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1.
Mymensingh Med J ; 28(4): 797-807, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31599243

RESUMO

The tubercular infections (TB) are most important cause of morbidity and mortality in SLE patients worldwide and an ongoing alarming issue in developing countries. This observational study was carried out in SLE clinic of BSMMU, Bangladesh from April 2015 to March 2016 after taking ethical clearance from IRB to observe frequency and risk factors of tuberculosis in SLE patients. A total 230 consecutive SLE patients were enrolled. Patient's clinical characteristics, history of TB, SLEDAI score, cumulative doses of immunosuppressants were recorded. In clinically suspected cases tuberculin test, chest X-ray, spot and first morning sputum for AFB, Gene Xpert MTB/RIF, ADA, FNAC and tissue biopsy were requested along with routine tests. The multivariate logistic regressions were done for risk factors. Out of 230 patients TB was documented in 23 (10%) subjects. Among TB cases 16 women and 7 men. Mean age of patients was 27.56±9.3 years and mean duration of occurrence of tuberculosis after SLE diagnosis was 4.26±5.38 years. Present and past TB was observed in 10 and 13 cases respectively. Cough, night sweat, fever, anorexia were significant presenting features. Fifteen and 8 patients had pulmonary and extra pulmonary TB respectively. Organ involvement pattern was multi-lobed lungs, joint, meninges, lymph nodes, peritoneum and pleura. High disease activity disease (SLEDAI score >12), total intake of prednisolone >1000mg were risk factors of TB. Frequency of tuberculosis was high (10%) in SLE patients. Awareness including prevention of flares and judicious use of steroids might reduce the rate of TB.


Assuntos
Lúpus Eritematoso Sistêmico/epidemiologia , Tuberculose/epidemiologia , Adolescente , Adulto , Bangladesh/epidemiologia , Feminino , Humanos , Masculino , Escarro , Tuberculose Pulmonar , Adulto Jovem
2.
Autoimmun Rev ; 18(11): 102395, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31520800

RESUMO

BACKGROUND: According to criteria for the classification of Systemic Lupus Erythematosus (SLE), thrombocytopenia is one of the disease-defining hematologic disorders. Since the recognition of Antiphospholipid Syndrome (APS), thrombocytopenia was frequently reported but several studies yielded contradictory results on the association between aPL-positivity and thrombocytopenia. METHODS: We evaluated the role of antiphospholipid antibodies (aPL) and different aPL profiles on the risk of thrombocytopenia in SLE patients by conducting a systematic review and meta-analysis of available literature from 1987 to 2018. MEDLINE, EMBASE, Cochrane Library, congress abstracts, and reference lists of eligible studies were searched. Studies were selected if they included SLE patients with descriptions of the exposure to aPL and the outcomes (thrombocytopenia). Two reviewers extracted study characteristics and outcome data from published reports. Estimates were pooled using random effects models and sensitivity analyses. We followed the PRISMA guidelines for all stages of the meta-analysis. PROSPERO registration number: CRD42015027378. RESULTS: From 3278 articles identified, 53 studies met inclusion criteria amounting to 9019 SLE patients. Twenty-nine percent of aPL-positive SLE patients had thrombocytopenia compared to 15.1% in aPL-negative SLE patients. The overall pooled Odds Ratio (OR) for thrombocytopenia in aPL positive patients was 2.48 (95% CI; 2.10-2.93). Among aPL subtypes, the risk of thrombocytopenia was highest for lupus anticoagulant (OR = 3.56 [95% CI, 2.57-5.25]), IgM anti-ß2-GP1(OR = 2.87 [95% CI; 2.57-5.25]), IgG and IgM anticardiolipin antibodies (OR = 1.87 [95% CI; 1.52-2.31] and OR = 1.73 [95% CI; 1.36-2.19] respectively). CONCLUSIONS: The occurrence of thrombocytopenia was strongly determined by various aPL profiles in SLE patients. While the association between IgM antibodies and other APS manifestations including thrombosis is debated, IgM isotypes are helpful in the risk stratification of thrombocytopenia in SLE.


Assuntos
Anticorpos Antifosfolipídeos/imunologia , Lúpus Eritematoso Sistêmico/epidemiologia , Trombocitopenia/epidemiologia , Estudos de Casos e Controles , Estudos de Coortes , Estudos Transversais , Humanos , Lúpus Eritematoso Sistêmico/imunologia , Fatores de Risco , Trombocitopenia/imunologia
3.
Autoimmun Rev ; 18(11): 102393, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31520802

