Maternal Systemic Lupus Erythematosus (SLE) High Risk for Preterm Delivery and Not for Long-Term Neurological Morbidity of the Offspring

Objective: Pregnancies of women with systemic lupus erythematosus (SLE) are associated with preterm delivery. As preterm delivery is associated with long-term neurological morbidity, we opted to evaluate the long-term neurologic outcomes of offspring born to mothers with SLE regardless of gestational age. Methods: Perinatal outcomes and long-term neurological disease of children of women with and without SLE during pregnancy were evaluated. Children of women with and without SLE were followed until 18 years of age for neurological diseases. Generalized estimating equation (GEE) models were used to assess perinatal outcomes. To compare cumulative neurological morbidity incidence a Kaplan–Meier survival curve was used, and a Cox proportional hazards model was used to control for confounders. Result: A total of 243,682 deliveries were included, of which 100 (0.041%) were of women with SLE. Using a GEE model, maternal SLE was noted as an independent risk factor for preterm delivery. The cumulative incidence of long-term neurological disease was not found to be significantly higher when using the Kaplan Meier survival curves and maternal SLE was not found to be associated with long-term neurological disease of the offspring when a Cox model was used. Conclusion: Despite the association of SLE with preterm delivery, no difference in long-term neurological disease was found among children of women with or without SLE.

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Low Dosage and Long-Term Use of Cyclophosphamide Improve the Survival of Patients with Systemic Lupus Erythematosus

10.21203/rs.3.rs-504049/v1 ◽

2021 ◽

Author(s):

Yoosuf Ali Ashraf Muhammad Hussenbocus ◽

Ziyi Jin ◽

Wenyou Pan ◽

Lin Liu ◽

Min Wu ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Cox Regression ◽

Systemic Lupus ◽

Survival Status ◽

Kaplan Meier ◽

Specific Mortality ◽

Set Up ◽

Overall Mortality

Abstract Background: Cyclophosphamide (CTX) is an alkylating agent used in the treatment of systemic lupus erythematosus (SLE) for its potent immunosuppression effect. Many aspects of the use of CTX in SLE have been previously studied. However, its relation to mortality in SLE had rarely been mentioned. Thus we investigate the effect of cyclophosphamide on organ involvements and the overall and cause-specific mortality of SLE patients.Methods: Information about CTX prescription were taken from medical records in the Jiangsu Lupus database that was set up to collect data from SLE patients since their first admission during 1999-2009 in Jiangsu province, China. Follow- up studies were carried out in 2010 and 2015 to check the survival status of the patients. Cox regression models were used to estimate hazard ratio (HR) and 95% CI. Kaplan-Meier model was used to assess the effect of CTX on mortality between organ involvements and non-involvements.Results: There were 221 deaths observed out of 2446 SLE patients. CTX users showed a lower mortality of SLE (8.4%) with adjusted HR (95% CI) of 0.74 (0.56-0.97), as compared to non-users. A decreased in overall mortality of SLE in low daily dosage of CTX, with adjusted HR (95% CI) of 0.54 (0.36-0.81) and a significant dose-response pattern (P = 0.004) between overall mortality of SLE and long-term use of CTX with adjusted HR (95% CI) 0.53 (0.35-0.80) were observed. In cause-specific mortality analyses, protective effective of CTX was found to be insignificant. However, CTX could eliminate the differences in mortality between organ involvement and non-involvement, including renal, neuropsychiatric, cardiopulmonary, gastrointestinal and hematological involvements.Conclusion: Low daily dosage and long-term use of CTX lowers the risk of overall mortality of SLE. CTX might improve the survival of patients with renal, neuropsychiatric, cardiopulmonary, gastrointestinal and hematological involvements.

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453: Long-term neurological morbidity of offspring born to women with systemic lupus erythematosus

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2019.11.469 ◽

2020 ◽

Vol 222 (1) ◽

pp. S297

Author(s):

Dora Davidov ◽

Gali Pariente ◽

Tamar Wainstock ◽

Eyal Sheiner

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Systemic Lupus ◽

Neurological Morbidity

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Identifying the Critical Threshold for Long-Term Pediatric Neurological Hospitalizations of the Offspring in Preterm Delivery

Journal of Clinical Medicine ◽

10.3390/jcm10132919 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2919

Author(s):

Shiran Zer ◽

Tamar Wainstock ◽

Eyal Sheiner ◽

Shayna Miodownik ◽

Gali Pariente

Keyword(s):

