scholarly journals Pregnancy outcomes between pregnant systemic lupus erythematosus patients with clinical remission and those with low disease activity: A comparative study

2021 ◽  
Author(s):  
Worawit Louthrenoo ◽  
Thananant Trongkamolthum ◽  
Nuntana Kasitanon ◽  
Antika Wongthanee
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Pregnancy Outcomes ◽  
Clinical Remission ◽  
Activity Index ◽  
Physician Global Assessment ◽  
Systemic Lupus ◽  
Low Disease Activity ◽  
Significant Difference

Objectives: This study aims to compare pregnancy outcomes between systemic lupus erythematosus (SLE) patients who attained clinical remission based on the Definition of Remission in SLE (DORIS) and those with lupus low disease activity based on Low Lupus Disease Activity State (LLDAS). Patients and methods: Between January 1993 and June 2017, a total of 90 pregnancies (one twin pregnancy) from 77 patients (mean age: 6.9±4.8 years; range, 17.9 to 37.3 years) were included in the study. The clinical remission and the LLDAS groups were modified into modified clinical remission and LLDAS groups, respectively by omitting Physician Global Assessment (PGA). The clinical SLE disease activity index (cSLEDAI) score was used for LLDAS. Results: Pregnancies in 49 patients occurred, when they were in modified clinical remission and in 57 in modified LLDAS. There was no significant difference in demographic characteristics, disease activity, or medication received at conception between the two groups. Pregnancy outcomes were similar between the modified clinical remission and the modified LLDAS groups in terms of successful pregnancy (83.67% vs. 84.21%), full-term births (38.78% vs. 38.60%), fetal losses (16.33% vs. 15.79%), spontaneous abortions (14.29% vs. 14.04%), small for gestational age infants (18.37% vs. 19.30%), low birth weight infants (42.86% vs. 40.35%), maternal complications (46.94% vs. 49.12%), and maternal flares (36.73% vs. 40.35%). The agreement of pregnancy outcomes was very high between the two groups (91.11% agreement). Conclusion: Pregnancy outcomes in SLE patients who achieved modified clinical remission and modified LLDAS were comparable.

Prolonged clinical remission and low disease activity statuses are associated with better quality of life in systemic lupus erythematosus

Lupus ◽  
2019 ◽  
Vol 28 (10) ◽  
pp. 1189-1196 ◽  
Author(s):  
N Poomsalood ◽  
P Narongroeknawin ◽  
S Chaiamnuay ◽  
P Asavatanabodee ◽  
R Pakchotanon
Keyword(s):  
Quality Of Life ◽  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Clinical Remission ◽  
Life Questionnaire ◽  
Systemic Lupus ◽  
Low Disease Activity ◽  
Significant Difference

Objective The objective of this study was to determine the association between disease activity status and health-related quality of life (HRQoL) in systemic lupus erythematosus (SLE) patients. Methods SLE patients in an out-patient clinic during the previous 12 months were included in the study. The Systemic Lupus Erythematosus-specific Quality-of-Life questionnaire (SLEQoL) was administered at the last visit. Disease activity status was determined retrospectively during the previous year. The categories of disease activity status were defined as: clinical remission (CR): clinical quiescent disease according to Systemic Lupus Erythematosus Disease Activity Index 2000, prednisolone ≤ 5 mg/day; low disease activity (LDA): SLEDAI-2K (without serological domain) ≤ 2, prednisolone ≤ 7.5 mg/day; and non-optimally controlled status: for those who were not in CR/LDA. Immunosuppressive drugs (maintenance dose) and antimalarials were allowed. Prolonged CR or LDA was defined as those with sustained CR or LDA for at least one year. The association between disease activity status and HRQoL was assessed by using regression analysis adjusting for other covariates. Results Of 237 SLE patients, 100 patients (42.2%) achieved prolonged CR, 46 patients (19.4%) achieved prolonged LDA and 91 patients (38.4%) were not in CR/LDA. Non-CR/LDA patients had significantly higher total SLEQoL score and in all domains compared to CR/LDA patients. No significant difference in SLEQoL domain scores was found between CR and LDA groups. Multivariable analysis revealed that non-CR/LDA was positively associated with SLEQoL score compared with CR/LDA (β 20.02, 95% confidence interval (CI) 6.81–33.23, p < 0.003). Moreover, non-CR/LDA was at a higher risk of impaired QoL (SLEQoL score > 80) compared with CR (hazard ratio 3.8; 95% CI 1.82–7.95; p < 0.001). However, there was no significant difference between CR and LDA in terms of SLEQoL score or impaired QoL. Other factors associated with higher SLEQoL score were damage index (β 9.51, 95% CI 3.52–15.49, p = 0.002) and anemia (β 24.99, 95% CI 5.71–44.27, p = 0.01). Conclusion Prolonged CR and LDA are associated with better HRQoL in SLE patients and have a comparable effect. Prolonged CR or optional LDA may be used as the treatment goal of a treat to target approach in SLE.