RESUMO

Systemic lupus erythematosus (SLE) is a complex disease with variable presentations, course and prognosis. Published studies present conflicting data regarding the impact of cigarette smoking on SLE risk, disease activity, clinical manifestations and treatment response. We performed a comprehensive literature search using Medline, EMBASE and the Cochrane Collaboration database, and hand searches of relevant bibliographies. All original studies investigating the relationship between smoking and SLE were included in TABALUP. Two investigators systematically extracted data from the relevant studies. When possible, meta-analyses were performed. The meta-analysis of 9 case-controls studies show an increased risk of SLE in current-smokers compared to never-smokers (OR: 1.49 [95%CI: 1.06-2.08]), while former-smokers were not at increased risk of SLE. Data on passive smoking remains scarce and controversial. Pooled analysis studies did not find an over-risk of anti-dsDNA, anti-Sm or anti-SSA positivity according to smoking status. Tobacco smoking significantly reduced the therapeutic effectiveness of hydroxychloroquine in cutaneous lesions (pooled OR 0.53; 95%CI: 0.305-0.927) and belimumab in systemic manifestations (HR 0.10; 95% CI 0.02-0.43). In addition to its usual adverse effects, cigarette smoking is a risk factor of SLE and negatively influences the course of the disease and its treatment. We believe that smoking cessation should be one of the main target of physicians treating SLE patients.


Assuntos
Lúpus Eritematoso Sistêmico/epidemiologia , Fumar Tabaco/epidemiologia , Estudos de Casos e Controles , Estudos de Coortes , Humanos , Hidroxicloroquina/uso terapêutico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Fatores de Risco
4.
MMWR Morb Mortal Wkly Rep ; 68(38): 819-824, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31557148

RESUMO

Rheumatic diseases are a leading cause of chronic, noncancer pain. Systemic lupus erythematosus (SLE) is a chronic autoimmune rheumatic disease characterized by periodic flares that can result in irreversible target organ damage, including end-stage renal disease. Both intermittent and chronic musculoskeletal pain, as well as fibromyalgia (considered a centralized pain disorder due to dysregulation of pain processing in the central nervous system), are common in SLE. Opioids are generally not indicated for long-term management of musculoskeletal pain or centralized pain (fibromyalgia) because of lack of efficacy, safety issues ranging from adverse medical effects to overdose, and risk for addiction (1,2). In this study of 462 patients with SLE from the population-based Michigan Lupus Epidemiology and Surveillance (MILES) Cohort and 192 frequency-matched persons without SLE, nearly one third (31%) of SLE patients were using prescription opioids during the study period (2014-2015), compared with 8% of persons without SLE (p<0.001). Among the SLE patients using opioids, 97 (68%) were using them for >1 year, and 31 (22%) were concomitantly on two or more opioid medications. Among SLE patients, those using the emergency department (ED) were approximately twice as likely to use prescription opioids (odds ratio [OR] = 2.1; 95% confidence interval [CI] = 1.3-3.6; p = 0.004). In SLE, the combined contributions of underlying disease and adverse effects of immunosuppressive and glucocorticoid therapies already put patients at higher risk for some known adverse effects attributed to long-term opioid use. Addressing the widespread and long-term use of opioid therapy in SLE will require strategies aimed at preventing opioid initiation, tapering and discontinuation of opioids among patients who are not achieving treatment goals of reduced pain and increased function, and consideration of nonopioid pain management strategies.


Assuntos
Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Vigilância da População , Adulto , Idoso , Estudos de Coortes , Serviço Hospitalar de Emergência , Feminino , Humanos , Lúpus Eritematoso Sistêmico/epidemiologia , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Manejo da Dor/métodos , Risco
5.
Autoimmun Rev ; 18(9): 102359, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31323362

RESUMO

OBJECTIVE: The aim of this study is to compare the frequency of remission, according to DORIS definitions, of inception patients from two European SLE cohorts, with a special focus on the differences between the therapeutic schemes of both Units. METHODS: Inception patients enrolled after 2000 from the longitudinal Cruces Lupus Cohort (CC) and Bordeaux Lupus Cohort (BC) were included. The main endpoint was the achievement of clinical remission on treatment (ClinROnT). ClinROnT was assessed yearly from the 1st until the 5th year following the diagnosis of SLE. RESULTS: 173 patients, 92 CC and 81 BC, were studied. The clinical presentation of both cohorts was similar, with no significant differences in the mean SLEDAI score at diagnosis (6.6 vs. 8.1, p = 0.06). Patients from CC were treated more frequently with hydroxychloroquine (mean 57 vs. 43 months), methotrexate (24% vs. 11%) and pulse methyl-prednisolone (42% vs. 26%), and received lower doses of oral prednisone (average dose during the follow up 2.3 vs. 7.2 mg/d, p < 0.001). Patients in CC were more likely to achieve ClinROnT at year one, 84% vs. 43% (p < 0.001). Prolonged ClinROnT during the 5 years of follow up was more frequent in CC: 70% vs. 28%, p < 0.001. Patients in CC were also more likely to achieve ClinROnT after controlling for baseline SLEDAI (adjusted HR 1.69, 95%CI 1.21-2.35) and for the presenting clinical manifestations (adjusted HR 1.72, 95% CI 1.2-2.4). CONCLUSION: Prolonged ClinROnT was achievable by using a therapeutic regime consisting of lower doses of oral prednisone and maximizing the use of hydroxychloroquine, pulse methyl-prednisolone and methotrexate.


