Factors associated with damage accrual in patients with systemic lupus erythematosus with no clinical or serological disease activity: a multicentre cohort study

2020 ◽  
Vol 2 (1) ◽  
pp. e24-e30 ◽  
Author(s):  
Diane Apostolopoulos ◽  
Rangi Kandane-Rathnayake ◽  
Worawit Louthrenoo ◽  
Shue Fen Luo ◽  
Yeong-Jian Wu ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cohort Study ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Factors Associated ◽  
Multicentre Cohort Study ◽  
Damage Accrual ◽  
Multicentre Cohort

scholarly journals POS0713 PREDICTORS OF HOSPITALIZATION IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: A 10-YEAR COHORT STUDY OF 398 PATIENTS FROM A TERTIARY CENTRE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 606.1-606
Author(s):  
H. Assunção ◽  
M. Rodrigues ◽  
A. R. Prata ◽  
J. A. P. Da Silva ◽  
L. Inês
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cohort Study ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Disease Duration ◽  
Cox Regression ◽  
Male Gender ◽  
Systemic Lupus ◽  
Damage Accrual ◽  
Active Disease

Background:Patients with systemic lupus erythematosus (SLE) often require hospitalization. The cause of admission may vary, but active disease and infection are consistently reported as the main reasons for hospitalization and are associated with worse survival and damage accrual. Recent improvements in the standard of care, including minimization of glucocorticoid dose and more effective and safe immunosuppressive regimens, may have changed the incidence and risk factors for hospitalization due to these causes. Hence, it is useful to identify predictors of hospitalization to further reduce the risk of admission for disease activity and severe infection in patients with SLE.Objectives:To identify predictors of hospitalization in patients with SLE, according to the underlying cause.Methods:Patients with SLE fulfilling classification criteria (ACR’97 and/or SLICC), regularly followed at an academic lupus clinic from January 2009 to December 2020 and with at least two outpatient visits were included in this cohort study. Time to first hospitalization up to 120 months was identified separately for the following admission causes: (a) any cause; (b) active SLE; (c) infection. Predictors of hospitalization were sought through survival analysis, with distinct models for each of the major admission causes. Univariate analysis was performed using Kaplan-Meier curves and Log-Rank tests. Tested variables assessed at baseline included: gender; age at SLE onset; age; disease duration; SLE Disease Activity Index (SLEDAI-2K) score; ongoing antimalarial use; ongoing immunosuppressants; ongoing prednisolone daily dose; lupus nephritis up to baseline; SLICC Damage Index (SDI) score. Variables with p<0.1 were further tested in multivariate Cox regression models. Hazard ratios (HR) were determined with 95% confidence intervals (95%CI).Results:We included 398 patients (female: 86.2%, mean age: 41.2±15.1 years, mean disease duration: 10.1±9.2 years; previous lupus nephritis: 28.9%; mean SLEDAI-2K score: 3.4±2.7; ongoing antimalarials: 78.9%; ongoing immunosuppressant: 29.9%; ongoing prednisolone >7.5 mg/day: 17.1%; SDI score ≥1: 28.4%). During the follow-up period, 50.5%, 23.6% and 17.3% were hospitalized at least once for any cause, active SLE or infection, respectively.In the multivariate model, significant baseline predictors for hospitalization due to active disease were (table 1): SLEDAI-2K score >5; disease duration ≤2 years; ongoing immunosuppressants; SDI score ≥1. Baseline independent predictors of hospitalization for infection included (table 1): male gender; SDI score ≥1; ongoing antimalarials were protective.Table 1.Predictors of hospitalization in multivariate Cox regression according to the admission causePredictorsHospitalization for active SLEHospitalization for infectionSLEDAI-2K score >52.43 (1.53-3.88)n.s.SLE duration ≤2 years1.70 (1.04-2.77)n.s.Ongoing immunosuppressant1.91 (1.24-2.95)n.s.SDI score ≥11.82 (1.16-2.86)2.14 (1.33-3.45)Male gendern.s.2.19 (1.23-3.89)No antimalarial treatmentn.s.2.20 (1.34-3.60)Risk for each predictor reported as Hazard Ratio (95% Confidence Interval); n.s.: non-significantConclusion:Tight control of disease activity, prevention of damage accrual, and treatment with antimalarials may contribute to minimize the risk of hospitalization for these two major causes of admission in patients with SLE.Disclosure of Interests:None declared

Risk factors for amenorrhea in juvenile systemic lupus erythematosus (JSLE): a Brazilian multicentre cohort study

Lupus ◽  
2007 ◽  
Vol 16 (7) ◽  
pp. 531-536 ◽  
Author(s):  
C.A.A. Silva ◽  
M.O. Hilário ◽  
M.V. Febrônio ◽  
S.K. Oliveira ◽  
M.T. Terreri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Cohort Study ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Juvenile Systemic Lupus Erythematosus ◽  
Multicentre Cohort Study ◽  
Multicentre Cohort

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

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.

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

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.