Low disease activity state in juvenile-onset systemic lupus erythematosus

Lupus ◽  
2021 ◽  
pp. 096120332110543
Author(s):  
Kubra Ozturk ◽  
Senğul Caglayan ◽  
Ayse Tanatar ◽  
Esra Baglan ◽  
Gulcin Yener Otar ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Low Dose ◽  
Systemic Lupus ◽  
Juvenile Onset ◽  
Low Disease Activity ◽  
Significant Difference ◽  
Activity State ◽  
Dose Corticosteroid

Objectives To determine the rate of achieving The Lupus Low Disease Activity State (LLDAS) in children with systemic lupus erythematosus (SLE) for tracing pertinent treatment modalities. Methods A total of 122 juvenile-onset SLE (jSLE) patients from six pediatric rheumatology centers in Turkey were enrolled in the study. LLDAS-50 was defined as encountering LLDAS for at least 50% of the observation time. According to the achievement of LLDAS-50, clinical features, immunological profiles, and treatments of patients with jSLE have been revealed. Results LLDAS of any duration was achieved by 82% of the cohort. Although only 10.8% of the patients achieved remission, 68.9% reached LLDAS-50. A significant difference was found between patients who reached LLDAS-50 and those who did not, in terms of the time to reach low-dose corticosteroid treatment ( p = 0.002), the presence of subacute cutaneous findings ( p = 0.007), and the presence of proteinuria ( p = 0.002). Both of the groups were under similar treatment approaches. However, the number of patients being treated with corticosteroids at the last visit was found to be significantly higher in patients who achieved LLDAS-50 ( p<0.001). Conclusion Targeting LLDAS in jSLE, even with long-term, low-dose corticosteroid use, seems to be an achievable goal in clinical practice.

scholarly journals Lupus Low Disease Activity State (LLDAS) attainment discriminates responders in a systemic lupus erythematosus trial: post-hoc analysis of the Phase IIb MUSE trial of anifrolumab

2018 ◽  
Vol 77 (5) ◽  
pp. 706-713 ◽  
Author(s):  
Eric F Morand ◽  
Teodora Trasieva ◽  
Anna Berglind ◽  
Gabor G Illei ◽  
Raj Tummala
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Controlled Trial ◽  
Systemic Lupus ◽  
Low Disease Activity ◽  
Link Type ◽  
Activity State ◽  
Post Hoc

