G J Pons-Estel1, L D Aspey2, G Bao3, B A Pons-Estel4, D Wojdyla5, V Saurit6, A Alvarellos6, F Caeiro6, M J Haye Salinas6, E I Sato7, E R Soriano8,9, L T L Costallat10, O Neira11, A Iglesias-Gamarra12, G Reyes-Llerena13, M H Cardiel14, E M Acevedo-Vásquez15, R Chacón-Díaz16, C Drenkard17. 1. Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Barcelona, Spain. 2. Department of Dermatology, Emory School of Medicine, Atlanta, USA. 3. Division of Rheumatology, Emory School of Medicine, Atlanta, USA. 4. Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Argentina. 5. GLADEL Consultant, Universidad Nacional de Rosario, Rosario, Argentina. 6. Servicio de Reumatología, Hospital Privado, Córdoba, Argentina. 7. Departamento de Medicina, Universidade Federal da São Paulo (UNIFESP), São Paulo, Brazil. 8. Sección de Reumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. 9. Fundación Dr Pedro M Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina. 10. Divisao de Reumatologia, Universidade Estadual de Campinas, Campinas, Brazil. 11. Sección de Reumatología, Hospital del Salvador, Facultad de Medicina, Universidad de Chile, Santiago, Chile. 12. Facultad de Medicina, Universidad Nacional de Colombia, Bogota, Colombia. 13. Servicio Nacional de Reumatología, Centro de Investigaciones Médico Quirúrgicas (CIMEQ), La Habana, Cuba. 14. Centro de Investigación Clínica de Morelia, Morelia, México. 15. Servicio de Reumatología, Hospital Nacional 'Guillermo Almenara Irigoyen', School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Perú. 16. Servicio de Reumatología, Hospital Universitario, Caracas, Venezuela. 17. Division of Rheumatology, Emory School of Medicine, Atlanta, USA cdrenka@emory.edu.
Abstract
OBJECTIVES: The objective of this study was to examine whether early discoid lupus erythematosus (DLE) would be a protective factor for further lupus nephritis in patients with systemic lupus erythematosus (SLE). METHODS: We studied SLE patients from GLADEL, an inception longitudinal cohort from nine Latin American countries. The main predictor was DLE onset, which was defined as physician-documented DLE at SLE diagnosis. The outcome was time from the diagnosis of SLE to new lupus nephritis. Univariate and multivariate survival analyses were conducted to examine the association of DLE onset with time to lupus nephritis. RESULTS: Among 845 GLADEL patients, 204 (24.1%) developed lupus nephritis after SLE diagnosis. Of them, 10 (4.9%) had DLE onset, compared to 83 (12.9%) in the group of 641 patients that remained free of lupus nephritis (hazard ratio 0.39; P = 0.0033). The cumulative proportion of lupus nephritis at 1 and 5 years since SLE diagnosis was 6% and 14%, respectively, in the DLE onset group, compared to 14% and 29% in those without DLE (P = 0.0023). DLE onset was independently associated with a lower risk of lupus nephritis, after controlling for sociodemographic factors and disease severity at diagnosis (hazard ratio 0.38; 95% confidence interval 0.20-0.71). CONCLUSIONS: Our data indicate that DLE onset reduces the risk of further lupus nephritis in patients with SLE, independently of other factors such as age, ethnicity, disease activity, and organ damage. These findings have relevant prognosis implications for SLE patients and their clinicians. Further studies are warranted to unravel the biological and environmental pathways associated with the protective role of DLE against renal disease in patients with SLE.
