Causes of death in systemic lupus erythematosus, long‐term followup of an inception cohort

Ward, Michael M.; Pyun, Elise; Studenski, Stephanie

doi:10.1002/art.1780381016

Cited by 181 publications

(103 citation statements)

References 35 publications

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“…In our study, SMR was higher in cohort 97acr (3.00) than in cohort 82acr (1.88). Mortality in SLE has been described as having a bimodal pattern, with an early mortality peak mainly due to active disease and a later peak associated to cardiovascular complications 44,45 . Given the disease duration of only 19 months at death in the 97acr cohort, this increased SMR can likely represent the first peak in the mortality curve.…”

Section: Discussionmentioning

confidence: 99%

The Influence of the 1997 Updated Classification Criteria for Systemic Lupus Erythematosus: Epidemiology, Disease Presentation, and Patient Management

Eilertsen¹,

Becker-Merok²,

Nossent³

2009

J Rheumatol

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ABSTRACT. Objective. The 1997 update of the American College of Rheumatology classification criteria (ACR97) for systemic lupus erythematosus (SLE) has not been validated. We determined to what extent their introduction influenced the epidemiology and clinical characteristics of the disease in northern Norway. Methods. Annual incidence and point-prevalence rates, clinical manifestations, and outcome were determined in an inception cohort of patients with SLE in northern Norway, included between 1996 and 2006, using ACR97 criteria (97acr). These findings were compared with a cohort from the same area enrolled 1978-1995 using the 1982 revised criteria ACR82 (82acr). Results. The mean annual incidence of SLE was 3.00 for cohort 97acr (n = 58) versus 2.63 for cohort 82acr (n = 81) (p = 0.5). All patients in the 97acr cohort also fulfilled the 1982 criteria; however, significantly fewer patients presented with discoid rash [odds ratio (OR) 0.31)], arthritis (OR 0.24), renal (OR 0.28) or hematological disorder (OR 0.27), and significantly more with anti-dsDNA (OR 2.57) and antiphospholipid antibodies (OR 27.9). Initial treatment with intravenous pulse methylprednisolone (OR 9.23), azathioprine (OR 6.32), and low-dose aspirin (OR 20.9) was increased in cohort 97acr. Five-(95.2%) and 10-year survival (91.9%) rates were also improved for cohort 97acr. Conclusion. The ACR97 criteria set has construct validity compared to the ACR82 criteria set. SLE incidence remains unchanged in northern Norway, but a significant reduction of renal disease and further improvements in survival rates occurred simultaneously with increased serological surveillance with ELISA-based assays and early immunosuppressive and anticoagulant therapy.

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Section: Discussionmentioning

confidence: 99%

The Influence of the 1997 Updated Classification Criteria for Systemic Lupus Erythematosus: Epidemiology, Disease Presentation, and Patient Management

Eilertsen¹,

Becker-Merok²,

Nossent³

2009

J Rheumatol

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“…In several cohort studies, it was found that atherosclerotic cardiovascular and cerebrovascular diseases are more common causes of late deaths than active SLE itself (1,(4)(5)(6). More recent studies have demonstrated that subclinical coronary heart disease and carotid plaque were present in a significantly higher proportion of SLE patients than in age-and sex-matched control subjects with similar risk factors (7,8).…”

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confidence: 99%

Incidence and risk factors of thromboembolism in systemic lupus erythematosus: A comparison of three ethnic groups

Mok

Tang

et al. 2005

Arthritis & Rheumatism

220

173

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Objective. To compare the incidence and risk factors for thromboembolic events in systemic lupus erythematosus (SLE) patients of different ethnic backgrounds.Methods. SLE patients who were newly diagnosed or were referred within 6 months of diagnosis between 1996 and 2002 were prospectively followed up for the occurrence of thromboembolic events. Cumulative hazard and risk factors for thromboembolism were evaluated and compared among patients of different ethnic origins.Results. We studied 625 patients who fulfilled the American College of Rheumatology criteria for SLE (89% women): 258 Chinese, 140 African Americans, and 227 Caucasians. The mean ؎ SD age at SLE diagnosis was 35.7 ؎ 14 years. After a followup of 3,094 patientyears, 48 arterial events and 40 venous events occurred in 83 patients. The overall incidence of arterial and venous thromboembolism was 16/1,000 patient-years and 13/1,000 patient-years, respectively. The cumulative hazard of arterial events at 60 months after the diagnosis of SLE was 8.5%, 8.1%, and 5.1% for the Chinese, African Americans, and Caucasians, respectively. The corresponding cumulative risk of venous events was 3.7%, 6.6%, and 10.3%, respectively (P ‫؍‬ 0.008 for Chinese versus Caucasians, by log rank test). Smoking, obesity, antiphospholipid antibodies, and use of antimalarial agents and exogenous estrogens were less frequent in the Chinese patients. In Cox regression models, low levels of high-density lipoprotein (HDL) cholesterol, Chinese ethnicity, oral ulcers, and serositis predicted arterial events, whereas male sex, low levels of HDL cholesterol, antiphospholipid antibodies, non-Chinese ethnicity, obesity, renal disease, and hemolytic anemia predicted venous events.Conclusion. There are ethnic differences in the incidence of arterial and venous thromboembolism in patients with SLE that cannot be fully explained by the clinical factors studied. Further evaluation of other genetic and immunologic factors is warranted.Premature atherosclerosis is a major cause of mortality and late morbidity in patients with systemic lupus erythematosus (SLE) (1-3). In several cohort studies, it was found that atherosclerotic cardiovascular and cerebrovascular diseases are more common causes of late deaths than active SLE itself (1,(4)(5)(6). More recent studies have demonstrated that subclinical coronary heart disease and carotid plaque were present in a significantly higher proportion of SLE patients than in age-and sex-matched control subjects with similar risk factors (7,8). The etiology of accelerated atherosclerosis in SLE is multifactorial and cannot be fully explained by traditional risk factors (9).Compared with individuals without SLE, the risk of myocardial infarction in SLE patients is 2-50 times higher, and the risk of stroke is 2-10 times higher (2,9,10). The prevalence of symptomatic coronary heart disease in SLE patients has been reported to be 6-20%, The Hopkins Lupus Cohort is supported by NIH grants R01-AR-43727 and M01-RR-00052 (to the outpatient Clinical Research Center).