Assuntos
Imunossupressores/administração & dosagem , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Prednisona/administração & dosagem , Administração Oral , Adulto , Estudos de Coortes , Intervalo Livre de Doença , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , França/epidemiologia , Glucocorticoides/administração & dosagem , Humanos , Hidroxicloroquina/administração & dosagem , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/epidemiologia , Masculino , Metotrexato/administração & dosagem , Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade , Indução de Remissão , Espanha/epidemiologia , Resultado do Tratamento , Adulto Jovem
6.
Mayo Clin Proc ; 94(8): 1436-1443, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31303426

RESUMO

OBJECTIVE: To assess the prevalence of atherosclerotic cardiovascular disease (ASCVD) and its individual phenotypes of coronary artery disease (CAD), peripheral artery disease (PAD), and cerebrovascular disease by age and sex in a large US cohort of hospitalized patients with systemic lupus erythematosus (SLE). METHODS: A nested case-control study of adults with and without SLE was conducted from the January 1, 2008, through December 31, 2014, National Inpatient Sample. Hospitalized patients with SLE were matched (1:3) by age, sex, race, and calendar year to hospitalized patients without SLE. The prevalences of CAD, PAD, and cerebrovascular disease were evaluated, and associations with SLE were determined after adjustment for common cardiovascular risk factors. RESULTS: Among the 252,676 patients with SLE and 758,034 matched patients without SLE, the mean age was 51 years, 89% were women, and 49% were white. Patients with SLE had a higher prevalence of ASCVD vs those without SLE (25.6% vs 19.2%; OR, 1.45; 95% CI, 1.44-1.47; P<.001). After multivariable adjustment, SLE was associated with a greater odds of ASCVD (adjusted odds ratio [aOR], 1.46; 95% CI, 1.41-1.51). The association between SLE and ASCVD was observed in women and men and was attenuated with increasing age. Also, SLE was associated with increased odds of CAD (aOR, 1.42; 95% CI, 1.40-1.44), PAD (aOR, 1.25; 95% CI, 1.22-1.28), and cerebrovascular disease (aOR, 1.68; 95% CI, 1.65-1.71). CONCLUSION: In hospitalized US patients, SLE was associated with increased ASCVD prevalence, which was observed in both sexes and was greatest in younger patients.


Assuntos
Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/epidemiologia , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/epidemiologia , Doença Arterial Periférica/epidemiologia , Adulto , Distribuição por Idade , Estudos de Casos e Controles , Comorbidade , Intervalos de Confiança , Feminino , Seguimentos , Humanos , Pacientes Internados/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Doença Arterial Periférica/diagnóstico , Prevalência , Estudos Retrospectivos , Índice de Gravidade de Doença , Distribuição por Sexo , Fatores de Tempo , Estados Unidos
7.
Medicine (Baltimore) ; 98(28): e16420, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305460

RESUMO

Systemic lupus erythematosus (SLE) is known to be one of the leading causes of end-stage renal disease (ESRD). The aim of this study was to estimate the incidence rate of ESRD and the risk for progression to ESRD in SLE patients compared to the general population.A total of 21,253 SLE patients were extracted from the Korean National Health Insurance Service database between 2008 and 2013. Age-and sex-matched controls (n = 106,265) were randomly sampled in a 5:1 ratio from non-SLE individuals. Both cohorts were followed up for development of ESRD until 2015.During the median 7.53 years of follow-up, 533 (2.51%) cases of ESRD were newly developed in SLE patients and 145 (0.14%) cases in matched controls (incidence rate: 4.075 and 0.219 per 1000 person-year, respectively). SLE patients were at higher risk for ESRD development compared to matched controls (hazard ratio [HR], 9.84; 95% confidence interval [CI] 8.10-11.96) after multivariate adjustment. In subgroup analysis, the risk for ESRD was higher in male (HR, 7.76; 95% CI 5.07-11.90) and female patients with SLE (HR, 10.48; 95% CI 8.41-13.07) than in matched controls. When analyzed by age group, the younger the age, the higher the risk of ESRD versus non-SLE matched controls; this result was also significant after adjustment. In subgroup analysis according to comorbidities, the SLE group had a significantly higher risk of ESRD than the non-SLE group in almost all subgroups.SLE was associated with an increased incidence of ESRD.


Assuntos
Falência Renal Crônica/epidemiologia , Falência Renal Crônica/etiologia , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/epidemiologia , Adulto , Idoso , Estudos de Coortes , Comorbidade , Progressão da Doença , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Risco , Adulto Jovem
8.
Lupus ; 28(9): 1031-1050, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31299878

RESUMO

Is systemic lupus erythematosus (SLE) is occurring more frequently now than in decades past? Despite improvements in the identification of patients with SLE, the development of new classification criteria, and the recognition of several biomarkers used alone or in combination, the diagnosis of SLE is still a challenge for clinicians, in particular early in the course of the disease, which makes the recognition of secular trends difficult to ascertain. Lacking a uniform definition of preclinical lupus or incomplete lupus, it is difficult to predict accurately which patients would go on to develop SLE. We will briefly review the classification criteria, early or preclinical SLE, the epidemiology of SLE, antinuclear antibodies-negative SLE, and biomarkers of the disease.