OBJECTIVES: The objective of this study was to examine whether early discoid lupus erythematosus (DLE) would be a protective factor for further lupus nephritis in patients with systemic lupus erythematosus (SLE). METHODS: We studied SLEpatients from GLADEL, an inception longitudinal cohort from nine Latin American countries. The main predictor was DLE onset, which was defined as physician-documented DLE at SLE diagnosis. The outcome was time from the diagnosis of SLE to new lupus nephritis. Univariate and multivariate survival analyses were conducted to examine the association of DLE onset with time to lupus nephritis. RESULTS: Among 845 GLADEL patients, 204 (24.1%) developed lupus nephritis after SLE diagnosis. Of them, 10 (4.9%) had DLE onset, compared to 83 (12.9%) in the group of 641 patients that remained free of lupus nephritis (hazard ratio 0.39; P = 0.0033). The cumulative proportion of lupus nephritis at 1 and 5 years since SLE diagnosis was 6% and 14%, respectively, in the DLE onset group, compared to 14% and 29% in those without DLE (P = 0.0023). DLE onset was independently associated with a lower risk of lupus nephritis, after controlling for sociodemographic factors and disease severity at diagnosis (hazard ratio 0.38; 95% confidence interval 0.20-0.71). CONCLUSIONS: Our data indicate that DLE onset reduces the risk of further lupus nephritis in patients with SLE, independently of other factors such as age, ethnicity, disease activity, and organ damage. These findings have relevant prognosis implications for SLEpatients and their clinicians. Further studies are warranted to unravel the biological and environmental pathways associated with the protective role of DLE against renal disease in patients with SLE.
Authors: Scott A Jenks; Chungwen Wei; Regina Bugrovsky; Aisha Hill; Xiaoqian Wang; Francesca M Rossi; Kevin Cashman; Matthew C Woodruff; Laura D Aspey; S Sam Lim; Gaobin Bao; Cristina Drenkard; Ignacio Sanz Journal: Ann Rheum Dis Date: 2021-06-03 Impact factor: 27.973
Authors: Bernardo A Pons-Estel; Eloisa Bonfa; Enrique R Soriano; Mario H Cardiel; Ariel Izcovich; Federico Popoff; Juan M Criniti; Gloria Vásquez; Loreto Massardo; Margarita Duarte; Leonor A Barile-Fabris; Mercedes A García; Mary-Carmen Amigo; Graciela Espada; Luis J Catoggio; Emilia Inoue Sato; Roger A Levy; Eduardo M Acevedo Vásquez; Rosa Chacón-Díaz; Claudio M Galarza-Maldonado; Antonio J Iglesias Gamarra; José Fernando Molina; Oscar Neira; Clóvis A Silva; Andrea Vargas Peña; José A Gómez-Puerta; Marina Scolnik; Guillermo J Pons-Estel; Michelle R Ugolini-Lopes; Verónica Savio; Cristina Drenkard; Alejandro J Alvarellos; Manuel F Ugarte-Gil; Alejandra Babini; André Cavalcanti; Fernanda Athayde Cardoso Linhares; Maria Jezabel Haye Salinas; Yurilis J Fuentes-Silva; Ana Carolina Montandon de Oliveira E Silva; Ruth M Eraso Garnica; Sebastián Herrera Uribe; Diana Gómez-Martín; Ricardo Robaina Sevrini; Rosana M Quintana; Sergio Gordon; Hilda Fragoso-Loyo; Violeta Rosario; Verónica Saurit; Simone Appenzeller; Edgard Torres Dos Reis Neto; Jorge Cieza; Luis A González Naranjo; Yelitza C González Bello; María Victoria Collado; Judith Sarano; Soledad Retamozo; María E Sattler; Rocio V Gamboa-Cárdenas; Ernesto Cairoli; Silvana M Conti; Luis M Amezcua-Guerra; Luis H Silveira; Eduardo F Borba; Mariana A Pera; Paula B Alba Moreyra; Valeria Arturi; Guillermo A Berbotto; Cristian Gerling; Carla A Gobbi; Viviana L Gervasoni; Hugo R Scherbarth; João C Tavares Brenol; Fernando Cavalcanti; Lilian T Lavras Costallat; Nilzio A Da Silva; Odirlei A Monticielo; Luciana Parente Costa Seguro; Ricardo M Xavier; Carolina Llanos; Rubén A Montúfar Guardado; Ignacio Garcia de la Torre; Carlos Pineda; Margarita Portela Hernández; Alvaro Danza; Marlene Guibert-Toledano; Gil Llerena Reyes; Maria Isabel Acosta Colman; Alicia M Aquino; Claudia S Mora-Trujillo; Roberto Muñoz-Louis; Ignacio García Valladares; María Celeste Orozco; Paula I Burgos; Graciela V Betancur; Graciela S Alarcón Journal: Ann Rheum Dis Date: 2018-07-25 Impact factor: 19.103