damage Index ◽

Systemic Lupus ◽

Damage Accrual ◽

Familial Lupus

Objectives This study aimed to compare the clinical features, damage accrual, and survival of patients with familial and sporadic systemic lupus erythematosus (SLE). Methods A multi-ethnic, multinational Latin American SLE cohort was studied. Familial lupus was defined as patients with a first-degree SLE relative; these relatives were interviewed in person or by telephone. Clinical variables, disease activity, damage, and mortality were compared. Odds ratios (OR) and 95% confidence intervals (CI) were estimated. Hazard ratios (HR) were calculated using Cox proportional hazard adjusted for potential confounders for time to damage and mortality. Results A total of 66 (5.6%) patients had familial lupus, and 1110 (94.4%) had sporadic lupus. Both groups were predominantly female, of comparable age, and of similar ethnic distribution. Discoid lupus (OR = 1.97; 95% CI 1.08–3.60) and neurologic disorder (OR = 1.65; 95% CI 1.00–2.73) were significantly associated with familial SLE; pericarditis was negatively associated (OR = 0.35; 95% CI 0.14–0.87). The SLE Disease Activity Index and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) were similar in both groups, although the neuropsychiatric (45.4% vs. 33.5%; p = 0.04) and musculoskeletal (6.1% vs. 1.9%; p = 0.02) domains of the SDI were more frequent in familial lupus. They were not retained in the Cox models (by domains). Familial lupus was not significantly associated with damage accrual (HR = 0.69; 95% CI 0.30–1.55) or mortality (HR = 1.23; 95% CI 0.26–4.81). Conclusion Familial SLE is not characterized by a more severe form of disease than sporadic lupus. We also observed that familial SLE has a higher frequency of discoid lupus and neurologic manifestations and a lower frequency of pericarditis.

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SAT0237 THE SYSTEMIC LUPUS INTERNATIONAL COLLABORATING CLINICS (SLICC) FRAILTY INDEX (SLICC-FI) PREDICTS DAMAGE ACCRUAL IN SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) PATIENTS. DATA FROM A LATIN AMERICAN MESTIZO COHORT

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3997 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1061.1-1062

Author(s):

M. F. Ugarte-Gil ◽

R. V. Gamboa Cárdenas ◽

C. Reategui Sokolova ◽

V. Pimentel-Quiroz ◽

M. Medina Chinchon ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Latin American ◽

Lupus Erythematosus ◽

Disease Duration ◽

Negative Binomial ◽

Frailty Index ◽

Systemic Lupus ◽

Research Support ◽

Damage Accrual

Background:The Systemic Lupus International Collaborating Clinics (SLICC) Frailty Index (SLICC-FI) has been developed as a predictor of outcomes in SLE patients1-3. However, it needs to be validated in several populations.Objectives:To evaluate the SLICC-FI as a predictor of future damage accrual in systemic lupus erythematosus (SLE) patients.Methods:Patients from a single-center prevalent cohort were included. Damage accrual was defined as the increase in SLICC/American College of Rheumatology (ACR) damage index (SDI) scores between the baseline and last visits. The SLICC-FI was measured at baseline. Univariable and multivariable negative binomial regression were performed to determine the association between the baseline SLICC-FI (per 0.05 increase) and damage accrual during follow-up, adjusted for sex, age at diagnosis, socioeconomic status, disease duration, SLE Disease Activity Index 2000 (SLEDAI-2K), SDI, prednisone daily dose, antimalarial and immunosuppressive drug use at baseline, and duration of follow-up.Results:Of the 265 patients included, 248 (93.6%) were female with mean (SD) age 35.1 (13.6) years at diagnosis. At baseline, mean (SD) SLE disease duration was 7.3 (6.5) years, SDI was 1.1 (1.3) and SLEDAI-2K was 5.3 (4.6). The mean (SD) baseline SLICC-FI was 0.22 (0.05). After a mean (SD) of 5.2 (2.2) years of follow-up, the SDI increased in 126 (47.5%) patients, and the final mean (SD) SDI score was 1.7 (1.7). Higher SLICC-FI scores at baseline predicted greater damage accrual in the univariable analysis [Incidence Rate Ratio (IRR)=1.283, (CI95% 1.072-1.536); p=0.007]. The SLICC-FI remained associated with damage accrual in the multivariable model, after adjustment for possible confounders [IRR= 1.224 (CI95% 1.007-1.488); p=0.042].Conclusion:The SLICC-FI predicts damage accrual in prevalent SLE, supporting the relevance of this index in the evaluation of SLE patients. This is the first study validating the SLICC-FI in South American populationReferences:[1]Legge A, Kirkland S, Rockwood K, et al. Construction of a Frailty Index as a Novel Health Measure in Systemic Lupus Erythematosus. J Rheumatol. 2020; 47: 72-81[2]Legge A, Kirkland S, Rockwood K, et al. Evaluating the Properties of a Frailty Index and Its Association With Mortality Risk Among Patients With Systemic Lupus Erythematosus. Arthritis Rheumatol. 2019; 71: 1297-107[3]Legge A, Kirkland S, Rockwood K, et al. Prediction of Damage Accrual in Systemic Lupus Erythematosus Using the Systemic Lupus International Collaborating Clinics Frailty Index (SLICC-FI). Arthitis Rheumatol. Epub ahead of print 2019 Oct 21.Disclosure of Interests:Manuel F. Ugarte-Gil Grant/research support from: Jannsen, Pfizer, Rocío Violeta Gamboa Cárdenas Grant/research support from: Pfizer, Cristina Reategui Sokolova: None declared, Victor Pimentel-Quiroz: None declared, Mariela Medina Chinchon: None declared, Claudia Elera-Fitzcarrald Consultant of: Tecnofarma, Jose Alfaro Lozano Speakers bureau: Lilly, Zoila Rodriguez Bellido: None declared, Cesar Pastor Asurza: None declared, Risto Perich Campos Consultant of: Pfizer, Speakers bureau: Pfizer, Graciela S Alarcon: None declared