ObjectivesIn a post-hoc analysis, we aimed to validate the Lupus Low Disease Activity State (LLDAS) definition as an endpoint in an systemic lupus erythematosus (SLE) Phase IIb randomised controlled trial (RCT) (MUSE [NCT01438489]) and then utilize LLDAS to discriminate between anifrolumab and placebo.MethodsPatients received intravenous placebo (n=102) or anifrolumab (300 mg, n=99; 1,000 mg, n=104) Q4W plus standard of care for 48 weeks. LLDAS attainment (SLE Disease Activity Index 2000 ≤4 without major organ activity, no new disease activity, Physician’s Global Assessment ≤1, prednisolone ≤7.5 mg/d and standard immunosuppressant dosage tolerance) was assessed. Associations with endpoints and LLDAS attainment differences between treatments were explored.ResultsLLDAS attainment at Week 52 was associated with SLE Responder Index 4 (SRI[4]) and British Isles Lupus Assessment Group–based Composite Lupus Assessment (BICLA) (74/85[87%] and 62/84[74%] were also SRI[4] and BICLA responders, respectively; both nominal p<0.001). Only 74/159 (47%) of SRI(4) and 62/121 (51%) of BICLA responders reached LLDAS.Anifrolumab-treated patients achieved earlier LLDAS, and more spent at least half their observed time in LLDAS (OR vs. placebo; 300 mg: 3.04, 95% CI 1.34 to 6.92, nominal p=0.008; 1,000 mg: 2.17, 95% CI 0.93 to 5.03, nominal p=0.072) vs placebo-treated patients. At Week 52, 17/102 (17%), 39/99 (39%) and 29/104 (28%) of patients on placebo, anifrolumab 300 and 1,000 mg, respectively, attained LLDAS (OR vs. placebo; 300 mg: 3.41, 95% CI 1.73 to 6.76, p<0.001; 1,000 mg: 2.03, 95% CI 1.01 to 4.07, nominal p=0.046).ConclusionsLLDAS attainment represents a clinically meaningful SLE outcome measure, and anifrolumab is associated with more patients who met LLDAS criteria versus placebo. These data support LLDAS as an SLE RCT endpoint.Trial registration numberNCT1438489; Post-results.

Evaluation of coagulation disorders by thromboelastography in children with systemic lupus erythematosus

Lupus ◽  
2018 ◽  
Vol 28 (2) ◽  
pp. 181-188 ◽  
Author(s):  
Z Li ◽  
J Xiao ◽  
H Song ◽  
Q Chen ◽  
H Han ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Maximum Amplitude ◽  
Disease Activity Index ◽  
Systemic Lupus ◽  
Significant Difference ◽  
Coagulation Status ◽  
Α Angle

Background The coagulation status of patients with systemic lupus erythematosus (SLE) is quite complicated, and there are currently no simple efficient methods for its evaluation. We explored the feasibility of thromboelastography (TEG) for this purpose. Methods Paediatric SLE patients were divided into different groups based on Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores. TEG parameters were compared between patients and healthy controls (HCs) and in patients by level of disease activity. Six patients treated with pulse methylprednisolone were also analysed before and after treatment. Results Thirty-nine children with SLE were enrolled, one of whom had bleeding and three of whom had thrombosis. The four TEG tracings of these four children were different. The TEG parameters of the patients (except the four children mentioned above) showed hypercoagulability, shortened R and K times, increased α-angle and maximum amplitude (MA), decreased LY30 and increased clot index (CI) compared with the parameters of the HCs ( P < 0.05). With respect to disease activity, patients with higher SLEDAI scores showed more obvious hypercoagulability with shortened R and K times and increased α-angle and CI ( P < 0.05). Furthermore, there was a negative correlation between both the R time and K time and SLEDAI scores ( r = –0.435, P < 0.01 and r  =  –0.572, P  < 0.001, respectively) and a positive correlation between both α-angle and CI and SLEDAI scores ( r = 0.581, P  < 0.001 and r  =  0.544, P  < 0.01, respectively). No significant difference in coagulation status was found between pre- and post-pulse therapy. Conclusions Compared with the HCs, paediatric SLE patients showed hypercoagulability caused by increased coagulation and decreased fibrinolysis. These coagulation changes were associated with disease activity. TEG could be a potential tool for evaluating the coagulation status of children with SLE.

scholarly journals High disease activity status suggests more severe disease and damage accrual in systemic lupus erythematosus

2020 ◽  
Vol 7 (1) ◽  
pp. e000372
Author(s):  
Rachel Koelmeyer ◽  
Hieu Tri Nim ◽  
Mandana Nikpour ◽  
Ying B Sun ◽  
Amy Kao ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Disease Severity ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Severe Disease ◽  
High Disease Activity ◽  
Physician Global Assessment ◽  
Systemic Lupus ◽  
Damage Accrual

