Risks, Subtypes, and Hospitalization Costs of Stroke Among Patients with Systemic Lupus Erythematosus: A Retrospective Cohort Study in Taiwan

Objective.To compare risks, subtypes, and hospitalization costs of stroke between cohorts with and without systemic lupus erythematosus (SLE).Methods.From the catastrophic illnesses registry of Taiwan’s universal health insurance claims data, we identified 13,689 patients with SLE diagnosed in 1997–2008 and selected 54,756 non-SLE controls, frequency-matched with age (every 5 years), sex, and index year. Age-specific and type-specific stroke incidence, hazard, and cost of stroke were compared between the 2 cohorts to the end of 2008.Results.Compared with the non-SLE cohort, the risk of stroke was 3.2-fold higher in the SLE cohort (5.53 vs 1.74 per 1000 person-years) with an overall adjusted HR of 2.90 (95% CI 2.52–3.33). The age-specific risk was the highest in patients 1–17 years old (HR 163, 95% CI 22.2–1197) and decreased as age increased (p = 0.004). Hypertension and renal disease were the most important comorbidities in the SLE cohort predicting stroke risk (HR 1.75, 95% CI 1.28–2.39 and HR 1.66, 95% CI 1.32–2.10, respectively). There were more hemorrhagic strokes in the SLE cohort than in the non-SLE cohort, but not significantly (28.0% vs 23.4%; p = 0.10). The hospitalization cost for stroke patients was more than twice the cost for those with SLE than for those without (p < 0.0001).Conclusion.Stroke risk and hospital care costs are considerably greater for patients with SLE than without. The relative risk of stroke is the highest in young patients with SLE.

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Incorporating Unstructured Patient Narratives and Health Insurance Claims Data in Pharmacovigilance: Natural Language Processing Analysis of Patient-Generated Texts About Systemic Lupus Erythematosus

JMIR Public Health and Surveillance ◽

10.2196/29238 ◽

2021 ◽

Vol 7 (6) ◽

pp. e29238

Author(s):

Shinichi Matsuda ◽

Takumi Ohtomo ◽

Shiho Tomizawa ◽

Yuki Miyano ◽

Miwako Mogi ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Health Insurance ◽

Language Processing ◽

Lupus Erythematosus ◽

Insurance Claims ◽

Systemic Lupus ◽

Patient Level ◽

Insurance Claims Data ◽

Health Insurance Claims Data ◽

Health Insurance Claims

Background Gaining insights that cannot be obtained from health care databases from patients has become an important topic in pharmacovigilance. Objective Our objective was to demonstrate a use case, in which patient-generated data were incorporated in pharmacovigilance, to understand the epidemiology and burden of illness in Japanese patients with systemic lupus erythematosus. Methods We used data on systemic lupus erythematosus, an autoimmune disease that substantially impairs quality of life, from 2 independent data sets. To understand the disease’s epidemiology, we analyzed a Japanese health insurance claims database. To understand the disease’s burden, we analyzed text data collected from Japanese disease blogs (tōbyōki) written by patients with systemic lupus erythematosus. Natural language processing was applied to these texts to identify frequent patient-level complaints, and term frequency–inverse document frequency was used to explore patient burden during treatment. We explored health-related quality of life based on patient descriptions. Results We analyzed data from 4694 and 635 patients with systemic lupus erythematosus in the health insurance claims database and tōbyōki blogs, respectively. Based on health insurance claims data, the prevalence of systemic lupus erythematosus is 107.70 per 100,000 persons. Tōbyōki text data analysis showed that pain-related words (eg, pain, severe pain, arthralgia) became more important after starting treatment. We also found an increase in patients’ references to mobility and self-care over time, which indicated increased attention to physical disability due to disease progression. Conclusions A classical medical database represents only a part of a patient's entire treatment experience, and analysis using solely such a database cannot represent patient-level symptoms or patient concerns about treatments. This study showed that analysis of tōbyōki blogs can provide added information on patient-level details, advancing patient-centric pharmacovigilance.

