OBJECTIVE: SLE has a relapsing-remitting course with disease activity flares over time. This study aims to identify clinical predictors of SLE flares. METHODS: This prospective cohort study over 24 months included all SLE patients on follow-up at one academic lupus clinic. Flare was defined as an increase in SLEDAI-2K score ≥4 points. Baseline clinical and demographic parameters were compared using survival analysis for time-to-flare outcome with univariate log-rank tests. Variables with significant differences were further evaluated as predictors with multivariate Cox regression models adjusting for potential confounding or contributing factors and hazard ratio (HR) calculation. RESULTS: A total of 202 SLE patients were included. Over the follow-up period, 1083 visits were documented and 16.8% of patients presented with flares. In multivariate analysis, the following parameters emerged as flare predictors: SLE diagnosis up to 25 years of age (HR = 2.14, P = 0.03), lupus nephritis previous to baseline visit (HR = 4.78, P < 0.0001) and immunosuppressor treatment for severe SLE (HR = 3.22, P < 0.001). Baseline disease activity, disease duration and treatment with prednisone or HCQ were not predictive factors. CONCLUSION: Patients with an SLE diagnosis before age 25 years, lupus nephritis or immunosuppressor treatment for severe SLE present greater HRs for flares, suggesting the need for tighter clinical monitoring. Current immunosuppressive strategies seem to be inefficient in providing flare prevention.
OBJECTIVE:SLE has a relapsing-remitting course with disease activity flares over time. This study aims to identify clinical predictors of SLE flares. METHODS: This prospective cohort study over 24 months included all SLEpatients on follow-up at one academic lupus clinic. Flare was defined as an increase in SLEDAI-2K score ≥4 points. Baseline clinical and demographic parameters were compared using survival analysis for time-to-flare outcome with univariate log-rank tests. Variables with significant differences were further evaluated as predictors with multivariate Cox regression models adjusting for potential confounding or contributing factors and hazard ratio (HR) calculation. RESULTS: A total of 202 SLEpatients were included. Over the follow-up period, 1083 visits were documented and 16.8% of patients presented with flares. In multivariate analysis, the following parameters emerged as flare predictors: SLE diagnosis up to 25 years of age (HR = 2.14, P = 0.03), lupus nephritis previous to baseline visit (HR = 4.78, P < 0.0001) and immunosuppressor treatment for severe SLE (HR = 3.22, P < 0.001). Baseline disease activity, disease duration and treatment with prednisone or HCQ were not predictive factors. CONCLUSION:Patients with an SLE diagnosis before age 25 years, lupus nephritis or immunosuppressor treatment for severe SLE present greater HRs for flares, suggesting the need for tighter clinical monitoring. Current immunosuppressive strategies seem to be inefficient in providing flare prevention.
Authors: Meghan Angley; Carolyn Drews-Botsch; Tené T Lewis; Martina Badell; S Sam Lim; Penelope P Howards Journal: Arthritis Care Res (Hoboken) Date: 2022-04-05 Impact factor: 5.178
Authors: Paul Chabert; William Danjou; Mehdi Mezidi; Julien Berthiller; Audrey Bestion; Abla-Akpene Fred; Claude Guerin; Laurent Argaud; Vincent Piriou; Eric Bonnefoy-Cudraz; Jean-Jacques Lehot; Jean-Luc Fellahi; Thomas Rimmele; Frederic Aubrun; Jean-Christophe Richard; Laure Gallay; Arnaud Hot Journal: Medicine (Baltimore) Date: 2021-09-03 Impact factor: 1.817
Authors: Celline C Almeida-Brasil; John G Hanly; Murray Urowitz; Ann Elaine Clarke; Guillermo Ruiz-Irastorza; Caroline Gordon; Rosalind Ramsey-Goldman; Michelle Petri; Ellen M Ginzler; D J Wallace; Sang-Cheol Bae; Juanita Romero-Diaz; Mary Anne Dooley; Christine Peschken; David Isenberg; Anisur Rahman; Susan Manzi; Søren Jacobsen; Sam Lim; Ronald F van Vollenhoven; Ola Nived; Andreas Jönsen; Diane L Kamen; Cynthia Aranow; Jorge Sanchez-Guerrero; Dafna D Gladman; Paul R Fortin; Graciela S Alarcón; Joan T Merrill; Kenneth Kalunian; Manuel Ramos-Casals; Kristján Steinsson; Asad Zoma; Anca Askanase; Munther A Khamashta; Ian N Bruce; Murat Inanc; Michal Abrahamowicz; Sasha Bernatsky Journal: Ann Rheum Dis Date: 2021-12-15 Impact factor: 27.973
Authors: Eve M D Smith; Kukatharmini Tharmaratnam; Eslam Al-Abadi; Kate Armon; Kathryn Bailey; Mary Brennan; Coziana Ciurtin; Janet Gardner-Medwin; Kirsty E Haslam; Daniel Hawley; Alice Leahy; Valentina Leone; Gulshan Malik; Zoe McLaren; Clarissa Pilkington; Athimalaipet V Ramanan; Satyapal Rangaraj; Annie Ratcliffe; Philip Riley; Ethan Sen; Arani Sridhar; Nick Wilkinson; Christian M Hedrich; Andrea Jorgensen; Michael W Beresford Journal: Rheumatology (Oxford) Date: 2022-08-03 Impact factor: 7.046