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Predictors of renal damage in systemic lupus erythematous patients: data from a multiethnic, multinational Latin American lupus cohort (GLADEL)

RMD Open ◽

10.1136/rmdopen-2020-001299 ◽

2020 ◽

Vol 6 (3) ◽

pp. e001299

Author(s):

Cristina Reátegui-Sokolova ◽

Manuel F Ugarte-Gil ◽

Guillermina B Harvey ◽

Daniel Wojdyla ◽

Guillermo J Pons-Estel ◽

...

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Latin American ◽

Lupus Erythematosus ◽

Renal Damage ◽

Cox Regression ◽

Damage Index ◽

Early Response ◽

Male Gender ◽

Systemic Lupus

AimA decrease in proteinuria has been considered protective from renal damage in lupus nephritis (LN), but a cut-off point has yet to be established. The aim of this study was to identify the predictors of renal damage in patients with LN and to determine the best cut-off point for a decrease in proteinuria.MethodsWe included patients with LN defined clinically or histologically. Possible predictors of renal damage at the time of LN diagnosis were examined: proteinuria, low complement, anti-double-stranded DNA antibodies, red cell casts, creatinine level, hypertension, renal activity (assessed by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)), prednisone dose, immunosuppressive drugs and antimalarial use. Sociodemographic variables were included at baseline. Proteinuria was assessed at baseline and at 12 months, to determine if early response (proteinuria <0.8 g/day within 12 months since LN diagnosis) is protective of renal damage occurrence. Renal damage was defined as an increase of one or more points in the renal domain of The Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI). Cox regression models using a backward selection method were performed.ResultsFive hundred and two patients with systemic lupus erythematosus patients were included; 120 patients (23.9%) accrued renal damage during their follow-up. Early response to treatment (HR=0.58), antimalarial use (HR=0.54) and a high SES (HR=0.25) were protective of renal damage occurrence, whereas male gender (HR=1.83), hypertension (HR=1.86) and the renal component of the SLEDAI (HR=2.02) were risk factors for its occurrence.ConclusionsEarly response, antimalarial use and high SES were protective of renal damage, while male gender, hypertension and higher renal activity were risk factors for its occurrence in patients with LN.

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The Main Challenges in Systemic Lupus Erythematosus: Where Do We Stand?

Journal of Clinical Medicine ◽

10.3390/jcm10020243 ◽

2021 ◽

Vol 10 (2) ◽

pp. 243

Author(s):

Matteo Piga ◽

Laurent Arnaud

Keyword(s):

Systemic Lupus Erythematosus ◽

Disease Activity ◽

Lupus Erythematosus ◽

Systemic Disease ◽

Unmet Need ◽

Clinical Manifestations ◽

New Drugs ◽

Systemic Lupus ◽

Major Step ◽

Damage Accrual

Systemic lupus erythematosus (SLE) is an immune-mediated multi-systemic disease characterized by a wide variability of clinical manifestations and a course frequently subject to unpredictable flares. Despite significant advances in the understanding of the pathophysiology and optimization of medical care, patients with SLE still have significant mortality and carry a risk of progressive organ damage accrual and reduced health-related quality of life. New tools allow earlier classification of SLE, whereas tailored early intervention and treatment strategies targeted to clinical remission or low disease activity could offer the opportunity to reduce damage, thus improving long-term outcomes. Nevertheless, the early diagnosis of SLE is still an unmet need for many patients. Further disentangling the SLE susceptibility and complex pathogenesis will allow to identify more accurate biomarkers and implement new ways to measure disease activity. This could represent a major step forward to find new trials modalities for developing new drugs, optimizing the use of currently available therapeutics and minimizing glucocorticoids. Preventing and treating comorbidities in SLE, improving the management of hard-to-treat manifestations including management of SLE during pregnancy are among the remaining major unmet needs. This review provides insights and a research agenda for the main challenges in SLE.

