scholarly journals Atrial Fibrillation/flutter Hospitalizations among US Medicaid Recipients with and without Systemic Lupus Erythematosus

2019 ◽  
Vol 47 (9) ◽  
pp. 1359-1365 ◽  
Author(s):  
Sarah K. Chen ◽  
Medha Barbhaiya ◽  
Daniel H. Solomon ◽  
Hongshu Guan ◽  
Kazuki Yoshida ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Cox Regression ◽  
The United States ◽  
Incidence Rates ◽  
Systemic Lupus ◽  
Cox Models ◽  
Age And Sex

Objective.Systemic lupus erythematosus (SLE) is a multisystem chronic inflammatory autoimmune disease with high prevalence of several risk factors for atrial fibrillation/flutter (AF). However, the incidence and risk of AF in SLE have not been well quantified.Methods.We used the United States Medicaid Analytic eXtract from 2007 to 2010 to identify beneficiaries aged 18–65 years, with prevalent SLE, each matched by age and sex to 4 non-SLE general Medicaid recipients. We estimated the incidence rates (IR) per 1000 person-years (PY) for AF hospitalizations and used multivariable Cox regression to estimate the HR for AF hospitalization.Results.We identified 46,876 US Medicaid recipients with SLE, and 187,504 age- and sex-matched non-SLE controls (93% female; mean age 41.5 ± 12.2 yrs). Known AF risk factors such as hypertension (HTN), cardiovascular disease (CVD), and kidney disease were more prevalent in patients with SLE. During a mean followup of 1.9 ± 1.1 years for SLE, and 1.8 ± 1.1 years for controls, the IR per 1000 PY for AF was 1.4 (95% CI 1.1–1.6) among patients with SLE and 0.7 (95% CI 0.6–0.8) among non-SLE controls. In age- and sex-matched and race-adjusted Cox models, the HR for AF was 1.79 (95% CI 1.43–2.24); after adjustment for baseline HTN and CVD, the adjusted HR was reduced to 1.17 (95% CI 0.92–1.48).Conclusion.SLE was associated with a doubled rate of hospitalization for AF compared to age- and sex-matched general Medicaid patients. In a race-adjusted model, the risk was 80% higher. However, the AF risk factors HTN and CVD were more prevalent among patients with SLE and accounted for the excess risk.

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

RMD Open ◽  
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.

Zoster after Cyclophosphamide for Systemic Lupus Erythematosus or Vasculitis: Incidence, Risk Factors, and Effect of Antiviral Prophylaxis

2018 ◽  
Vol 45 (11) ◽  
pp. 1541-1548 ◽  
Author(s):  
Camille Garnier ◽  
David Ribes ◽  
Dominique Chauveau ◽  
Antoine Huart ◽  
Grégory Pugnet ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Protective Effect ◽  
Lupus Erythematosus ◽  
Postherpetic Neuralgia ◽  
Systemic Vasculitis ◽  
Laboratory Data ◽  
University Hospital ◽  
Systemic Lupus ◽  
Cox Models

Objective.To assess the incidence and the risk factors for zoster in patients exposed to intravenous cyclophosphamide (CYC) for systemic vasculitis or systemic lupus erythematosus (SLE), as well as the protective effect of prophylaxis by valacyclovir (VCV).Methods.This retrospective study included all adults treated by intravenous CYC for SLE or systemic vasculitis between 2011 and 2015 at Toulouse University Hospital, France. Zoster occurrence was recorded using medical chart review, laboratory data, and patient interviews. Univariate Cox models were computed to assess the risk factors for zoster and the protective effect of prophylaxis by VCV.Results.The cohort consisted of 110 patients (81 systemic vasculitis and 29 SLE). During a mean followup of 3.4 years after CYC initiation, 10 cases of zoster occurred, leading to an overall incidence of 27.9/1000 patient-years (95% CI 15.2–50.6); it was 59.4/1000 patients (95% CI 27.5–123.6) during the year after CYC initiation. Four patients experienced persistent postherpetic neuralgia. Probable risk factors were lymphopenia < 500/µl at CYC initiation (HR 5.11, 95% CI 0.94–27.93) and female sex (HR 4.36, 95% CI 0.51–37.31). The incidence was higher in patients with SLE (HR as compared with systemic vasculitis patients = 2.68, 95% CI 0.54–13.26). None of the 19 patients exposed to VCV during the followup developed zoster.Conclusion.The incidence of zoster is high in systemic vasculitis and in patients with SLE exposed to intravenous CYC. CYC may favor postherpetic neuralgia. Prophylaxis by VCV should be considered, particularly in cases of lymphopenia < 500/µl at CYC initiation and during the year after.