Assuntos
Anticorpos Antinucleares/imunologia , Biomarcadores/metabolismo , Lúpus Eritematoso Sistêmico/epidemiologia , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/imunologia
9.
Lupus ; 28(10): 1197-1204, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31299880

RESUMO

BACKGROUND: The aim of this study was to explore the association between tumor necrosis factor superfamily number 4 (TNFSF4) rs1234315, rs2205960 polymorphisms and systemic lupus erythematosus (SLE) susceptibility. METHODS: A meta-analysis was performed on the association between rs1234315 and rs2205960 polymorphisms and SLE by allelic contrast, additive model, recessive model and dominant model. RESULTS: Regarding rs1234315 polymorphism, a total of five studies were included (6575 cases, 14,798 controls). Meta-analysis showed significant associations between the T allele and SLE in overall subjects and Asians (OR = 1.310, 95%CI: 1.104-1.553, p = 0.002; OR = 1.458, 95%CI: 1.328-1.602, p < 0.001). With respect to the rs2205960 polymorphism, significant associations between the T allele and SLE were found in all subjects (OR = 1.333, 95%CI: 1.254-1.418, p < 0.001), Asians (OR = 1.407, 95%CI: 1.345-1.471, p < 0.001) and Europeans (OR = 1.254, 95%CI: 1.185-1.328, p < 0.001). Results also showed significant associations between the additive model and SLE in all subjects and Asians (OR = 1.934, 95%CI: 1.500-2.494, p < 0.001; OR = 1.882, 95%CI: 1.318-2.689, p = 0.001). Furthermore, we detected significant associations between the dominant model and SLE in all subjects and Asians (OR = 1.421, 95%CI: 1.239-1.629, p < 0.001; OR = 1.297, 95%CI: 1.083-1.555, p = 0.005). Significant associations were found between the recessive model and SLE in overall subjects and Asians (OR = 1.677, 95%CI: 1.312-2.144, p < 0.001; OR = 1.751, 95%CI: 1.235-2.483, p = 0.002). CONCLUSION: The present study suggested that TNFSF4 rs1234315 and rs2205960 polymorphisms were associated with SLE susceptibility.


Assuntos
Predisposição Genética para Doença , Lúpus Eritematoso Sistêmico/genética , Ligante OX40/genética , Alelos , Grupo com Ancestrais do Continente Asiático/genética , Grupo com Ancestrais do Continente Europeu/genética , Humanos , Lúpus Eritematoso Sistêmico/epidemiologia , Polimorfismo de Nucleotídeo Único
10.
Pan Afr Med J ; 32: 181, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31312295

RESUMO

Introduction: The term anti-nuclear antibody (ANA) is used to define a large group of autoantibodies which specifically bind to nuclear elements. Although healthy individuals may also have ANA positivity, the measurement of ANA is generally used in the diagnosis of autoimmune disorders. However, various studies have shown that ANA testing may be overused, especially in pediatrics clinics. Our aim was to investigate the reasons for antinuclear antibody (ANA) testing in the general pediatrics and pediatric rheumatology clinics of our hospital and to determine whether ANA testing was ordered appropriately by evaluating chief complaints and the ultimate diagnoses of these cases. Methods: The medical records of pediatric patients in whom ANA testing was performed between January 2014 and June 2016 were retrospectively evaluated. Subjects were grouped according to the indication for ANA testing and ANA titers. Results: ANA tests were ordered in a total of 409 patients during the study period, with 113 positive ANA results. The ANA test was ordered mostly due to joint pain (50% of the study population). There was an increased likelihood of autoimmune rheumatic diseases (ARDs) with higher ANA titer. The positive predictive value of an ANA test was 16% for any connective tissue disease and 13% for lupus in the pediatric setting. Conclusion: in the current study, more than one-fourth of the subjects were found to have ANA positivity, while only 15% were ultimately diagnosed with ARDs. Our findings underline the importance of an increased awareness of correct indications for ANA testing.


Assuntos
Anticorpos Antinucleares/sangue , Doenças Autoimunes/diagnóstico , Doenças do Tecido Conjuntivo/diagnóstico , Doenças Reumáticas/diagnóstico , Adolescente , Instituições de Assistência Ambulatorial , Doenças Autoimunes/epidemiologia , Doenças Autoimunes/imunologia , Criança , Pré-Escolar , Doenças do Tecido Conjuntivo/epidemiologia , Doenças do Tecido Conjuntivo/imunologia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/imunologia , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Doenças Reumáticas/epidemiologia , Doenças Reumáticas/imunologia , Turquia/epidemiologia
11.
Clin Exp Rheumatol ; 37(5): 879-884, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31287401

