J M Pego-Reigosa1, Í Rúa-Figueroa2, F J López-Longo3, M Galindo-Izquierdo4, J Calvo-Alén5, A Olivé-Marqués6, V del Campo7, M J García-Yébenes8, E Loza-Santamaría8, R Blanco9, R Melero-González10, P Vela-Casasempere11, T Otón-Sánchez12, E Tomero-Muriel13, E Uriarte-Isacelaya14, M C Fito-Manteca15, M Freire-González16, J Narváez17, A Fernández-Nebro18, A Zea-Mendoza19, J Rosas20, J Carlos Rosas. 1. Rheumatology Department, University Hospital Complex, Instituto de Investigación Biomédica de Vigo, Spain jose.maria.pego.reigosa@sergas.es. 2. Rheumatology Department, Doctor Negrín University Hospital of Gran Canaria, Spain. 3. Rheumatology Department, Gregorio Marañón University Hospital, Madrid, Spain. 4. Rheumatology Department, Doce de octubre University Hospital, Madrid, Spain. 5. Rheumatology Department, Sierrallana Hospital, Torrelavega, Spain. 6. Rheumatology Department, Germans Trías I Pujol University Hospital, Badalona, Spain. 7. Preventive Medicine and Epidemiology Department, University Hospital Complex, Instituto de Investigación Biomédica de Vigo, Spain. 8. Research Unit, Spanish Society of Rheumatology, Madrid, Spain. 9. Rheumatology Department, Marqués de Valdecilla University Hospital, Santander, Spain. 10. Rheumatology Department, University Hospital Complex, Instituto de Investigación Biomédica de Vigo, Spain. 11. Rheumatology Department, University Hospital of Alicante, Alicante, Spain. 12. Rheumatology Department, Hospital of Torrejón, Madrid, Spain. 13. Rheumatology Department, La Princesa University Hospital, Madrid, Spain. 14. Rheumatology Department, Donostia Hospital, San Sebastián, Spain. 15. Rheumatology Department, Hospital of Navarra, Pamplona, Spain. 16. Rheumatology Department, University Hospital Complex of A Coruña, A Coruña, Spain. 17. Rheumatology Department, Bellvitge University Hospital, Barcelona, Spain. 18. Rheumatology Department, University Hospital Carlos Haya, Málaga, Spain. 19. Rheumatology Department, Ramón y Cajal University Hospital, Madrid, Spain. 20. Rheumatology Department, Marina Baixa Hospital, Villajoyosa, and the Spanish Society of Rheumatology Systemic Autoimmune Diseases Study Group (EASSER), Spain.
Abstract
OBJECTIVES: The objectives of this paper are to study the impact of disease activity in a large cohort of patients with systemic lupus erythematosus (SLE) and estimate the rate of response to therapies. METHODS: We conducted a nationwide, retrospective, multicenter, cross-sectional cohort study of 3658 SLE patients. Data on demographics, disease characteristics: activity (SELENA-SLEDAI), damage, severity, hospitalizations and therapies were collected. Factors associated with refractory disease were identified by logistic regression. RESULTS: A total of 3658 patients (90% female; median SLE duration (interquartile range): 10.4 years (5.3-17.1)) were included. At the time of their last evaluation, 14.7% of the patients had moderate-severe SLE (SELENA-SLEDAI score ≥6). There were 1954 (53.4%) patients who were hospitalized for activity at least once over the course of the disease. At some stage, 84.6% and 78.8% of the patients received glucocorticoids and antimalarials, respectively, and 51.3% of the patients received at least one immunosuppressant. Owing to either toxicity or ineffectiveness, cyclophosphamide was withdrawn in 21.5% of the cases, mycophenolate mofetil in 24.9%, azathioprine in 40.2% and methotrexate in 46.8%. At some stage, 7.3% of the patients received at least one biologic. A total of 898 (24.5%) patients had refractory SLE at some stage. Renal, neuropsychiatric, vasculitic, hematological and musculoskeletal involvement, a younger age at diagnosis and male gender were associated with refractory disease. CONCLUSIONS: A significant percentage of patients have moderately-to-severely active SLE at some stage. Disease activity has a big impact in terms of need for treatment and cause of hospitalization. The effectiveness of the standard therapies for reducing disease activity is clearly insufficient. Some clinical features are associated with refractory SLE.
OBJECTIVES: The objectives of this paper are to study the impact of disease activity in a large cohort of patients with systemic lupus erythematosus (SLE) and estimate the rate of response to therapies. METHODS: We conducted a nationwide, retrospective, multicenter, cross-sectional cohort study of 3658 SLEpatients. Data on demographics, disease characteristics: activity (SELENA-SLEDAI), damage, severity, hospitalizations and therapies were collected. Factors associated with refractory disease were identified by logistic regression. RESULTS: A total of 3658 patients (90% female; median SLE duration (interquartile range): 10.4 years (5.3-17.1)) were included. At the time of their last evaluation, 14.7% of the patients had moderate-severe SLE (SELENA-SLEDAI score ≥6). There were 1954 (53.4%) patients who were hospitalized for activity at least once over the course of the disease. At some stage, 84.6% and 78.8% of the patients received glucocorticoids and antimalarials, respectively, and 51.3% of the patients received at least one immunosuppressant. Owing to either toxicity or ineffectiveness, cyclophosphamide was withdrawn in 21.5% of the cases, mycophenolate mofetil in 24.9%, azathioprine in 40.2% and methotrexate in 46.8%. At some stage, 7.3% of the patients received at least one biologic. A total of 898 (24.5%) patients had refractory SLE at some stage. Renal, neuropsychiatric, vasculitic, hematological and musculoskeletal involvement, a younger age at diagnosis and male gender were associated with refractory disease. CONCLUSIONS: A significant percentage of patients have moderately-to-severely active SLE at some stage. Disease activity has a big impact in terms of need for treatment and cause of hospitalization. The effectiveness of the standard therapies for reducing disease activity is clearly insufficient. Some clinical features are associated with refractory SLE.
Authors: Edsaul Emilio Perez-Guerrero; Jorge Ivan Gamez-Nava; Jose Francisco Muñoz-Valle; Ernesto German Cardona-Muñoz; David Bonilla-Lara; Nicte Selene Fajardo-Robledo; Arnulfo Hernan Nava-Zavala; Teresa Arcelia Garcia-Cobian; Ana Rosa Rincón-Sánchez; Jessica Daniela Murillo-Vazquez; David Cardona-Müller; Maria Luisa Vazquez-Villegas; Sylvia Elena Totsuka-Sutto; Laura Gonzalez-Lopez Journal: Clin Exp Med Date: 2017-02-27 Impact factor: 5.057
Authors: Joan T Merrill; Susan Manzi; Cynthia Aranow; Anca Askanase; Ian Bruce; Eliza Chakravarty; Ben Chong; Karen Costenbader; Maria Dall'Era; Ellen Ginzler; Leslie Hanrahan; Ken Kalunian; Joseph Merola; Sandra Raymond; Brad Rovin; Amit Saxena; Victoria P Werth Journal: Lupus Sci Med Date: 2018-03-23
Authors: Beatriz Tejera Segura; Iñigo Rua-Figueroa; Jose Maria Pego-Reigosa; Victor Del Campo; Chris Wincup; David Isenberg; Anisur Rahman Journal: BMJ Open Date: 2019-06-14 Impact factor: 2.692