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Incorporating Unstructured Patient Narratives and Health Insurance Claims Data in Pharmacovigilance: Natural Language Processing Analysis of Patient-Generated Texts About Systemic Lupus Erythematosus (Preprint)

10.2196/preprints.29238 ◽

2021 ◽

Author(s):

Shinichi Matsuda ◽

Takumi Ohtomo ◽

Shiho Tomizawa ◽

Yuki Miyano ◽

Miwako Mogi ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Health Insurance ◽

Language Processing ◽

Lupus Erythematosus ◽

Insurance Claims ◽

Systemic Lupus ◽

Patient Level ◽

Insurance Claims Data ◽

Health Insurance Claims Data ◽

Health Insurance Claims

BACKGROUND Gaining insights that cannot be obtained from health care databases from patients has become an important topic in pharmacovigilance. OBJECTIVE Our objective was to demonstrate a use case, in which patient-generated data were incorporated in pharmacovigilance, to understand the epidemiology and burden of illness in Japanese patients with systemic lupus erythematosus. METHODS We used data on systemic lupus erythematosus, an autoimmune disease that substantially impairs quality of life, from 2 independent data sets. To understand the disease’s epidemiology, we analyzed a Japanese health insurance claims database. To understand the disease’s burden, we analyzed text data collected from Japanese disease blogs (tōbyōki) written by patients with systemic lupus erythematosus. Natural language processing was applied to these texts to identify frequent patient-level complaints, and term frequency–inverse document frequency was used to explore patient burden during treatment. We explored health-related quality of life based on patient descriptions. RESULTS We analyzed data from 4694 and 635 patients with systemic lupus erythematosus in the health insurance claims database and tōbyōki blogs, respectively. Based on health insurance claims data, the prevalence of systemic lupus erythematosus is 107.70 per 100,000 persons. Tōbyōki text data analysis showed that pain-related words (eg, pain, severe pain, arthralgia) became more important after starting treatment. We also found an increase in patients’ references to mobility and self-care over time, which indicated increased attention to physical disability due to disease progression. CONCLUSIONS A classical medical database represents only a part of a patient's entire treatment experience, and analysis using solely such a database cannot represent patient-level symptoms or patient concerns about treatments. This study showed that analysis of tōbyōki blogs can provide added information on patient-level details, advancing patient-centric pharmacovigilance.

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Chorea as a First Manifestation in Young Patients with Systemic Lupus Erythematosus who Was Initially Diagnosed with Rheumatic Fever

Clinical Medicine Insights Case Reports ◽

10.4137/ccrep.s9143 ◽

2012 ◽

Vol 5 ◽

pp. CCRep.S9143 ◽

Cited By ~ 2

Author(s):

Jamal A Albishri

Keyword(s):

Systemic Lupus Erythematosus ◽

Rheumatic Fever ◽

Lupus Erythematosus ◽

Young Patients ◽

Systemic Lupus ◽

Incorrect Diagnosis ◽

Rare Manifestation ◽

Specific Increase ◽

Anti Phospholipid Syndrome

Chorea is a rare manifestation of systemic lupus erythematosus (SLE). We report on a young patient with chorea who was diagnosed initially with rheumatic fever. Follow up and further evaluation confirmed the diagnosis of SLE and anti-phospholipid syndrome. Of special interest were the negative antiphospholipid (aPL) antibodies and the initial diagnosis of rheumatic fever which is still not uncommon problem in our region. The rarity of such presentation with joint and non specific increase of antistreptolysin O (ASO) titer might be the factors that led to an incorrect diagnosis. Early diagnosis and treatment of SLE and anti-phospholipid syndrome are very crucial and should be considered with such presentation.

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Repeat Testing of Antibodies and Complements in Systemic Lupus Erythematosus: When Is It Enough?

The Journal of Rheumatology ◽

10.3899/jrheum.161365 ◽

2018 ◽

Vol 45 (6) ◽

pp. 827-834 ◽

Cited By ~ 6

Author(s):

Thomas C. Raissi ◽

Carly Hewson ◽

Janet E. Pope

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Chart Review ◽

Cost Effective ◽

Complement C3 ◽

Systemic Lupus ◽

Abnormal Result ◽

Repeat Testing ◽

Nuclear Antigens ◽

The Cost

Objective.Patients with systemic lupus erythematosus (SLE) frequently undergo repeat testing for antibodies against extractable nuclear antigens (anti-ENA), but it is not known whether this is necessary or cost-effective. This study characterized the frequencies of changes in anti-ENA, anti–dsDNA, and complement C3 and C4 upon repeat testing.Methods.Chart review was done at one site of 130 patients with SLE enrolled in the 1000 Canadian Faces of Lupus prospective registry with annual antibody and complement testing. We determined the frequency of seroconversion (changes) on the next test and over the entire followup given 1 or multiple consistent results, and the cost to detect these changes.Results.Overall, 89.4% of patients had no changes in anti-ENA screening results from the first available test, 3.3% changed from negative to positive, and 7.3% from positive to negative. Following a single anti-ENA test, 3.9% of negative tests changed to positive and 4.2% of positive changed to negative on the next test. After multiple consistent tests, the frequencies of changes progressively declined. No changes from the first test were observed in anti-dsDNA, C3, and C4 in 60.8%, 83.3%, and 75.4% of patients, respectively. After 2 consistent anti-ENA tests, the cost to detect 1 change was above US$2000.Conclusion.Anti-ENA results change infrequently, especially following 1 or more negative tests. The high cost and lack of evidence that changes affect management suggest that repeating anti-ENA tests routinely is unnecessary. Anti-dsDNA and complements change more frequently after an abnormal result, but less after a normal value.