Longterm Outcomes and Damage Accrual in Patients with Childhood Systemic Lupus Erythematosus with Psychosis and Severe Cognitive Dysfunction

2013 ◽  
Vol 40 (4) ◽  
pp. 513-519 ◽  
Author(s):  
Lily Siok Hoon Lim ◽  
Arlette Lefebvre ◽  
Susanne Benseler ◽  
Earl D. Silverman
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Cognitive Dysfunction ◽  
Lupus Erythematosus ◽  
Clinical Course ◽  
Immunosuppressive Treatment ◽  
Damage Index ◽  
Response To Treatment ◽  
Systemic Lupus ◽  
Damage Accrual

Objective.(1) To describe the clinical course and response to treatment; and (2) to evaluate and compare damage accrual of distinct phenotypic subgroups of patients with clinically important psychiatric illness of pediatric systemic lupus erythematosus (pSLE).Methods.A single-center cohort study of patients with pSLE followed at a pediatric lupus clinic from 1985 to July 2009. Clinical course and response to treatment were studied. Remission was defined by absence of psychiatric/cognitive symptoms while receiving minimal doses of prednisone. Disease activity and damage were measured using SLE Disease Activity Index and SLE Damage Index.Results.Fifty-three children were included: 40 with psychosis and cognitive dysfunction (PSYC group) and 13 with isolated cognitive dysfunction (COG group). All received immunosuppressive treatment. Eighteen of 32 treated with azathioprine required a change to cyclophosphamide for poor response but none on cyclophosphamide required a change. The median times to remission were 72 weeks (PSYC) and 70 weeks (COG). Eight patients (7 PSYC, 1 COG) experienced flare following response/remission. New damage was noted in 50% of children at a median of 11 months: 57% of PSYC group, 31% of COG group. Persistent cognitive dysfunction was seen in 16% of PSYC patients and 15% of COG patients.Conclusion.Most patients responded to immunosuppressive treatment, although median time to remission was > 1 year. Roughly half the patients acquired a new damage item, most of which did not interfere with functional abilities. Fewer than 20% of patients developed neuropsychiatric damage. Both phenotypes of psychiatric pSLE responded equally well to current treatment.

scholarly journals AB0302 FACTORS ASSOCIATED WITH GESTATIONAL DIABETES MELLITUS (GDM) IN A MULTI-ETHNIC SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) COHORT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1177.1-1177
Author(s):  
S. S. Shaharir ◽  
R. Mustafar ◽  
M. S. Mohamed Said ◽  
R. Abd Rahman
Keyword(s):  
Diabetes Mellitus ◽  
Systemic Lupus Erythematosus ◽  
Logistic Regression ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Factors Associated ◽  
In Pregnancy

Background:The risks of insulin resistance and diabetes mellitus are elevated in systemic lupus erythematosus (SLE) patients. The use of glucocorticoid and anti-double stranded DNA antibodies positive are among the factors reported to be associated with the risk of gestational diabetes mellitus (GDM) in SLE patients. However, the relationship between GDM in Asian SLE patients is still obscure.Objectives:To determine the prevalence of gestational diabetes mellitus (GDM) in a multi-ethnic SLE cohort in Malaysia and the associated risk factors.Methods:This was a retrospective study of SLE pregnant women who have completed their antenatal care in Universiti Kebangsaan Malaysia Medical Centre (UKMMC) from 2004 until 2019. Screening and diagnosis of gestational diabetes mellitus (GDM) were as recommended in the guidelines by the Ministry of Health Malaysia. Information on SLE disease activity and treatment at 6 months before pregnancy and during pregnancy were determined from the medical records. Univariate and multi-variable logistic regression analyses were performed to determine the factors associated with GDM in the SLE patients.Results:A total of 89 patients with 202 pregnancies were included in the study. Malay was the predominant ethnic in this cohort (n=82, 67.2%), followed by Chinese (n=33,27.0%) and Indian (n=7, 5.7%). The most common system involvement of SLE was musculoskeletal (n=91, 74.6%), followed by haematological (n=78, 63.9%), lupus nephritis (54.9%, n=67) and mucocutaneous (n=66, 54.1%). The prevalence of GDM was 8.9% (n=18). More patients with GDM had positive anti-cardiolipin IgG antibody (aCL IgG) and lupus anticoagulant (LA) antibody as compared to the patients with no GDM, (55.6% vs 25.8%, p=0.01) and (50.0% vs 25.4%, p=0.05) respectively. On the other hand, the use of hydroxychloroquine (HCQ) in pregnancy was significantly lower in GDM patients (11.1%) as compared to no GDM group (39.1%), p=0.02. There was no significant difference in the ethnicity, SLE system involvement, disease activity status and immunosupressant use including steroid, azathioprine and cyclosporine A at 6 months before and during pregnancy between the GDM and non-GDM group. A forward logistic regression which include aCL IgG, LA and HCQ use in pregnancy, only the HCQ use remained significantly associated with lower risk of GDM in the model with OR= 0.12, 95% C.I = 0.02-0.94, p=0.04.Conclusion:Our study demonstrates the potential benefit of hydroxychloroquine in reducing the risk of gestational diabetes mellitus in SLE patients. The prevalence of antiphospholipid antibodies particularly aCL IgG and LA was found to be higher among patients with GDM. Further prospective studies are needed to confirm this association.References:[1]Dong Y, Dai Z, Wang Z, et al. Risk of gestational diabetes mellitus in systemic lupus erythematosus pregnancy: a systematic review and meta-analysis. BMC Pregnancy and Childbirth. 2019 May;19(1):179. DOI: 10.1186/s12884-019-2329-0.Disclosure of Interests:None declared