RESUMO

OBJECTIVES: We set out to determine the causes of death in childhood-onset systemic lupus erythematosus (cSLE). METHODS: The medical records of children aged <18 years who were diagnosed with SLE from 1985 to 2016 in the Division of Nephrology, Department of Paediatrics, Faculty of Medicine, Prince of Songkla University, Thailand, were reviewed. RESULTS: There was a total of 331 patients, 272 girls and 59 boys, of whom 77 (23.3%) died, 28.6% within the first year after diagnosis. Only 29 medical records of the 77 confirmed-death patients were available for evaluation of cause of death; 7 boys and 22 girls, with a mean age at presentation of 10.9±3.1 years. The mean follow-up duration was 4.6±3.7 (range 0.2-12.6) years. The major cause of death was sepsis (n=13 patients with 15 identified organisms, which were Acinetobacter baumannii (9), Escherichia coli (3), Candida albicans (2) and Aspergillosis (1)), followed by acute respiratory distress syndrome (ARDS) (6), severe heart condition (3), acute kidney injury (AKI) (2), chronic kidney disease (CKD) (2) and intracranial haemorrhage (1). Conditions at the time of death were sepsis (25), pneumonia (16), AKI (15), bleeding disorders (11), neurological complications (10), ARDS (10), CKD (4), AKI in addition to CKD (3). CONCLUSIONS: The cause of death in cSLE is usually multi-factorial and it is difficult to assign a single dominant cause. Sepsis was the most common cause of death and, together with sepsis-related organ failure, was the most common condition at the time of death. The most common organism was Acinetobacter baumannii.


Assuntos
Lúpus Eritematoso Sistêmico , Sepse/mortalidade , Adolescente , Causas de Morte , Criança , Doenças Transmissíveis/epidemiologia , Doenças Transmissíveis/mortalidade , Comorbidade , Feminino , Humanos , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/mortalidade , Masculino , Estudos Retrospectivos , Sepse/epidemiologia , Centros de Atenção Terciária , Tailândia
12.
Lupus ; 28(10): 1273-1278, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31354025

RESUMO

INTRODUCTION: Registries are essential to keep track of systemic lupus erythematosus (SLE) epidemiology and to provide better care to patients. The Colombian Ministry of Health has adopted a registry (SISPRO) to gather comprehensive information coming from the Colombian health system, which provides close to universal coverage (around 95%). The information collected from SISPRO is available for scientific analysis. OBJECTIVES: We used data collected by SISPRO to estimate prevalence and specific characteristics of patients with SLE registered from January 2012 to December 2016. METHODS: This is a descriptive epidemiological study using the International Statistical Classification of Diseases and Related Health Problems as search terms related to SLE, based on SISPRO data. Criteria for diagnosis are not explicitly addressed in each individual case. RESULTS: National records report 41,804 patients with a diagnosis of SLE for an estimated prevalence of 91.9/100,000 subjects (based on a total population of 47,663,162), being more frequent in women (89% cases). When adjusted, female and male prevalences were 204.3 and 20.2 per 100,000 (ratio 10.1) with a 7.9:1 female:male ratio, and were highest in the 45-49-year age group. CONCLUSIONS: This is the first study that describes demographic characteristics of SLE in Colombia, with useful information for decision makers. It also suggests a similar prevalence to other countries.


Assuntos
Lúpus Eritematoso Sistêmico/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Colômbia/epidemiologia , Feminino , Humanos , Lactente , Lúpus Eritematoso Sistêmico/diagnóstico , Masculino , Pessoa de Meia-Idade , Prevalência , Sistema de Registros , Distribuição por Sexo , Adulto Jovem
13.
Lupus ; 28(7): 906-913, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31159650

RESUMO

OBJECTIVES: Systemic lupus erythematosus (SLE) is a chronic, multisystemic, immune-mediated disorder associated with a substantial hospitalization risk. As a comparatively rare disease, there is a sparsity of research examining the burden of hospital admission in the contemporary era. We aim to describe national trends in hospitalization rates in England between 1998 and 2015 for SLE, using rheumatoid arthritis (RA) and general population rates as comparison cohorts for benchmarking. METHODS: Hospital admission rates, emergency and day-case admission rates, length of stay and bed days used were calculated using finished consultant episodes from Hospital Episode Statistics data. Cochran-Armitage tests and linear regression quantified the significance and magnitude of change over time. RESULTS: SLE admissions increased from 8.97 to 9.04 per 100,000 (p < 0.001) between 1998 and 2015. By comparison, RA admissions rose from 71.0 to 171.6 per 100,000 (p < 0.001) and all-cause admissions rose from 24,500 to 34,500 per 100,000 (p < 0.001). Emergency admissions decreased both for SLE (2.6 to 1.2 per 100,000) and RA (12.8 to 4.4 per 100,000) despite all-cause emergency admissions increasing from 9400 to 10,300 per 100,000. SLE and RA day cases increased, whilst median length of stay decreased. Despite increasing admissions, total bed days for SLE and RA fell by 60% and 90%, respectively. CONCLUSIONS: Whilst all-cause emergency admissions rose in the general population, those for SLE fell. Length of stay and bed days reduced and day cases increased, probably reflecting changing therapeutic strategies. This potentially large reduction in resource utilization warrants consideration when assessing the impact of new therapies.