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“…Premature atherosclerosis has recently been recognized as an important cause of morbidity and mortality in SLE (2), and coronary artery disease accounts for up to 30% of all deaths in some reported series (3). Classic risk factors for cardiovascular disease in SLE appear to be similar to those in the general population, but specific factors such as steroid treatment, chronic inflammation, and renal disease could account for enhanced atheroma formation (4).…”

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confidence: 99%

Antibodies to high‐density lipoprotein and β₂‐glycoprotein I are inversely correlated with paraoxonase activity in systemic lupus erythematosus and primary antiphospholipid syndrome

Alves

Ames

Donohue

et al. 2002

Arthritis & Rheumatism

187

129

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Objective. To determine the prevalence of antihigh-density lipoprotein (anti-HDL) antibodies and to establish a possible relationship between anti-HDL, anticardiolipin antibodies (aCL), anti-␤ 2 -glycoprotein I (anti-␤ 2 GPI), and paraoxonase (PON) activity in patients with systemic lupus erythematosus (SLE) and primary antiphospholipid syndrome (APS).Methods. Thirty-two patients with SLE and 36 with primary APS were enrolled in a cross-sectional study. Twenty age-and sex-matched healthy subjects were used as controls. Serum levels of IgG and IgM aCL, anti-␤ 2 GPI, and antiprothrombin antibodies and IgG anti-HDL were measured by enzyme-linked immunosorbent assay. Total cholesterol, HDL cholesterol, HDL 2 , and HDL 3 were determined by standard enzymatic techniques. PON activity was assessed by quantification of nitrophenol formation, and total antioxidant capacity (TAC) by chemiluminescence.Results. Levels of total HDL, HDL 2 , and HDL 3 were reduced in patients with SLE compared with controls (mean ؎ SD 0.51 ؎ 0.3, 0.37 ؎ 0.3, and 0.14 ؎ 0.1 mmoles/liter, respectively, versus 1.42 ؎ 0.9, 1.01 ؎ 0.7, and 0.40 ؎ 0.2). Patients with SLE and primary APS had higher titers of anti-HDL antibodies and lower PON activity than controls. In the SLE population, PON activity was inversely correlated with IgG anti-HDL titers (r ‫؍‬ ؊0.48, P ‫؍‬ 0.005) whereas in the primary APS population, IgG anti-␤ 2 GPI was the only independent predictor of PON activity (r ‫؍‬ ؊0.483, P ‫؍‬ 0.003). In the SLE group, anti-HDL was inversely correlated with TAC (r ‫؍‬ ؊0.40, P < 0.02), and PON activity was positively correlated with TAC (r ‫؍‬ 0.43, P < 0.02).Conclusion. IgG anti-HDL and IgG anti-␤ 2 GPI antibodies are associated with reduced PON activity in patients with SLE and primary APS. Since the physiologic role of PON is to prevent low-density lipoprotein oxidation with its attendant atherogenic effects, the reported interactions may be relevant to the development of atherosclerosis in SLE and primary APS.

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Causes of death in systemic lupus erythematosus, long‐term followup of an inception cohort

Cited by 181 publications

References 35 publications

The Influence of the 1997 Updated Classification Criteria for Systemic Lupus Erythematosus: Epidemiology, Disease Presentation, and Patient Management

The Influence of the 1997 Updated Classification Criteria for Systemic Lupus Erythematosus: Epidemiology, Disease Presentation, and Patient Management

Incidence and risk factors of thromboembolism in systemic lupus erythematosus: A comparison of three ethnic groups

Antibodies to high‐density lipoprotein and β₂‐glycoprotein I are inversely correlated with paraoxonase activity in systemic lupus erythematosus and primary antiphospholipid syndrome

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Causes of death in systemic lupus erythematosus, long‐term followup of an inception cohort

Cited by 181 publications

References 35 publications

The Influence of the 1997 Updated Classification Criteria for Systemic Lupus Erythematosus: Epidemiology, Disease Presentation, and Patient Management

The Influence of the 1997 Updated Classification Criteria for Systemic Lupus Erythematosus: Epidemiology, Disease Presentation, and Patient Management

Incidence and risk factors of thromboembolism in systemic lupus erythematosus: A comparison of three ethnic groups

Antibodies to high‐density lipoprotein and β2‐glycoprotein I are inversely correlated with paraoxonase activity in systemic lupus erythematosus and primary antiphospholipid syndrome

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Antibodies to high‐density lipoprotein and β₂‐glycoprotein I are inversely correlated with paraoxonase activity in systemic lupus erythematosus and primary antiphospholipid syndrome