CHA2DS2-VASc score for prediction of ischemic stroke in patients with systemic lupus erythematosus without atrial fibrillation

Lupus ◽  
2018 ◽  
Vol 27 (8) ◽  
pp. 1240-1246 ◽  
Author(s):  
W-S Hu ◽  
C-L Lin
Keyword(s):  
Atrial Fibrillation ◽  
Systemic Lupus Erythematosus ◽  
Ischemic Stroke ◽  
Roc Curve ◽  
Lupus Erythematosus ◽  
Predictive Ability ◽  
Systemic Lupus ◽  
Roc Curve Analysis ◽  
Discrimination Power ◽  
Cox Models

Objective We conducted this study to assess the role of CHA2DS2-VASc score in predicting ischemic stroke among systemic lupus erythematosus (SLE) patients without atrial fibrillation (AF). Methods We selected the SLE patients from the Registry of Catastrophic Illnesses Patient Database in Taiwan. We excluded the SLE patients with AF or atrial flutter. The patients were followed up until the occurrence of ischemic stroke, censored for death or withdrawal from the dataset, or the end of follow-up. Cox models were performed to obtain the hazard ratios (HRs) and the 95% confidence intervals (CIs) of ischemic stroke associated with the CHA2DS2-VASc score. A receiver operating characteristic (ROC) curve was generated to evaluate the predictive ability of CHA2DS2-VASc score for ischemic stroke in SLE patients without AF. Results A total of 11,962 study participants were included in this study. The incidence of ischemic stroke increased from 4.00 per 1000 person-years (PYs) for patients with a CHA2DS2-VASc score of 0 to 87.4 per 1000 PYs for those with a CHA2DS2-VASc score of ≧6. Moreover, patients with a CHA2DS2-VASc score of ≧2 were 3.98-fold (95% CI 3.15–5.04) more likely to develop ischemic stroke than those with a CHA2DS2-VASc score of <2 (14.0 vs. 2.99 per 1000 PYs). ROC curve analysis of the CHA2DS2-VASc score demonstrated a moderate discrimination power for ischemic stroke development with a c-statistic of 0.65(95% CI 0.62–0.69). Conclusions We found that a CHA2DS2-VASc score greater than or equal to 2 in SLE patients without AF is associated with a significantly higher rate of ischemic stroke.

Atherosclerotic Vascular Events in Systemic Lupus Erythematosus: An Evolving Story

2019 ◽  
Vol 47 (1) ◽  
pp. 66-71
Author(s):  
Murray B. Urowitz ◽  
Jiandong Su ◽  
Dafna D. Gladman
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Early Recognition ◽  
Systemic Lupus ◽  
Vascular Events ◽  
Cox Models ◽  
Mortality And Morbidity ◽  
University Of Toronto

Objective.Atherosclerotic vascular events (AVE) are a major cause of mortality and morbidity in systemic lupus erythematosus (SLE). We aimed to determine the effect of early recognition and therapy for both classic risk factors for AVE and for SLE, on the burden of AVE in SLE in recent decades.Methods.Inception patients who entered the University of Toronto Lupus Clinic between 1975 and 1987 followed to 1992 (Cohort 1), and between 1999 and 2011 followed to 2016 (Cohort 2) were studied. AVE attributed to atherosclerosis and occurring during the 17 years were identified. SLE disease activity and therapy as well as hypertension, hypercholesterolemia, hyperglycemia, and smoking were assessed. Analysis included descriptive statistics on baseline characteristics, traditional risk factors over the followup, outcome rates by each 100 person-years (PY), Kaplan-Meier cumulative AVE curves, as well as competing risk Cox models adjusted by inverse probability weights.Results.Of the 234 patients in Cohort 1, 26 patients (11%) had an AVE compared with 10 of 262 patients (3.8%) in Cohort 2. The rate per 100 PY of followup was 1.8 in Cohort 1 and 0.44 in Cohort 2 (p < 0.0001). Better control of all risk factors and disease activity was achieved in Cohort 2. There was a reduction of 60% in the risk for AVE in Cohort 2.Conclusion.The incidence of AVE in SLE in the modern era has declined in large part owing to more effective management of classic coronary artery risk factors and of SLE.

scholarly journals Asymptomatic Coronary Artery Calcifications in Men with Systemic Lupus Erythematosus