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A longitudinal multiethnic study of biomarkers in systemic lupus erythematosus: Launching the GLADEL 2.0 Study Group

Lupus ◽

10.1177/0961203320988586 ◽

2021 ◽

pp. 096120332098858

Author(s):

José A Gómez-Puerta ◽

Guillermo J Pons-Estel ◽

Rosana Quintana ◽

Romina Nieto ◽

Rosa M Serrano Morales ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Renal Disease ◽

Latin American ◽

Lupus Erythematosus ◽

Renal Involvement ◽

Systemic Lupus ◽

Original Cohort ◽

Beneficial Effects ◽

New Generation ◽

Methodological Aspects

Introduction: After more than 20 years of sustained work, the Latin American Group for the Study of Lupus (GLADEL) has made a significant number of contributions to the field of lupus, not only in the differential role that race/ethnicity plays in its course and outcome but also in several other studies including the beneficial effects of using antimalarials in lupus patients and the development of consensus guidelines for the treatment of lupus in our region. Methods: A new generation of “Lupus Investigators” in more than 40 centers throughout Latin America has been constituted in order to continue the legacy of the investigators of the original cohort and to launch a novel study of serum and urinary biomarkers in patients with systemic lupus erythematosus. Results: So far, we have recruited 807 patients and 631 controls from 42 Latin-American centers including 339 patients with SLE without renal involvement, 202 patients with SLE with prevalent but inactive renal disease, 176 patients with prevalent and active renal disease and 90 patients with incident lupus nephritis. Conclusions: The different methodological aspects of the GLADEL 2.0 cohort are discussed in this manuscript, including the challenges and difficulties of conducting such an ambitious project.

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Interest on the internet for systemic lupus erythematosus: Analysis of Google Trends in Latin American countries

Lupus ◽

10.1177/09612033211010337 ◽

2021 ◽

pp. 096120332110103

Author(s):

Paul J Tejada-Llacsa ◽

Pamela Villacorta-Landeo ◽

Eder Aguilar-Buitrón ◽

Graciela S Alarcón ◽

Manuel F Ugarte-Gil

Keyword(s):

Systemic Lupus Erythematosus ◽

Latin American ◽

Lupus Erythematosus ◽

Google Trends ◽

The Internet ◽

Systemic Lupus ◽

Web Based ◽

Pan American ◽

Health Institutions ◽

Latin American Countries

Background/Objective Information available on the internet about Systemic Lupus Erythematosus (SLE) can influence the doctor-patient relationship. Therefore, the aim of this study was to identify the terms used for SLE on the internet. Methods We analyzed the data downloaded from Google Trends, considering the term “Lupus” in a six-year web-based research. The frequency of the terms for each Pan-American country was obtained automatically from Google Trends, which reports relative search volumes or RSV (on a scale from 0 to 100) across regions. Results We obtained a total of 67 registered terms in 18 countries. The terms were distributed into five categories. The categories with interest in all countries were “definition” and “symptoms”. Conclusions Google Trends allows us to find useful information about SLE on the internet; once the accuracy of this information is validated, it can be used by patients, health institutions, rheumatologists and other health professionals.

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Disease Damage Accrual and Low Bone Mineral Density in Female Patients with Systemic Lupus Erythematosus

Biological Research For Nursing ◽

10.1177/10998004211005550 ◽

2021 ◽

pp. 109980042110055

Author(s):

María Correa-Rodríguez ◽

Gabriela Pocovi-Gerardino ◽

José-Luis Callejas-Rubio ◽

Raquel Ríos-Fernández ◽

Blanca Rueda-Medina ◽

...

Keyword(s):

Bone Mineral Density ◽

Systemic Lupus Erythematosus ◽

Lumbar Spine ◽

Bone Mass ◽

Disease Activity ◽

Lupus Erythematosus ◽

Mineral Density ◽

Systemic Lupus ◽

Damage Accrual ◽

Disease Damage

Osteoporosis is a common comorbidity in patients with systemic lupus erythematosus (SLE), but the potential contribution of disease-associated factors to bone status in SLE is not well known because the reported risk factors from different studies differ greatly. We aimed to examine frequency of reduced bone mass in women with SLE, and determine their potential associations with disease activity, damage accrual and SLE-related clinical markers. A cross-sectional study including 121 Caucasian pre-menopausal and postmenopausal women was conducted (mean age 49.2 ± 12.4 years). The SLE Disease Activity Index (SLEDAI-2 K) and the SDI Damage Index were used to assess disease activity and disease-related damage, respectively. Bone mineral density (BMD) of the left femoral neck and lumbar spine (L2–L4) were measured by dual-energy X-ray absorptiometry. Ten patients (8.3%) had osteoporosis, 63 (52.1%) patients had osteopenia and 6.8% of women had history of previous fracture. Patients with low bone mass had a significantly higher mean SDI (1.3 ± 1.2 versus 0.7 ± 1.0 p = 0.003). T-score at lumbar spine was inversely correlated with SDI score (r = -0.222, p = 0.014) and complement C3 level ( r = −0.206, p = .024). SDI scores were significantly different between patients with osteoporosis, osteopenia, and normal BMD after adjusting for covariates ( p = .004). There is a high prevalence of low BMD in Caucasian women with SLE, and this status was associated with higher damage accrual scores, supporting that disease damage may itself be a major contributor to the low BMD. Women with SLE with organ damage require regular bone status monitoring to prevent further musculoskeletal damage.

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