Assuntos
Artrite Reumatoide/terapia , Recursos em Saúde/tendências , Hospitalização/tendências , Lúpus Eritematoso Sistêmico/terapia , Adulto , Artrite Reumatoide/epidemiologia , Serviço Hospitalar de Emergência/tendências , Inglaterra/epidemiologia , Recursos em Saúde/estatística & dados numéricos , Humanos , Tempo de Internação/tendências , Modelos Lineares , Estudos Longitudinais , Lúpus Eritematoso Sistêmico/epidemiologia , Pessoa de Meia-Idade , Admissão do Paciente/tendências
14.
Clin Exp Rheumatol ; 37(5): 791-796, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31172923

RESUMO

OBJECTIVES: Systemic lupus erythematosus is associated with an increased risk of developing an endocrine disease. These endocrinopathies can closely mimic SLE symptoms ranging from fatigue to renal involvement but the treatment is often very different. METHODS: A careful review of the PubMed and MEsH databases linking endocrine disease to SLE was performed. A retrospective analysis of the 708 SLE patient cohort at University College London Hospital (UCLH) has been completed. They have been followed for at least one year from 1978 to 2017. In our study, we report how often these endocrine diseases are identified in lupus patients compared to the general population and whether these patients with both diseases had a poorer prognosis. We have attempted to establish if the endocrine diseases develop before or after the lupus diagnosis. RESULTS: The literature search produced some conflicting results. 708 SLE patients were included in our study. We found 67 endocrine diseases in 55 different patients of our cohort. The most common endocrinopathy was hypothyroidism (5.22%) followed by type 2 diabetes mellitus (1.41%) and hyperthyroidism (1.41%). Other endocrine disorders also identified were type 1 diabetes mellitus (0.42%) and hyperparathyroidism (0.70%). In terms of mortality, lupus patients with concomitant endocrine disease had similar outcomes compared to those without endocrine disease (16.36% died vs. 15.16%). In general terms, these endocrine diseases were developed after the lupus diagnosis. We found that the 21.8% of our SLE plus endocrinopathy patients also have an increased risk of developing a second endocrine disease. CONCLUSIONS: We report concomitant endocrine disease in 7.76 % of our 708 SLE cohort followed, for almost 40 years, at UCLH. These patients have increased liability to develop a second endocrine disease, but overall there is no difference in terms of mortality between SLE patients with or without an endocrinopathy. It is important to capture endocrine diseases in SLE as the symptoms they cause may mimic SLE features, but require quite distinct treatment.


Assuntos
Doenças do Sistema Endócrino/epidemiologia , Lúpus Eritematoso Sistêmico , Comorbidade , Diabetes Mellitus Tipo 2/epidemiologia , Humanos , Hipertireoidismo/epidemiologia , Hipotireoidismo/epidemiologia , Londres , Lúpus Eritematoso Sistêmico/epidemiologia , Estudos Retrospectivos
15.
Lupus ; 28(8): 977-985, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31189414

RESUMO

Antimalarials (AMs) reduce disease activity and improve survival in patients with systemic lupus erythematosus (SLE), but studies have reported low AM prescribing frequencies. Using a real-world electronic health record cohort, we examined if patient or provider characteristics impacted AM prescribing. We identified 977 SLE cases, 94% of whom were ever prescribed an AM. Older patients and patients with SLE nephritis were less likely to be on AMs. Current age (odds ratio = 0.97, p < 0.01) and nephritis (odds ratio = 0.16, p < 0.01) were both significantly associated with ever AM use after adjustment for sex and race. Of the 244 SLE nephritis cases, only 63% were currently on AMs. SLE nephritis subjects who were currently prescribed AMs were more likely to be followed by a rheumatologist than a nephrologist and less likely to have undergone dialysis or renal transplant (both p < 0.001). Non-current versus current SLE nephritis AM users had higher serum creatinine (p < 0.001), higher urine protein (p = 0.05), and lower hemoglobin levels (p < 0.01). As AMs reduce disease damage and improve survival in patients with SLE, our results demonstrate an opportunity to target future efforts to improve prescribing rates among multi-specialty providers.


Assuntos
Antimaláricos/uso terapêutico , Registros Eletrônicos de Saúde/estatística & dados numéricos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Nefrite Lúpica/tratamento farmacológico , Adulto , Idoso , Estudos de Coortes , Creatinina/sangue , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Lúpus Eritematoso Sistêmico/epidemiologia , Nefrite Lúpica/epidemiologia , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Estados Unidos/epidemiologia
16.
Lupus ; 28(8): 954-960, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31221051

