Evolution of disease burden over five years in a multicenter inception systemic lupus erythematosus cohort

Abstract

Objective. We describe disease activity, damage, and the accrual of key autoantibodies in an inception systemic lupus erythematosus (SLE) cohort. Methods. The Systemic Lupus International Collaborating Clinics (SLICC) International Research Network, comprising 27 centers from 11 countries, has followed an inception cohort of SLE patients yearly according to a standardized protocol. Of these patients, 298 were followed for a minimum of 5 years and constitute the study population. Disease activity was assessed using the SLE Disease Activity Index 2000 (SLEDAI-2K) and damage was assessed using the SLICC/American College of Rheumatology Damage Index (SDI). Antinuclear antibody (ANA), anti-DNA, and anticardiolipin antibody (aCL) levels and lupus anticoagulant were assessed yearly. Descriptive statistics were generated and repeated-measures general linear models were used to evaluate SLEDAI-2K and SDI over time between whites and nonwhites. Results. Of the 298 patients, 87% were women, 55% were white, 12% were African American, 14% were Asian, 16% were Hispanic, and 2% were categorized as "other." At enrollment, the mean age was 35.3 years, the mean SLEDAI-2K score was 5.9, and the mean disease duration was 5.5 months. Mean SLEDAI-2K scores decreased in the first year and then remained low. SLEDAI-2K scores were significantly lower at each year in whites compared to nonwhites. Mean SDI scores increased progressively over 5 years; there was no significant difference between whites and nonwhites. As expected, ANA positivity was high and anti-DNA positivity was relatively low at enrollment, and both increased over 5 years. Although lupus anticoagulant increased slightly over 5 years, aCL positivity did not. Conclusion. Disease activity in newly diagnosed patients decreases over their first 5 years, while damage increases. Antibody positivity ran variable courses over this period.

Characteristics of Polish patients with systemic lupus erythematosus obtained from SESAME registry. Activity of the disease, degree of impairment, and availability of social care

“…The Euro-Lupus study revealed that European patients, the majority of whom are Caucasians, are characterized by a lower frequency of the organ manifestation of SLE compared to patients from Asia, and North and South America [2,6]. This observation was also confirmed by other authors [5,22]. Moreover, the results of another multicenter European study [11] suggest that the activity of SLE can also differ within the same continent.…”

“…At enrollment in the study, patients with a history of obstetric failures did not differ significantly from the remaining women in terms of median SELENA SLEDAI score (8 [4][5][6][7][8][9][10][11][12] vs. 8 [4][5][6][7][8][9][10][11][12] T Ta ab bl le e I IV V. . Prevalence of active involvement or injury of various organs/systems determined on the basis of SLE Activity Index (n = 269)…”

“…Activity of the disease is a basic prognostic factor in SLE patients; also, the side effects of chronic corticosteroid therapy and immunosuppressive treatment should not be undervalued [5]. This is reflected by the necessity of offering specialist medical surveillance to SLE patients, as well as providing them proper access to healthcare resources.…”

The Registry of Systemic Lupus Erythematosus Patients, a Eurasian Cohort (Renaissance)

“…Urowitz и соавт. [29], анализируя ре-зультаты наблюдения 298 больных в течение 5 лет, устано-вили, что высокая активность СКВ отмечается в дебюте; в течение пяти последующих лет она снижается под воз-действием лечения, но за этот период значительно увели-чивается число НП.…”

Belimumab in systemic lupus erythematosus: a perspective review

“…Physicians currently manage SLE with multiple immunosuppressive medications that improve disease control, some of which may also put patients at risk for potential severe side effects from broad immunosuppression [Askanase et al 2009;Carneiro and Sato, 1999]. Moreover, patients may continue to develop disease flares despite what appears to be optimal treatment, requiring escalation of therapy including increased use of corticosteroids and possibly contributing to subsequent long-term damage [Urowitz et al 2012]. Thus, there continues to be a need for more effective and safe options to treat SLE.…”