Purpose of review The purpose of this review is highlighting the most recent evidence on the clinical efficacy and toxicity of antimalarials in systemic lupus erythematosus (SLE). Recent findings New data confirm the effects of antimalarials in preventing SLE activity, damage and infections and in decreasing mortality. An important reduction in use of health resources is related to continued antimalarial use. Hydroxychloroquine (HCQ) may prevent preeclampsia in pregnant women with SLE. HCQ ocular toxicity is infrequent and could be associated with blood levels. Gastrointestinal and skin toxicity are underrecognized and could influence adherence. Prolongation of QT interval is extremely unusual with HCQ. Doses of HCQ of 200 mg/day seem to offer a good efficacy/toxicity balance. HCQ protection against herpes zoster and Pneumocystis jirovecii infection has been shown. On the contrary, HCQ prescription by doctors and adherence by patients are both under recommended standards. The recent coronavirus disease 2019 pandemic has resulted in a significant shortage of HCQ in many countries with possible consequences in the correct treatment of lupus patients. Summary Recent evidence reinforces the central role of HCQ in SLE therapy. The reduction in activity, damage accrual and mortality is consistent across studies, countries and ethnical groups. On the contrary, and despite the well established beneficial effects of prolonged regular HCQ therapy, many SLE patients do never take this drug or it is eventually stopped in the setting of severe flares, pregnancy or presumed toxicity. Every effort must be made to assure the correct prescription of HCQ and not to withdraw the drug unless unequivocal signs of toxicity are present.
OBJECTIVE To compare the influence of antiphospholipid antibodies (aPL) on global and cardiovascular damage in patients with systemic lupus erythematosus (SLE) diagnosed before and after year 2000. METHODS 286 patients from the Lupus-Cruces cohort with a minimum follow-up of 5 years, divided into two sub-cohorts according to the date of diagnosis, before 2000 (<2000) and from 2000 on (≥2000). We compared the mean SDI score and global and cardiovascular damage-free survival rates in the presence/absence of aPL in both sub-cohorts. Variables potentially modulating damage among aPL-positive patients were analysed. RESULTS The sub-cohorts were comparable for demographic and lupus-related variables except for treatment variables: the ≥2000 sub-cohort received lower doses of prednisone and more hydroxychloroquine, low-dose aspirin, statins, immunosuppressive agents and Vitamin D. aPL-positive patients in the <2000, but not in the ≥2000 sub-cohort, accrued more damage compared with aPL-negative. In the <2000 sub-cohort, the adjusted HRs for global and cardiovascular damage in aPL-positive vs. aPL-negative patients were 1.98 (95% CI 1.24-3.14) and 9.3 (95% CI 3.24-26.92), respectively. No differences in damage were seen between aPL-positive and aPL-negative patients in the ≥2000 sub-cohort. Hypertension (HR 4.64, 95%CI 1.33-16.19), lupus anticoagulant (HR 3.85, 95%CI 1.1-13.41) and the number of months on hydroxychloroquine (HR 0.97, 95%CI 0.95-0.99) were independent predictors of vascular damage in the combined analysis of all aPL-positive patients. CONCLUSION The effects of aPL on damage accrual in SLE patients have been reduced over the last years. The widespread use of hydroxychloroquine and a better thromboprophylaxis are likely causing this change.
BackgroundAntihistone antibodies (AHA) have been linked to Drug-Induced Lupus Erythematosus (DILE) for decades1. However, for some authors this relationship is not so clear and sugest that the presence of these autoantibodies is related to other autoimmune diseases more frequently2,3,4.ObjectivesThe main objetive of this work was to study the association of AHA with different autoimmune entities (including DILE) and secondarily, look into which clinical manifestations and which autoantibodies are more frequently related to AHA.MethodsWe performed a descriptive study. A database was constituted using all patients with AHA+ in any blood analysis between years 2000 and 2016 in the University Hospital Complex of Vigo. The variables of the study were: presence of autoimmune disease, clinical manifestations and related autoantibodies.ResultsVariableMenWomenAll% Total Age504546Gender155873100SLE8273548DILE0000Scleroderma0445Sjögren18912Rheumatoid Arthritis0334No diagnosis5192433Malar rash1111216Photosensitivity2111318Oral ulcers1101115Arthritis6313751Lupic nephropathy4131723Raynaud1111216Hematological abnormalities5202534AntiRo+4121622AntiLa+25710AntiSm+381115AntiDNAds+3252838None of the 73 patients AHA+ developed DILE while almost the 50% of them suffer any other autoimmune disease. We found a high percentage of AHA+ patients with lupus erythematous complications such as arthritis and hematological abnormalities. AntiDNAds antibody was the more frequent coexpressed autoantibody.Conclusions AHA detection is not useful as DILE screening.AHA+ sugest the presence of other autoimmune disease rather than DILE.AHA+ may be related to lupus erythematous systemic complications. References Fritzler MJ, Tan EM. Antibodies to histone in drug-induced and idiopathic lupus erythematosus. J Clin Invest. 1978;62:560–567.Peng SL, Craft J. Antinuclear antibodies. In: Ruddy S, Harris ED, Sledge CB, eds. Kelley's Textbook of Rheumatology. 6th ed. Philadelphia, Pa: WB Saunders; 2001:166.Kubo M, Ihn H, Yasawa N, et al. Prevalence and antigen specificity of antihistone antibodies in patients with polymyositis/dermatomyositis. J Invest Dermatol. 1999;112:711–715.Zirwas MJ, Kress DW, Deng JS. The Utility of Antihistone Antibody Screening in the Diagnosis of Drug-Induced Lupus Erythematosus. Arch Dermatol Apr 2004; VOL 140: 494–495. Disclosure of InterestNone declared
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