RESUMO

BACKGROUND: Blood pressure visit-to-visit variability is a novel risk factor for deleterious long-term cardiac and renal outcomes in the general population. We hypothesized that patients with systemic lupus erythematosus (SLE) have greater blood pressure visit-to-visit variability than control subjects and that blood pressure visit-to-visit variability is associated with a higher comorbidity burden. METHODS: We studied 899 patients with SLE and 4172 matched controls using de-identified electronic health records from an academic medical center. We compared blood pressure visit-to-visit variability measures in patients with SLE and control subjects and examined the association between blood pressure visit-to-visit variability and patients' characteristics. RESULTS: Patients with SLE had higher systolic blood pressure visit-to-visit variability 9.7% (7.8-11.8%) than the control group 9.2% (7.4-11.2%), P < 0.001 by coefficient of variation. Additional measures of systolic blood pressure visit-to-visit variability (i.e. standard deviation, average real variation, successive variation and maximum measure-to-measure change) were also significantly higher in patients with SLE than in control subjects. In patients with SLE, blood pressure visit-to-visit variability correlated significantly with age, creatinine, CRP, triglyceride concentrations and the Charlson comorbidity score (all P < 0.05). Hydroxychloroquine use was associated with reduced blood pressure visit-to-visit variability (P < 0.001), whereas the use of antihypertensives, cyclophosphamide, mycophenolate mofetil and corticosteroids was associated with increased blood pressure visit-to-visit variability (P < 0.05). CONCLUSION: Patients with SLE had higher blood pressure visit-to-visit variability than controls, and this increased blood pressure visit-to-visit variability was associated with greater Charlson comorbidity scores, several clinical characteristics and immunosuppressant medications. In particular, hydroxychloroquine prescription was associated with lower blood pressure visit-to-visit variability.


Assuntos
Comorbidade , Hidroxicloroquina/uso terapêutico , Hipertensão/epidemiologia , Inflamação/complicações , Lúpus Eritematoso Sistêmico/epidemiologia , Corticosteroides/uso terapêutico , Adulto , Pressão Sanguínea/efeitos dos fármacos , Estudos de Casos e Controles , Ciclofosfamida/uso terapêutico , Bases de Dados Factuais , Feminino , Humanos , Hipertensão/tratamento farmacológico , Modelos Logísticos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Ácido Micofenólico/uso terapêutico , Fatores de Risco , Índice de Gravidade de Doença
17.
Autoimmun Rev ; 18(7): 733-737, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31059847

RESUMO

OBJECTIVE: To analyze the impact of chronic kidney disease (CKD) on major clinical outcome in SLE by using a nationwide database. PATIENTS AND METHODS: Characteristics of all admitted SLE patients experiencing CKD (eGFR <60 mL/min/1.73 m2) in France from 2009 to 2015 were analyzed through the French medico- administrative database. Factors associated with CKD and major clinical outcomes such as end-stage renal disease (ESRD), cardiovascular event (CVE), septic shock and death were assessed. We used a multivariate Cox proportional hazard model and subdistribution hazard models to analyze survival without major clinical events according to the presence of CKD. RESULTS: From 2009 to 2015, 26,320 SLE patients were hospitalized in France. Among them, 6439 (86.5% women; mean age 45.7 [16.5] years old) had a baseline stay in 2009 during which CKD was reported in 428 (6.7%) cases. Multivariate analysis showed that lupus nephritis (OR 6.6 [5.2-8.4]), high blood pressure (OR 3.5 [2.8-4.5]), septic shock (OR 3.2 [1.7-6.0]) and past cardiovascular history (OR 1.4 [1.0-2.0]) were associated with CKD status. From 2009 to 2015, ESRD, CVE, septic shock, and death occurred in 4.0%, 14.4%, 6.3% and 9.6% of the 6439 SLE patients. CKD at baseline was independently and strongly associated with the occurrence of ESRD (sdHR 15.9 [11.6-21.9]), CVE (sdHR 1.7 [1.4-2.2]), septic shock (sdHR 2.1 [1.5-2.8]) and death (HR 1.7 [1.3-2.2]) during the follow up. CONCLUSION: CKD is a major risk factor for overall morbidity and mortality in SLE patients, highlighting the need for early pre-CKD lupus nephritis diagnosis and treatment.


Assuntos
Lúpus Eritematoso Sistêmico/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Adulto , Doenças Cardiovasculares/epidemiologia , Feminino , França/epidemiologia , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Modelos de Riscos Proporcionais , Choque Séptico/epidemiologia
18.
Drug Discov Ther ; 13(2): 96-100, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31080209

RESUMO

Oligoarticular arthritis (inflammation of upto 4 joints) has a wide range of infectious and non-infectious etiologies. The aim of our study was to identify the features which could help in the differentiation of infectious from non-infectious arthritis. The study was prospective and observational, and included 100 patients with oligoarticular inflammatory arthritis. The final diagnosis was made using standard diagnostic criteria and the patients were categorized into infectious and non-infectious groups. Among the 100 patients who were recruited, the following final diagnosis were made: peripheral spondyloarthritis (n = 37), axial spondyloarthritis (n = 11), tuberculosis (n = 19), brucellosis (n = 6), septic arthritis (n = 6), gouty arthritis (n = 5), early rheumatoid arthritis (n = 5), non-tubercular mycobacteria (n = 2), SLE (n = 2), post-chikungunya arthritis (n = 2), acute lymphocytic leukaemia (n = 1), pachydermoperiostosis (n = 1), sarcoidosis (n = 1) and juvenile idiopathoic arthritis (n = 1). The patients were categorized into two groups: infectious (33) and non-infectious (60). The presence of monoarthritis, clinically-significant weight loss, hepatomegaly, splenomegaly and erosive arthritis were significantly more common in the infectious group as compared to the non-infectious group.