ObjectiveDisease severity in SLE is an important concept related to disease activity, treatment burden and prognosis. We set out to evaluate if high disease activity status (HDAS), based on ever attainment of a Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) disease activity score of ≥10, is an indicator for disease severity in SLE.MethodsUsing prospectively collected data, we assessed the association of HDAS with sociodemographic and disease characteristics and adverse clinical outcomes using logistic regression or generalised estimating equations.ResultsOf 286 patients with SLE, who were observed for a median (range) of 5.1 years (1–10.8 years), 43.7% experienced HDAS at least once during the observational period. Autoantibody positivity, particularly anti-dsDNA and anti-Sm positivity, were associated with increased likelihood of HDAS. Age ≥45 years at diagnosis was associated with reduced likelihood of HDAS (p=0.002). Patients with HDAS had higher Physician Global Assessment score (>1: OR 8.1, p<0.001) and were more likely to meet criteria for flare (mild/moderate flare: OR 4.4, p<0.001; severe flare: OR 17.2, p<0.001) at the time of experiencing HDAS. They were also more likely to have overall higher disease activity, as defined by time-adjusted mean SLEDAI-2K score in the highest quartile (OR 11.7, 95% CI 5.1 to 26.6; p>0.001), higher corticosteroid exposure (corticosteroid dose in highest quartile: OR 7.7, 95% CI 3.9 to 15.3; p<0.001) and damage accrual (OR 2.3, 95% CI 1.3 to 3.9; p=0.003) when compared with non-HDAS patients.ConclusionsHDAS is associated with more severe disease, as measured by higher disease activity across time, corticosteroid exposure and damage accrual. The occurrence of HDAS may be a useful prognostic marker in the management of SLE.

scholarly journals Salivary anti-nuclear antibody (ANA) mirrors serum ANA in systemic lupus erythematosus

2022 ◽  
Vol 24 (1) ◽  
Author(s):  
Ting Zhang ◽  
Yong Du ◽  
Qingqing Wu ◽  
Hao Li ◽  
Thao Nguyen ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Point Of Care ◽  
Disease Activity Index ◽  
Enzyme Linked Immunosorbent Assay ◽  
Physician Global Assessment ◽  
Healthy Controls ◽  
Systemic Lupus

Abstract Objectives To assay salivary anti-nuclear antibody (ANA) and its isotypes in patients with systemic lupus erythematosus (SLE) and to investigate relevant clinical associations. Methods Saliva samples were collected from SLE patients and assayed for salivary ANA using immunofluorescence (IF). Isotypes of salivary ANA, including IgG-ANA, IgA-ANA, and IgM-ANA, were quantified using enzyme-linked immunosorbent assay. The correlations between clinical parameters and levels of salivary ANA and isotypes were evaluated. Results Salivary ANA IF intensities were significantly higher in SLE patients than in healthy controls, irrespective of SLE patient disease activity, and strongly correlated with serum ANA titers. Salivary ANA was detected in 67.14% of SLE patients and 10.00% of healthy controls (p < 0.001). Among ANA-positive samples, 80.85% exhibited a nuclear ANA pattern, and 42.55% exhibited a cytoplasmic ANA pattern. Salivary IgG-ANA, IgA-ANA, and IgM-ANA levels, as assayed by ELISA, were significantly increased in both active and less active SLE patients compared with healthy controls, and levels of each isotype were significantly correlated with serum ANA titer. Salivary IgM-ANA levels correlated with the physician global assessment (PGA), SLE disease activity index (SLEDAI), and negatively with serum C3 and C4. Salivary IgG-ANA also correlated with erythrocyte sedimentation rate (ESR), SLEDAI, and negatively with serum C3. Conclusion Salivary ANA levels correlate with serum ANA titer, and salivary IgM-ANA and IgG-ANA correlate variably with PGA, SLEDAI, ESR and complement levels. These findings underscore the potential of using salivary ANA and ANA isotypes as surrogates for serum ANA, particularly for future point-of-care applications since saliva is easier to obtain than blood.