Preterm Delivery ◽

Gestational Age ◽

Cox Model ◽

Survival Curve ◽

Cohort Analysis ◽

Critical Threshold ◽

Kaplan Meier ◽

Neurological Morbidity ◽

Meier Survival Curve

We opted to investigate whether a critical threshold exists for long-term pediatric neurological morbidity, and cerebral palsy (CP), in preterm delivery, via a population-based cohort analysis. Four study groups were classified according to their gestational age at birth: 24–27.6, 28–31.6, 32–36.6 weeks and term deliveries, evaluating the incidence of long-term hospitalizations of the offspring due to neurological morbidity. Cox proportional hazard models were performed to control for confounders. A Kaplan–Meier survival curve was used to compare the cumulative neurological morbidity incidence for each group. A total of 220,563 deliveries were included: 0.1% (118) occurred at 24–27.6 weeks of gestation, 0.4% (776) occurred at 28–31.6 weeks of gestation, 6% (13,308) occurred at 32–36.6 weeks of gestation and 93% (206,361) at term. In a Cox model, while adjusting for confounders, delivery before 25 weeks had a 3.9-fold risk for long-term neurological morbidity (adjusted HR (hazard ratio) = 3.9, 95% CI (confidence interval) 2.3–6.6; p < 0.001). The Kaplan–Meier survival curve demonstrated a linear association between long-term neurological morbidity and decreasing gestational age. In a second Cox model, adjusted for confounders, infants born before 25 weeks of gestation had increased rates of CP (adjusted HR = 62.495% CI 25.6–152.4; p < 0.001). In our population, the critical cut-off for long-term neurological complications is delivery before 25 weeks gestation.

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Long-Term Treatment of the Patient with Systemic Lupus Erythematosus

Nishi Nihon Hifuka ◽

10.2336/nishinihonhifu.37.924 ◽

1975 ◽

Vol 37 (6) ◽

pp. 924-929 ◽

Cited By ~ 1

Author(s):

Hideaki YAMAURA ◽

Masaharu RIKIMARU ◽

Isamu TAKAHASHI ◽

Sadao ANAN ◽

Tomio AKIYAMA ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Term Treatment ◽

Systemic Lupus ◽

Long Term Treatment

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Antiphospholipid syndrome nephropathy in patients with systemic lupus erythematosus and antiphospholipid antibodies: Prevalence, clinical associations, and long-term outcome

Arthritis & Rheumatism ◽

10.1002/art.20433 ◽

2004 ◽

Vol 50 (8) ◽

pp. 2569-2579 ◽

Cited By ~ 152

Author(s):

Maria G. Tektonidou ◽

Flora Sotsiou ◽

Lidia Nakopoulou ◽

Panayiotis G. Vlachoyiannopoulos ◽

Haralampos M. Moutsopoulos

Keyword(s):

Systemic Lupus Erythematosus ◽

Antiphospholipid Syndrome ◽

Lupus Erythematosus ◽

Antiphospholipid Antibodies ◽

Systemic Lupus ◽

Term Outcome ◽

Long Term Outcome ◽

Clinical Associations ◽

Antiphospholipid Syndrome Nephropathy

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Symptomatic osteonecrosis of the hip and knee in patients with systemic lupus erythematosus: Prevalence, pattern, and comparison of natural course

Lupus ◽

10.1177/09612033211031007 ◽

2021 ◽

pp. 096120332110310

Author(s):

Mehmet Ersin ◽

Mehmet Demirel ◽

Mehmet Ekinci ◽

Lezgin Mert ◽

Çiğdem Çetin ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Rheumatic Diseases ◽

Lupus Erythematosus ◽

Bone Structure ◽

Survival Rates ◽

Knee Joints ◽

Joint Involvement ◽

Systemic Lupus ◽

Kaplan Meier ◽

The Mean

Objective Osteonecrosis (ON), also known as avascular necrosis, is characterized by the collapse of the architectural bone structure secondary to the death of the bone marrow and trabecular bone. Osteonecrosis may accompany many conditions, especially rheumatic diseases. Among rheumatic diseases, osteonecrosis is most commonly associated with systemic lupus erythematosus (SLE). We assessed prevalence and distribution pattern of symptomatic ON in patients with SLE and compare the natural courses of hip and knee ON. Methods 912 SLE patients admitted between 1981 and 2012 were reviewed. SLE patients with symptomatic ON were retrospectively identified both from the existing SLE/APS database. The prevalence of symptomatic ON was calculated; with ON, the joint involvement pattern was determined by examining the distribution of the joints involved, and then the data about the hip and knee joints were entered in the Kaplan-Meier analysis. Kaplan-Meier methods were used to calculate 5- and 10-year rates of ON-related hip (the hip group) and knee survival (the knee group). Results Symptomatic ON developed in various joints in 97 of 912 patients with SLE, and the overall prevalence of ON was detected as 10.6%. The mean age at the time of SLE and ON diagnoses were 27.9 ± 9.9 (14–53) and 34.2 ± 11.3 (16–62) years, respectively. The mean duration from diagnosis of SLE to the first development of ON was 70.7± 60.2 (range = 0–216) months. The most common site for symptomatic ON was the hips (68%, n=66), followed by the knees (38%, n = 37). According to Kaplan-Meier analysis, hip and knee joint survival rates associated with 5-year ON were 51% and 88%, and 10-year survival rates were 43% and 84%, respectively. Conclusion We observed that the prevalence of symptomatic ON in patients with SLE was 10.6%. With the estimated 10-year survival rates of 40% versus 84% for the hip and knee joints, respectively, hip involvement may demonstrate a more aggressive course to end-stage osteoarthritis than the knee involvement.

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