Predicting flares in patients with stable systemic lupus erythematosus

Cho, Jiacai; Lahiri, Manjari; Teoh, Lay Kheng; Dhanasekaran, Preeti; Cheung, Peter; Lateef, Aisha

doi:10.1016/j.semarthrit.2019.01.001

Cited by 13 publications

(12 citation statements)

References 29 publications

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“…The clinical manifestations, serologic findings and treatment of the cohort had been described in other publications. 15 Briefly, the most common manifestations were leukopenia (68.1%), arthritis (59.5%) and non-scarring alopecia (40%). Anti-nuclear antibody was positive in 94.8%, and anti-double stranded DNA was positive in 90.5%, 90% were treated with HCQ and 76.7% were on maintenance immunosuppression (azathioprine, mycophenolate mofetil, calcineurin inhibitors, methotrexate, leflunomide, cyclophosphamide, belimumab, or rituximab).…”

Section: Resultsmentioning

confidence: 99%

Differential impact of disease activity and damage on health-related quality of life in patients with systemic lupus erythematosus

Riaz

Shen

Lateef

et al. 2022

Lupus

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Background To study the association between disease activity, disease-related organ damage and health-related quality of life (HRQoL) among Asian patients with systemic lupus erythematosus (SLE). Methods We prospectively recruited adult SLE patients from a single tertiary center and followed them three-monthly. We recorded the SLE Disease Activity Index 2000 (SLEDAI-2K) at each visit. SLICC-ACR damage index (SDI) and HRQoL (Medical Outcomes Survey Short Form 36 (SF-36)) were recorded annually. We evaluated the association between SLEDAI-2K and SDI with SF-36 physical (PCS) and mental (MCS) component scores using linear mixed effect models. Results We studied 198 patients, comprising Chinese, Malays and Indians. The mean (SD) age at enrollment was 47.1 (12.5) years. The baseline median (IQR) SLEDAI-2k was 2 (0–4). While the mean PCS improved significantly in the second and third year, MCS was unchanged. In the multivariable mixed model analysis, SDI, but not SLEDAI-2k, was significantly associated with poorer PCS (estimate of coefficient (SE) −0.81 (0.29), p < .01). Conversely, SLEDAI-2k, but not SDI, was negatively associated with MCS (estimate of coefficient (SE) −0.36 (0.17), p = .04). Conclusion In this cohort of multi-ethnic Asian SLE patients, disease activity is associated with poorer mental, but not physical, HRQoL; whereas disease-related damage is associated with poorer physical, but not mental HRQoL. Our findings suggest a need to differentially approach the impaired HRQoL in SLE patients at different phases of disease; possibly by treating disease activity in patients with impaired mental HRQoL and addressing disease-related damage in patients with impaired physical functioning.

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Section: Resultsmentioning

confidence: 99%

Differential impact of disease activity and damage on health-related quality of life in patients with systemic lupus erythematosus

Riaz

Shen

Lateef

et al. 2022

Lupus

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“…Although several studies have assessed the prognostic impact of serum anti-dsDNA levels in clinically quiescent SLE (Table 1), their interpretation is hampered by heterogeneity in the detection assay, definition of abnormal/high concentrations and duration of patient follow-up (Supplementary Table S6). 24,42,43,45,46,[50][51][52][53] Nonetheless, an increased incidence of flares (up to threefold) has been reported for patients at clinical remission who display high/increasing anti-dsDNA, especially high-avidity autoantibodies. 25,42,51,52 Accordingly, in a retrospective study of inactive SLE patients, addition of high anti-dsDNA to low C3 or C4 measurements enhanced the specificity for flare prediction (from 93.3% to 97.8% and from 41.9% to 71.0%, respectively).…”

Section: Anti-dsdna Levels At Clinical Remission and Risk Of Flaresmentioning

confidence: 99%

“…A number of studies have determined the flare predictive value of composite serological activity, defined as low C3 and/or low C4 and/or high anti-dsDNA levels, without reporting on individual serological markers. 41,50,55,[57][58][59] As an example, in a cohort of 152 SLE patients with stable/inactive disease who were followed for a median 31.5 months, C3 and/or C4 hypocomplementemia at baseline visit was linked to increased risk for severe relapses (multivariable HR 2.91; 95% CI 1.34-6.40). 50 Likewise, persistence of abnormal serology despite clinically inactive disease has been associated with increased and/or earlier incidence of relapses in patients with SLE 41,50,[57][58][59] and lupus nephritis.…”