FRI0184 ATTRIBUTION OF NEUROPSYCHIATRIC MANIFESTATIONS TO SYSTEMIC LUPUS ERYTHEMATOSUS IN POLISH COHORT OF PATIENTS WITH THE USE OF THE ITALIAN MODEL

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 675.1-676
Author(s):  
K. Pawlak-Bus ◽  
W. Schmidt ◽  
P. Leszczynski
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Disease Onset ◽  
Damage Index ◽  
Physician Global Assessment ◽  
Systemic Lupus ◽  
American College Of Rheumatology ◽  
Italian Model

Background:Distinguishing primary NPSLE (neuropsychiatric systemic lupus erythematosus) from secondary causes remains challenging (1). Attribution models were developed in order to aim clinicians in correct classification of NPSLE cases (2).Objectives:To investigate the prevalence of primary NPSLE manifestations assigned with Italian model of attribution (2).Methods:We retrospectively assessed clinical details of 164 patients with SLE classified with 2012 SLICC (Systemic Lupus International Collaborating Clinics) classification criteria, 21 were excluded due to incomplete information. Data was gathered with a questionnaire comprising demographics, medical history, laboratory results (concentrations of antibodies against double stranded DNA – anti-dsDNA, complement components C3 and C4), disease activity measured with Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and Physician Global Assessment (PGA) and damage determined with SLICC/ACR (American College of Rheumatology) Damage Index (SDI). Neuropsychiatric manifestations were categorized in accordance with 1999 ACR glossary and attribution of manifestations was performed with the use of Italian model with the score ≥7 out of 10 points enabling assignment to primary NPSLE group (2). Statistical analysis was conducted with Statistica v.13.3 using Mann-Whitney U, chi-square and Fisher exact test.Results:We encountered 155 NP manifestations in our cohort and 52 (34%) were attributed to SLE. Characteristics of the study groups are presented in Table 1. Exact manifestations and their attribution rates are presented on Graph 1. Patients with attributable NPSLE were younger, had earlier disease onset, presented higher disease activity, lower damage accrual without taking NP damage into account and more often had increased anti-dsDNA serum concentration.Table 1.Demographic and laboratory characteristics with disease activity and damage of the study groups, N(%) or mean(±SD).CharacteristicPatients with attributed NPSLE manifestationsPatients without attributed NPSLE manifestationsPatients34 (23.8%)109 (76.2%)Sex, female30 (88.2%)102 (93.6%)Age (years)37.6 (±11.7)44.3 (±13.9)*Age of disease onset (years)32.5 (±11.4)37.6 (±12.6)*Disease duration (years)5.1 (±4.1)6.8 (±5.6)SLEDAI-2K29.2 (±10.7)12.2 (±8.1)*patients with clinically active disease (defined as SLEDAI-2K≥6 in clinical manifestations)34 (100%)93 (85.3%)*SLEDAI-2K without NP manifestations14.8 (±8.4)11.0 (±6.7)*PGA2.1 (±1.0)1.2 (±1.0)*SDI0.5 (±0.8)0.7 (±1.1)SDI without NP damage0.3 (±0.6)0.7 (±1.1)*low C3/C4 complement component concentration in serum21 (61.8%)55 (50.4%)elevated anti-dsDNA autoantibody concentration in serum27 (79.4%)55 (50.4%)*NPSLE – neuropsychiatric systemic lupus erythematosus, SLEDAI-2K – Systemic Lupus Erythematosus Disease Activity Index version 2000, PGA – physician global assessment, SDI – SLICC/ACR (Systemic Lupus International Collaborating Clinics/American College of Rheumatology) Damage Index*p<0,05, Mann-Whitney U, χ2or Fisher’s exact test, as appropriateConclusion:Primary NP manifestations in patients with SLE occur mainly in young patients with high disease activity. Cerebrovascular disease, seizures, psychosis and cranial neuropathy are most frequent primary NPSLE manifestations.References:[1]The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum. 1999;42(4):599–608.[2]Bortoluzzi A, Scirè CA, Bombardieri S, Caniatti L, Conti F, De Vita S, et al. Development and validation of a new algorithm for attribution of neuropsychiatric events in systemic lupus erythematosus. Rheumatol Oxf Engl. 2015;54(5):891–8.Disclosure of Interests:None declared

Clinical Remission and Low Disease Activity Outcomes Over 10 Years in Systemic Lupus Erythematosus

2019 ◽  
Vol 71 (6) ◽  
pp. 822-828 ◽  
Author(s):  
Konstantinos Tselios ◽  
Dafna D. Gladman ◽  
Zahi Touma ◽  
Jiandong Su ◽  
Nicole Anderson ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Clinical Remission ◽  
Systemic Lupus ◽  
Low Disease Activity
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