Assuntos
Artrite Infecciosa/epidemiologia , Artrite/classificação , Doenças não Transmissíveis/epidemiologia , Adolescente , Adulto , Artrite/diagnóstico , Artrite Gotosa/diagnóstico , Artrite Gotosa/epidemiologia , Artrite Infecciosa/diagnóstico , Artrite Juvenil/diagnóstico , Artrite Juvenil/epidemiologia , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/epidemiologia , Brucelose/diagnóstico , Brucelose/epidemiologia , Feminino , Humanos , Índia , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sarcoidose/epidemiologia , Espondilartrite/diagnóstico , Espondilartrite/epidemiologia , Centros de Atenção Terciária , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Adulto Jovem
19.
Lupus ; 28(7): 834-842, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31117886

RESUMO

OBJECTIVE: The aim of this study was to assess whether lupus is associated with poorer outcomes after primary total hip arthroplasty (THA). METHODS: We used the 1998-2014 US National Inpatient Sample data. Multivariable-adjusted separate logistic regression models assessed the association of lupus with post-operative complications (implant infection, transfusion, THA revision and mortality) and health care utilization outcomes (total hospital charges, discharge to an inpatient facility and length of hospital stay >3 days) post-THA, adjusting for demographics, underlying diagnosis, comorbidity, insurance payer and hospital characteristics, using odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Among 4,116,485 primary THA hospitalizations, 22,557 (0.5%) were in patients with lupus. Patients with lupus were younger and more likely to be female, African-American or Hispanic, living in the South, or to have Medicaid insurance, and had higher comorbidity or lower income. In multivariable-adjusted analyses, the presence of lupus was associated with significantly higher risk of implant infection, transfusion, discharge to an inpatient facility and higher hospital charges above the median, with respective ORs of 1.95 (95% CI, 1.28, 2.97), 1.34 (95% CI, 1.25, 1.43), 1.21 (95% CI, 1.01, 1.44) and 1.38 (95% CI, 1.30, 1.47). Lupus was not significantly associated with the risk of revision, mortality or hospital stay >3 days; the ORs were 1.10 (95% CI, 0.68, 1.78), 0.95 (95% CI, 0.61, 1.47) and 1.06 (95% CI, 0.99, 1.13), respectively. CONCLUSIONS: Lupus was associated with a higher risk of implant infection, transfusion, discharge to an inpatient facility and higher hospital charges post-primary THA. Insight into modifiable factors associated with these outcomes may improve outcomes in patients with lupus undergoing THA.


Assuntos
Artroplastia de Quadril/efeitos adversos , Tempo de Internação/estatística & dados numéricos , Lúpus Eritematoso Sistêmico/complicações , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Modelos Logísticos , Lúpus Eritematoso Sistêmico/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Resultado do Tratamento , Estados Unidos/epidemiologia
20.
BMC Pregnancy Childbirth ; 19(1): 179, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31113392

RESUMO

BACKGROUND: It is well established that the risks of insulin resistance and diabetes mellitus are elevated in systemic lupus erythematosus (SLE) patients. However, the relationship between SLE pregnancy and gestational diabetes mellitus (GDM) is still obscure. We perform the present systematic review and meta-analysis to determine the relationship between GDM and SLE pregnancy. METHODS: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, relevant studies were carefully retrieved through PubMed, Cochrane library and Web of Science, China National Knowledge Infrastructure, Wanfang database and China Biology Medicine database from inception till 30 August 2018. GDM risk ratio (RR) of pregnant SLE patients versus controls was calculated to evaluate the association between GDM and SLE. Pooled RRs and 95% confidence intervals (CIs) were calculated using random effects model by R software. RESULTS: The literature retrieval identified 339 potential studies in total, and five studies containing 3432 pregnant participants with 248 GDM events were included finally. Pooled analysis found that the risk of GDM were not significant increased in SLE patients compared to controls (RR = 1.08, 95% CI = 0.49 to 2.41, Z = 0.19 and P = 0.848). Nevertheless, meta-regression identified that glucocorticoids use and anti-double stranded DNA antibodies positive of SLE patients were positively associated with the risk of GDM. CONCLUSIONS: Our meta-analysis demonstrated that SLE pregnancy may not increase the risk of GDM, but the steroid use during pregnancy was associated with increased risk of GDM. Further large prospective and basic immunologic studies should be implemented for exploring the mechanism underlying glucocorticoids use and GDM.


Assuntos
Diabetes Gestacional/etiologia , Lúpus Eritematoso Sistêmico/complicações , Complicações na Gravidez/etiologia , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/epidemiologia , Razão de Chances , Gravidez , Complicações na Gravidez/epidemiologia
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