2018 ◽  
Vol 45 (5) ◽  
pp. 663-670 ◽  
Author(s):  
Juanita Romero-Díaz ◽  
Roberto Iván Acosta-Hernández ◽  
Sergio Criales-Vera ◽  
Erick Kimura-Hayama ◽  
Maricruz Domínguez-Quintana ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Coronary Artery ◽  
Cumulative Dose ◽  
Lupus Erythematosus ◽  
Coronary Artery Calcification ◽  
Systemic Lupus ◽  
Increased Risk ◽  
Coronary Artery Atherosclerosis ◽  
Age And Sex

Objective.To determine whether the prevalence and extent of asymptomatic coronary artery atherosclerosis are increased in men with systemic lupus erythematosus (SLE) compared with age- and sex-matched controls, and to define the associated risk factors.Methods.Ninety-five patients with SLE (mean ± SD age, 34.7 ± 10.1 yrs) and 100 control subjects (age 34.8 ± 9.7 yrs) with no history of coronary artery disease were screened for coronary artery calcification using multidetector computed tomography. The extent of calcification was measured using the Agatston score. The frequency of risk factors for calcification was compared between patients and controls, and the relationship between clinical and immunological characteristics and the presence of coronary artery calcification was investigated.Results.Coronary artery calcification was more frequent in patients than controls [18% vs 7%, respectively (OR 2.89, 95% CI 1.07–8.65)]. These factors were independently associated with the presence of calcifications: age (OR 1.12, 95% CI 1.04–1.20), SLE diagnosis (OR 3.38, 95% CI 1.07–10.64), diabetes mellitus (OR 6.88, 95% CI 1.50–31.62), Framingham risk score (OR 1.12, 95% CI 1.00–1.23), and glomerular filtration rate (OR 0.98, 95% CI 0.96–1.00). Among patients with SLE, coronary artery calcifications were observed starting at age 32 years, within 2.3 years of diagnosis. Increasing age (OR 1.18, 95% CI 1.06–1.31), Systemic Lupus International Collaborating Clinics score (OR 2.85, 95% CI 1.21–6.73), and cumulative dose of prednisone (OR 1.04, 95% CI 1.01–1.08) were independent risk factors.Conclusion.Men with SLE are at an increased risk of coronary artery calcifications than age- and sex-matched controls. Among patients with SLE, the increased risk is associated to older age, increasing chronic damage, and cumulative dose of corticosteroids.

Low C4 as a risk factor for severe neuropsychiatric flare in patients with systemic lupus erythematosus

Lupus ◽  
2020 ◽  
Vol 29 (10) ◽  
pp. 1238-1247
Author(s):  
Kuniyuki Aso ◽  
Michihito Kono ◽  
Michihiro Kono ◽  
Toshiyuki Watanabe ◽  
Yuka Shimizu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Cox Regression ◽  
Survival Rates ◽  
Serum Levels ◽  
University Hospital ◽  
Systemic Lupus ◽  
Free Survival ◽  
Patient Enrolment

Objective This study aimed to explore the risk factors for ‘severe’ neuropsychiatric (NP) flare in patients with systemic lupus erythematosus (SLE). Methods This retrospective study comprised newly diagnosed 184 adult SLE patients who visited Hokkaido University Hospital between 2006 and 2017. In this study, severe NP flare was defined as the occurrence of at least one newly developed British Isles Lupus Assessment Group A score in the neurological domain. Overall severe NP flare-free survival was estimated by Kaplan–Meier analysis. Clinical and demographic profiles at SLE diagnosis were assessed as potential risk items in the adjusted multivariate Cox regression model. Results The median follow-up period was 7.9 years (interquartile range (IQR) 4.6–12.3) years. A total of 28 (15.2%) patients had one or more severe NP flares during the observation period. The median time from patient enrolment date to severe NP flare occurrence was 3.1 years (IQR 0.9–6.3 year). The 2- and 10-year severe NP flare-free survival rates were 92.7% and 86.0%, respectively. Among the manifestations of severe NP flare, psychosis was the most frequent (19.1%). In the multivariate model, low serum levels of C4 (hazard ratio (HR) = 3.67, p = 0.013) and severe NP manifestations at SLE diagnosis (HR = 7.11, p < 0.001) emerged as independent risk factors for developing severe NP flare. Conclusion The first severe NP flare presented early in the course of SLE. Low C4 level and severe NP manifestations at SLE diagnosis could predict the development of severe NP flare.

Risk Factors Associated with Systemic Lupus Erythematosus in Oman

2020 ◽  
Vol 03 (04) ◽  
Author(s):  
Asma Al-Kindi ◽  
Batool Hassan ◽  
Aliaa Al-Moqbali ◽  
Aliya Alansari
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Factors Associated
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