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Influence of statin therapy on antiphospholipid antibodies and endothelial dysfunction in young patients with coronary artery disease and systemic lupus erythematosus

Archives of Medical Science ◽

10.5114/aoms.2019.90271 ◽

2019 ◽

Author(s):

Adam Mazurek ◽

Krzysztof Gryga ◽

Kamil Bugala ◽

Teresa Iwaniec ◽

Jacek Musial ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Endothelial Dysfunction ◽

Statin Therapy ◽

Lupus Erythematosus ◽

Antiphospholipid Antibodies ◽

Young Patients ◽

Systemic Lupus ◽

Artery Disease

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Response to: ‘Increased stroke incidence in systemic lupus erythematosus patients: risk factors or disease itself?’ by Bruzzese and Zullo

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2017-212604 ◽

2017 ◽

Vol 77 (10) ◽

pp. e72-e72

Author(s):

Elizabeth V Arkema ◽

Marios Rossides ◽

Mia Von Euler ◽

Elisabet Svenungsson ◽

Christopher Sjöwall ◽

...

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Systemic Lupus ◽

Stroke Incidence

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Increased stroke incidence in systemic lupus erythematosus patients: risk factors or disease itself?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2017-212600 ◽

2017 ◽

Vol 77 (10) ◽

pp. e71-e71 ◽

Cited By ~ 1

Author(s):

Vincenzo Bruzzese ◽

Angelo Zullo

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Systemic Lupus ◽

Stroke Incidence

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Premature Aortic Atherosclerosis in Systemic Lupus Erythematosus: A Controlled Transesophageal Echocardiographic Study

The Journal of Rheumatology ◽

10.3899/jrheum.090665 ◽

2009 ◽

Vol 37 (1) ◽

pp. 71-78 ◽

Cited By ~ 19

Author(s):

CARLOS A. ROLDAN ◽

JOSEPH JOSON ◽

JANEEN SHARRAR ◽

CLIFFORD R. QUALLS ◽

WILMER L. SIBBITT

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Independent Predictor ◽

Young Patients ◽

Intima Media Thickness ◽

Age At Diagnosis ◽

Aortic Atherosclerosis ◽

Systemic Lupus ◽

Cyclophosphamide Therapy ◽

Echocardiographic Study

Objective.Premature carotid and coronary atherosclerosis are common in systemic lupus erythematosus (SLE), but data on aortic atherosclerosis (AA) are limited. Thus, using multiplane transesophageal echocardiography (TEE), we sought to determine the prevalence and clinical correlates of AA in patients with SLE.Methods.Forty-seven patients with SLE (44 women, age 38 ± 12 years) and 21 healthy controls (19 women, age 34 ± 12 years) underwent clinical and laboratory evaluations and TEE to assess AA defined as aortic intima media thickness (IMT) > 0.86 mm or plaques as > 50% focal IMT as compared with surrounding walls. TEE studies were interpreted by an experienced observer unaware of subjects’ clinical data.Results.The prevalence of abnormal aortic IMT, plaques, or both lesions was higher in patients as compared to controls (37%, 23%, and 43% vs 14%, 0%, and 14%, respectively, all p ≤ 0.02). In patients, age at diagnosis of SLE was the only positive independent predictor of AA [OR 1.12 per year from diagnosis of SLE, 95% confidence interval (CI) 1.04–1.19, p = 0.001] and cyclophosphamide therapy was the only negative independent predictor of AA (OR 0.186, 95% CI 0.153–0.95, p = 0.04, equivalent to 5.4 times less likely to develop AA).Conclusion.AA is common in young patients with SLE and is predicted by a later age at diagnosis of SLE, but is negatively correlated with cyclophosphamide therapy. Thus, early diagnosis and more aggressive immunosuppressive therapy may be required to decrease the development and progression of atherosclerosis in patients with SLE.

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