The Relationships of High-Sensitivity C-Reactive Protein and Homocysteine Levels With Disease Activity, Damage Accrual, and Cardiovascular Risk in Systemic Lupus Erythematosus

2019 ◽  
Vol 22 (2) ◽  
pp. 169-177 ◽  
Author(s):  
Gabriela Pocovi-Gerardino ◽  
Maria Correa-Rodríguez ◽  
José-Luis Callejas Rubio ◽  
Raquel Ríos Fernández ◽  
María Martín Amada ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
High Sensitivity ◽  
Cvd Risk Factors ◽  
Systemic Lupus ◽  
Cvd Risk ◽  
Damage Accrual ◽  
Hs Crp

Chronic inflammation coupled with cardiovascular disease (CVD) risk factors influences the progression of atherosclerosis in systemic lupus erythematosus (SLE). High-sensitivity C-reactive protein (hs-CRP) and homocysteine (Hcy) are associated with the risk of CVD in the general population, but their associations with CV risk and disease activity in SLE are unclear. In this cross-sectional study ( N = 139 SLE patients, mean age = 45.27 ± 13.18 years), we investigated associations between hs-CRP and Hcy levels and disease activity, damage accrual, and CVD risk in SLE. Disease activity and damage accrual were measured with the SLE Activity Index 2000 (SLEDAI-2K), the Systemic Lupus Erythematosus International Collaborating Clinics Group/American College of Rheumatology damage index (SDI), and anti-double-stranded DNA antibodies (anti-dsDNA). CVD risk factors of obesity, diabetes mellitus, hypertension, blood lipids, and ankle–brachial index were collected. Linear regression analysis and one-way analysis of variance were used to analyze relationships of hs-CRP and Hcy with SLE activity, damage accrual, and CVD risk factors. Results: hs-CRP correlated significantly with SLEDAI-2K ( p = .036), SDI ( p = .00), anti-dsDNA titers ( p = .034), diabetes ( p = .005), and obesity ( p = .027). hs-CRP and Hcy correlated with triglyceride (TG) levels ( p = .032 and p < .001, respectively), TG/high-density lipoprotein cholesterol index ( p = .020 and p = .001, respectively), and atherogenic index of plasma ( p = .006 and p = .016, respectively). hs-CRP levels >3 mg/L correlated with SDI score ( p = .012) and several CVD risk factors. Discussion: Findings suggest SLE patients with elevated hs-CRP and/or Hcy have a higher prevalence of CVD risk factors.

scholarly journals Measuring Disease Activity and Damage with Validated Metrics: A Systematic Review on Mortality and Damage in Systemic Lupus Erythematosus

2018 ◽  
Vol 45 (10) ◽  
pp. 1448-1461 ◽  
Author(s):  
Stephanie O. Keeling ◽  
Ben Vandermeer ◽  
Jorge Medina ◽  
Trish Chatterley ◽  
Tatiana Nevskaya ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Damage Index ◽  
Disease Activity Index ◽  
Evaluation Methodology ◽  
Systemic Lupus ◽  
Increased Risk ◽  
Damage Accrual

Objective.To identify the effect of disease activity and damage, measured by validated indices, on mortality and damage accrual, in order to inform upcoming Canadian systemic lupus erythematosus (SLE) recommendations.Methods.Following GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology to fill in evidence-to-decision tables to create recommendations for “minimal investigations needed to monitor SLE patients at baseline and subsequent visits,” a systematic literature review was performed. The effect of disease activity and damage, measured by validated metrics, on mortality and damage was systematically reviewed, with metaanalyses performed when available.Results.A title/abstract screen of 5599 articles identified 816 articles for full paper review, with 102 meeting inclusion criteria and 53 with extractable data. Thirty-three articles describing outcomes related to disease activity and 20 articles related to damage were identified. Mortality was associated with higher SLE Disease Activity Index-2000 scores in 6 studies (HR 1.14, 95% CI 1.06–1.22) and higher Systemic Lupus International Collaborating Clinics/ACR Damage Index scores in 6 studies (HR 1.53, 95% CI 1.28–1.83). Higher SLE Activity Measure scores were associated with increased risk of damage in 3 studies (OR 1.06, 95% CI 1.04–1.08). British Isles Lupus Assessment Group was associated with mortality in 1 study with HR of 1.15.Conclusion.Active SLE disease and damage are associated with and predict greater mortality and damage. The use of validated disease activity and damage metrics is important in the assessment of disease activity and damage and will inform upcoming Canadian recommendations for the assessment of SLE.

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