Ann Rheum Dis 2014 Feb 13
The number of flares patients experience impacts on damage accrual in systemic lupus erythematosus: data from a multiethnic Latin American cohort.
Abstract
Purpose
To determine the association between the number of flares systemic lupus erythematosus (SLE) patients experience and damage accrual, independently of other known risk factors.
Methods
SLE patients (34 centres, nine Latin American countries) with a recent diagnosis (≤2 years) and ≥3 evaluations were studied. Disease activity was ascertained with the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and damage with the SLICC/ACR Damage Index (SDI). Flare was defined as an increase ≥4 points in the SLEDAI between two study visits. An ambidirectional case- crossover design was used to determine the association between the number of flares and damage accrual.
Results
901 patients were eligible for the study; 500 of them (55.5%) experienced at least one flare, being the mean number of flares 0.9 (SD: 1.0). 574 intervals from 251 patients were included in the case-crossover design since they have case and control intervals, whereas, the remaining patients did not. Their mean age at diagnosis was 27.9 years (SD: 11.1), 213 (84.9%) were women. The mean baseline SDI and SLEDAI were 1.3 (1.3) and 13.6 (8.1), respectively. Other features were comparable to those of the entire sample. After adjusting for possible confounding variables, the number of flares, regardless of their severity, was associated with damage accrual (SDI) OR 2.05, 95% CI 1.43 to 2.94, p<0.001 (OR 2.62, 95% CI 1.31 to 5.24, p=0.006 for severe and OR 1.91, 95% CI 1.28 to 2.83, p=0.001 for mild-moderate).
Conclusions
The number of flares patients experience, regardless of their severity, increases the risk of damage accrual, independently of other known risk factors.
Related Questions
How would you approach management of a patient with longstanding history of SLE, but having active psoriasis?
Since methotrexate (MTX) worked well before, I'd revisit other possible ways to use it in ways that minimize GI issues. For example, splitting up oral MTX over 24 hours can help alleviate GI side effects (eg 2.5 mg q 12 hours for 3 doses), yet have greater efficacy due to a larger area under the cu...
What is your approach to practical monitoring of lupus disease activity in clinical practice?
ANSWER TO QUESTION 1:I am so glad I am being asked this question!I use my clinical assessment (or physician global assessment).I generally love the 2023 EULAR SLE management update (Fanouriakis et al., PMID 37827694). However, I disagree with their recommendation that clinicians monitor the SLEDAI (...
Do you ever consider discontinuing hydroxychloroquine in patients with SLE in longstanding remission except in cases of overt toxicity?
I’ll assume that this question is only for SLE patients who are tolerating it well, have been in remission, and are not on steroids or other immunosuppressants (since hydroxychloroquine, HCQ, is safer than all of these).Since very few things in medicine are 100%, the answer must be “yes.” However, 9...
How do you utilize anifrolumab for SLE in your practice?
The answer to this SLE question involves a complex decision-making process. It is such an important question! I apologize in advance for the long answer. I am in the camp of achieving remission in my SLE patients and getting them off prednisone in the safest ways possible (Fanouriakis et al., PMID 3...