Multicenter lupus register from Argentina, the RELESSAR database: Influence of ethnicity on disease phenotype

Abstract

Objective The objective is to describe the main characteristics of patients with systemic lupus erythematosus (SLE) in Argentina and to examine the influence of ethnicity on the expression of the disease. Patients and methods RELESSAR is a multicentre register carried out by 106 researchers from 67 rheumatologic Argentine centres. It is a cross-sectional study of SLE (1982/1997 ACR) patients. RELESSAR electronic database includes demographic, cumulative SLE manifestations, SELENA-SLEDAI, SLICC-SDI, Katz’s severity and Charlson’s comorbidity indexes and treatment patterns. Results We included 1,610 patients, 91.7% were female with a median age at diagnosis of 28.1 ± 12.8; 96.2% met ≥4 ACR 1982/97 criteria. Frequent manifestations were arthritis (83.5%), malar rash (79.5%), photosensitivity (75.3%), haematological (63.8%) and renal disease (47.4%), antinuclear antibodies (96%), anti-dsDNA (66.5%) and anti-Smith antibodies (29%). The mean Selena-SLEDAI score at last visit was 3.18 (SD 4.3) and mean SDI was 1 (SD 1.3). The accumulated treatments most frequently used were antimalarials (90.4%), corticosteroids (90%), azathioprine (31.8%), intravenous cyclophosphamide (30.2%), mycophenolate mofetil or mycophenolic acid (24.5%), methotrexate (19.3%), belimumab 5.3% and rituximab 5.1%. Refractory lupus was diagnosed in 9.3% of the cases. The main causes of death were lupus activity (25.0%), activity and concomitant infections (25.0%), infections (18.2%), vascular disease (13.6%) and cancer (4.5%). Mortality was associated with higher SLEDAI, Katz, damage indexes and comorbidities. Of the 1610 patients included, 44.6% were Caucasian, 44.5% Mestizo, 8.1% Amerindian and 1.2% Afro-Latin American. Mestizo patients had higher male representation, low socioeconomic status, more inadequate medical coverage, fewer formal years of education and shorter disease duration. Polyadenopathies and Raynaud’s phenomenon were more frequent in Caucasians. In the logistic regression analysis higher damage index (OR 1.28, CI 95% 1.02–1.61, p = 0.03) remained associated to mestizo ethnicity. Conclusions This study represents the largest number of adult patients with SLE studied in Argentina. Caucasian patients were differentiated by having Raynaud’s phenomenon and polyadenopathy more frequently, while patients of Mestizo origin had higher damage indexes.

Active lupus in Argentina: Results of a multicenter and national registry

“…These two groups have already been described in a previous RELESSAR study as being associated with a more disadvantaged socioeconomic position, less medical coverage, fewer years of formal education, a shorter time to diagnosis due to the presentation of a more aggressive disease in comparison with the Caucasian group. 10 Of interest, the use of antimalarials was similar in our two groups as opposed to what has been reported in other studies; this probably reflects the fact that, overall, more than 95% of our patients were receiving these compounds.…”

“…These two groups have already been described in a previous RELESSAR study as being associated with a more disadvantaged socioeconomic position, less medical coverage, fewer years of formal education, a shorter time to diagnosis due to the presentation of a more aggressive disease in comparison with the Caucasian group. 10…”

“…RELESSAR is a multicenter cross-sectional registry being conducted by 106 researchers from 67 Argentinean rheumatology centers; patients were enrolled between January 2015 and March 2019. 10 Accumulated data were obtained from the clinical records of patients with more than one visit at each center.…”

Frecuencia de eventos cardiovasculares en pacientes con lupus eritematoso sistémico. Datos del registro RELESSAR transversal

“…Estudio descriptivo y transversal para el cual se tomaron los pacientes ingresados en el registro RELESSAR transversal 11 . Se describieron las variables sociodemográficas, clínicas del LES, tratamientos instaurados, comorbilidades a través del índice de Charlson, score de actividad (Systemic Lupus Erythematosus Disease Activity Index, SLEDAI) 12 y score de daño (Systemic Lupus International Collaborating Clinics/American College of Rheumatology, SLICC) 13 .…”

Results and prognosis of kidney transplantation in lupus nephritis: Experience of an Argentine center

“…In the Argentine multicenter RELESSAR registry, the prevalence of LN was 42.2%. 2 On the other hand, it has been seen that non-Caucasian origin, male gender, and earlier onset of the disease have been associated with a higher frequency of kidney disease development and worse long-term prognosis. 3 Despite advances in current treatments, LN leads to endstage chronic kidney disease (ESKD) in up to 20% of patients, requiring dialysis or renal transplant (RT).…”