Impact of Early Versus Late Systemic Lupus Erythematosus Diagnosis on Clinical and Economic Outcomes

Oglesby, Alan; Korves, Caroline; Laliberté, François; Dennis, Glynn; Rao, Sapna; Suthoff, Ellison; Wei, R.; Duh, Mei Sheng

doi:10.1007/s40258-014-0085-x

Cited by 77 publications

(81 citation statements)

References 20 publications

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“…A higher percentage of cases than controls was treated with corticosteroids or anti-rheumatic medications (methotrexate and hydroxychloroquine), consistent with the hypothesis that a diagnosis of SLE led to a more aggressive and targeted treatment, possibly improving patient outcome over time [17-19]. …”

Section: Discussionsupporting

confidence: 64%

“…SLE is a frequent diagnosis (20-60%) in patients who evolve over time from undifferentiated CTD to a specific CTD [6], however it may take several years for a definitive diagnosis to be made [15, 16]. On the other hand, early diagnosis and targeted and timely therapy may prevent flares and late organ damage [17], improve quality of life [18], and decrease healthcare utilization and costs [19-21]. …”

Section: Introductionmentioning

confidence: 99%

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The Avise Lupus Test and Cell-bound Complement Activation Products Aid the Diagnosis of Systemic Lupus Erythematosus

Mossell

Goldman

Barken³

et al. 2016

TORJ

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Background:Systemic lupus erythematosus (SLE) is a multifaceted disease, and its diagnosis may be challenging. A blood test for the diagnosis of SLE, the Avise Lupus test, has been recently commercialized and validated in clinical studies.Objectives:To evaluate the use of the Avise Lupus test by community rheumatologists.Methods:The study is a longitudinal, case-control, retrospective review of medical charts. Cases had a positive test result, and controls had a negative result; all patients were anti-nuclear antibodies (ANA) positive but negative for SLE-specific autoantibodies. Features of SLE, diagnosis, and medications at two time points were recorded.Results:Twenty of the 23 cases (87%) and 4 of the 23 controls (17%) were diagnosed with SLE (sensitivity=83%; specificity=86%). More cases than controls (43% vs. 17%) fulfilled 4 American College of Rheumatology (ACR) classification criteria of SLE. Sensitivity of the test was significantly higher than the ACR score (83% vs. 42%, p=0.006). A higher percentage of patients who met the classification criteria had elevated cell-bound complement activation products (CB-CAPs) compared to patients who did not. Anti-rheumatic medications were used in a higher percentage of cases than controls (83% vs. 35% at baseline, p=0.002), suggesting that cases were treated more aggressively early on.Conclusion:A positive Avise Lupus test result aids in formulating a SLE diagnosis when diagnosis based on standard-of-care tests and clinical features may be challenging, and impacts patient management. Prospective studies will be performed to better evaluate the clinical utility of the test and of CB-CAPs as biomarkers of SLE.

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Section: Discussionsupporting

confidence: 64%

Section: Introductionmentioning

confidence: 99%

The Avise Lupus Test and Cell-bound Complement Activation Products Aid the Diagnosis of Systemic Lupus Erythematosus

Mossell

Goldman

Barken³

et al. 2016

TORJ

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“…For example, a Danish cohort of 100 people with lupus nephritis followed for a median of 15 years found that delayed diagnosis and delayed intervention increased risk of progression to end-stage renal failure. (3) Furthermore a US health insurance database study found that diagnosis (defined as date of the first International Classification of Diseases (ICD)-9 code for SLE) delayed more than 6 months from symptom-onset (defined as the second diagnostic code for a symptom of SLE such as malar rash, photosensitivity, arthritis, 5 pleurisy or an ANA test in the 12 months prior to SLE diagnosis) lead to greater flare rates, healthcare utilisation and more insurance claims (4) suggesting that earlier diagnosis may enhance patient outcomes.…”

Section: It Is Not Clear Where Delays Between Symptom-onset and Sle Dmentioning

confidence: 99%

“…An alternative screening test such as a more specific or inexpensive biomarker for SLE during the period of non-specific symptoms and medical visits may enhance early detection. Previous studies have suggested that if diagnosis of SLE could be made earlier patient outcomes could be improved and healthcare costs reduced (3,4). It is hoped that tools such as this model may enable earlier diagnosis of individuals with clinical features suggestive of SLE.…”

Section: Model Validationmentioning

confidence: 99%

Early Clinical Features in Systemic Lupus Erythematosus: Can They Be Used to Achieve Earlier Diagnosis? A Risk Prediction Model

Rees

Doherty

Lanyon

et al. 2017

Arthritis Care & Research

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Arthritis Care & ResearchThis article is protected by copyright. All rights reserved.3 Significance and Innovation• People diagnosed with SLE consult their GP more than twice as frequently as controls on average in the 5 years prior to diagnosis• People diagnosed with SLE consult their GP with clinical features attributable to SLE in the five years preceding diagnosis• This suggests that there are potential opportunities to reduce diagnostic delay for people with SLE in primary care.• A risk prediction model has been developed and validated which may be used to identify people at risk of SLE in future clinical practice.

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“…However, evidence from one tertiary care center suggests that only 60% of patients with SLE meet ACR criteria [5]; apparently, patients with early signs or limited disease are excluded by this tool. The development of improved diagnostic biomarkers facilitating the early detection of SLE is of utmost importance, not only because this would allow for rapid treatment and subsequent prevention of organ damage, but also because of the positive economic impact of early diagnosis [6]. …”

Section: Introductionmentioning

confidence: 99%

Diagnostic and prognostic tests in systemic lupus erythematosus

Wahezi

Putterman

2017

Best Practice & Research Clinical Rheumatology

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Systemic lupus erythematous (SLE) is a chronic autoimmune inflammatory disease characterized by autoantibodies directed against numerous self-nuclear antigens. Due to the heterogeneous nature of lupus, it has been challenging to identify markers that are sensitive and specific enough for its diagnosis and monitoring. However, with the sequencing of the human genome, rapid development of high throughput approaches has allowed for a better understanding of the etiopathogenesis of complex diseases, including SLE. Here we will present a review of the latest advancements in biomarker discovery during the ‘omics’ era, using these novel technologies, for assisting in the diagnosis and prognosis of patients with SLE.

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Impact of Early Versus Late Systemic Lupus Erythematosus Diagnosis on Clinical and Economic Outcomes

Abstract: Patients diagnosed with SLE sooner may experience lower flare rates, less healthcare utilization, and lower costs from a commercially insured population perspective. This finding needs to be further explored within the context of background SLE disease activity.

Cited by 77 publications

References 20 publications

The Avise Lupus Test and Cell-bound Complement Activation Products Aid the Diagnosis of Systemic Lupus Erythematosus

The Avise Lupus Test and Cell-bound Complement Activation Products Aid the Diagnosis of Systemic Lupus Erythematosus

Early Clinical Features in Systemic Lupus Erythematosus: Can They Be Used to Achieve Earlier Diagnosis? A Risk Prediction Model

Diagnostic and prognostic tests in systemic lupus erythematosus

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