Section: Composite Serological Activity and Serological Activity Asse...mentioning

confidence: 99%

“…41,50,55,[57][58][59] As an example, in a cohort of 152 SLE patients with stable/inactive disease who were followed for a median 31.5 months, C3 and/or C4 hypocomplementemia at baseline visit was linked to increased risk for severe relapses (multivariable HR 2.91; 95% CI 1.34-6.40). 50 Likewise, persistence of abnormal serology despite clinically inactive disease has been associated with increased and/or earlier incidence of relapses in patients with SLE 41,50,[57][58][59] and lupus nephritis. 55 We also identified studies that evaluate the prognostic effect of serological activity not at a predetermined timepoint but during the disease course after controlling for confounding factors such as clinical activity or background treatment (Supplementary Table S7).…”

Section: Composite Serological Activity and Serological Activity Asse...mentioning

confidence: 99%

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The association between lupus serology and disease outcomes: A systematic literature review to inform the treat-to-target approach in systemic lupus erythematosus

Kostopoulou

Ugarte‐Gil

Pons-Éstel³

et al. 2022

Lupus

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Introduction Serological markers such as anti-double stranded (ds)DNA antibodies and complement fractions C3/C4, are integral components of disease activity assessment in patients with systemic lupus erythematosus (SLE). However, it remains uncertain whether treatment should aim at restoration of serological abnormalities. Objectives To analyze and critically appraise the literature on the prognostic impact of active lupus serology despite clinical disease quiescence. Methods A systematic literature review was performed in PubMed and EMBASE using the PICOT(S) (population, index, comparator, outcome(s), timing, setting) system to identify studies evaluating the association of serum anti-dsDNA, C3 and C4 levels assessed at the time of clinical remission or during the disease course, against the risk for impending flares and organ damage. Risk of bias was determined by the Quality in Prognosis Studies and ROB2 tools for observational and randomized controlled studies, respectively. Results Fifty-three studies were eligible, the majority having moderate (70.6%) or high (11.8%) risk of bias and not adequately controlling for possible confounders. C3 hypocomplementemia during stable/inactive disease was associated with increased risk (2.0 to 3.8-fold) for subsequent flare in three out of seven relevant studies. Three out of four studies reported a significant effect of C4 hypocomplementemia on flare risk, including one study in lupus nephritis (likelihood ratio-positive 12.0). An increased incidence of flares (2.0 to 2.8-fold) was reported in 11 out of 16 studies assessing the prognostic effect of high anti-dsDNA, and similarly, the majority of studies yielded significant relationships with renal flares. Six studies examined the effect of combined (rather than individual) serological activity, confirming the increased risk (2.0 to 2.7-fold) for relapses. No consistent association was found with organ damage. Conclusion Notwithstanding the heterogeneity and risk of bias, existing evidence indicates a modest association between abnormal serology and risk for flare in patients with stable/inactive SLE. These findings provide limited support for inclusion of serology in the treat-to-target approach but rationalize to further investigate their prognostic implications especially in lupus nephritis.

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“…They include age, disease duration, remission duration, high anti-dsDNA and hypocomplementaemia. [5][6][7] These factors were assessed in the interaction analysis of the CORTICOLUP study. To answer more specifically to the comment of Mousavi et al, demographic classifications such as 'African-American, Caucasians or Hispanics', although requested by some health authorities, are non-relevant in France and other parts of the word.…”

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confidence: 99%

Response to: ‘Comments on the article: "Withdrawal of low-dose prednisone in SLE patients with a clinically quiescent disease for more than 1 year: a randomised clinical trial"’ by Mousavi and Taherifard

2020

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Predicting flares in patients with stable systemic lupus erythematosus

Cited by 13 publications

References 29 publications

Differential impact of disease activity and damage on health-related quality of life in patients with systemic lupus erythematosus

Differential impact of disease activity and damage on health-related quality of life in patients with systemic lupus erythematosus

The association between lupus serology and disease outcomes: A systematic literature review to inform the treat-to-target approach in systemic lupus erythematosus

Response to: ‘Comments on the article: "Withdrawal of low-dose prednisone in SLE patients with a clinically quiescent disease for more than 1 year: a randomised clinical trial"’ by Mousavi and Taherifard

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