Background:Treat-to-target strategy with remission as the target has been proposed for the management of SLE. However, there is not a uniform definition of remission.Objectives:To determine the protective value of remission state on organ damage accrual in SLE patients through a SLR.Methods:Two independent reviewers identified studies in Medline and Cochrane Library. Data on remission definitions and rates as well as damage accrual (assessed by the SLICC/ACR damage index [SDI]) were extracted. Definitions of remission included disease activity indices (SLEDAI and its variants and PGA), serological activity, prednisone (PDN) daily dose (mg/day), immunosuppressive (IS) drugs, antimalarial (AM) use and duration of remission. The quality of the studies was evaluated with the Newcastle-Otawa Scale (NOS).Results:Eight manuscripts were included comprising more than 6,000 patients from America, Europe and Asia Pacific. All the studies were longitudinal. The majority of the studies reached more than seven out nine points in the NOS. Remission rates ranged between 10 and almost 50%; they tend to be lower in America as compared to Asia Pacific and Europe. All definitions required a clinical SLEDAI=0, and allowed antimalarial use. However, there were differences regarding the inclusion of serological activity, PGA, prednisone or immunosuppressive drug use as well as minimum remission duration required. Even less stringent definition of remission prevented damage accrual. The risk of damage accrual was two to five-fold lower in those patients on remission.AuthorsCountry/ RegionPatientsRemissionAchieving remission (%)Damage: remission vs not remissionNOSZen et alItaly224SLEDAI=0Serologic= allowedPGA= NRPDN ≤ 5IS=YesAM=YesDuration=5 years37.5%Unremitted diseaseOR=2.53; p=0.0087Tani et alItaly115SLEDAI=0SerologicPGA= NRPDN ≤ 5IS=YesAM=YesDuration=NR49.6%ΔSLICC 0.12 vs 0.48,p= 0.0188Ugarte-Gil et alLatin America1,350SLEDAI=0Serologic= not allowedPGA= NRPDN ≤ 5IS=YesAM=YesDuration=NR20.2%New damageHR 0.60 p=0.0042Severe new damageHR 0.32 p=0.00338Tsang-A-Sjoe et alNetherlands224SLEDAI=0Serologic= allowedPGA= NRPDN ≤ 5IS=YesAM=YesDuration>5 years37.6%OR=0.20; p=0.0018Mok et alChina769SLEDAI=0Serologic= AllowedPGA<0.5PDN ≤ 5IS=YesAM=YesDuration≥5years25.1%Not being on remission for at least 5 yearsOR: 2.42; p<0.0017Tselios et alCanada267SLEDAI=0Serologic= AllowedPGA=NRPDN no restrictionIS no restrictionAM=YesDuration≥5years10.1%SDI after 10 years: 0.96 vs 1.53 (not on remission, not on LDAS), p for trend =0.0297Petri et alUS1,356SLEDAI=0Serologic= NRPGA<0.5PDN ≤ 5IS=YesAM=YesDuration= NRNRRate ratio per percentage of follow-upRR(<25%)=0.54; p<0.0001RR(25-49%)=0.47; p<0.0001RR(50-74%)=0.43; p<0.0001RR(>75%)=0.45; p=0.00197Golder et alAsia Pacific1,707SLEDAI=0Serologic=YesPGA<0.5PDN ≤ 5IS=YesAM=YesDuration= NR35.8%HR=0.55; p<0.00016NR: Not recorded. OR: Odds Ratio. HR: Hazard ratio. RR: Rate ratioConclusion:In SLE patients, achieving remission, even with less stringent definitions, prevented damage accrual.Disclosure of Interests: :Manuel F. Ugarte-Gil Grant/research support from: Jannsen, Pfizer, Claudia Mendoza Pinto: None declared, Guillermo Pons-Estel Grant/research support from: JANSSEN and GSK, Consultant of: JANNSEN, GSK and SANOFI, Speakers bureau: PFIZER, JANNSEN and GSK, Cristina Reategui Sokolova: None declared, Ronald van Vollenhoven Grant/research support from: AbbVie, Arthrogen, Bristol-Myers Squibb, GlaxoSmithKline, Lilly, Pfizer, and UCB, Consultant of: AbbVie, AstraZeneca, Biotest, Bristol-Myers Squibb, Celgene, GSK, Janssen, Lilly, Medac, Merck, Novartis, Pfizer, Roche, and UCB, George Bertsias Grant/research support from: GSK, Consultant of: Novartis, Graciela S Alarcon: None declared, Bernardo Pons-Estel Grant/research support from: GSK, Janssen, Consultant of: GSK, Janssen, Speakers bureau: GSK, Janssen
Background:An increased risk of severe COVID-19 outcomes may be seen in patients with autoimmune diseases on moderate to high daily doses of glucocorticoids, as well as in those with comorbidities. However, specific information about COVID-19 outcomes in SLE is scarce.Objectives:To determine the characteristics associated with severe COVID-19 outcomes in a multi-national cross-sectional registry of COVID-19 patients with SLE.Methods:SLE adult patients from a physician-reported registry of the COVID-19 GRA were studied. Variables collected at COVID-19 diagnosis included age, sex, race/ethnicity, region, comorbidities, disease activity, time period of COVID-19 diagnosis, glucocorticoid (GC) dose, and immunomodulatory therapy. Immunomodulatory therapy was categorized as: antimalarials only, no SLE therapy, traditional immunosuppressive (IS) drug monotherapy, biologics/targeted synthetic IS drug monotherapy, and biologic and traditional IS drug combination therapy. We used an ordinal COVID-19 severity outcome defined as: not hospitalized/hospitalized without supplementary oxygen; hospitalized with non-invasive ventilation; hospitalized with mechanical ventilation/extracorporeal membrane oxygenation; and death. An ordinal logistic regression model was constructed to assess the association between demographic characteristics, comorbidities, medications, disease activity and COVID-19 severity. This assumed that the relationship between each pair of outcome groups is of the same direction and magnitude.Results:Of 1069 SLE patients included, 1047 (89.6%) were female, with a mean age of 44.5 (SD: 14.1) years. Patient outcomes included 815 (78.8%) not hospitalized/hospitalized without supplementary oxygen; 116 (11.2) hospitalized with non-invasive ventilation, 25 (2.4%) hospitalized with mechanical ventilation/extracorporeal membrane oxygenation and 78 (7.5%) died. In a multivariate model (n=804), increased age [OR=1.03 (1.01, 1.04)], male sex [OR =1.93 (1.21, 3.08)], COVID-19 diagnosis between June 2020 and January 2021 (OR =1.87 (1.17, 3.00)), no IS drug use [OR =2.29 (1.34, 3.91)], chronic renal disease [OR =2.34 (1.48, 3.70)], cardiovascular disease [OR =1.93 (1.34, 3.91)] and moderate/high disease activity [OR =2.24 (1.46, 3.43)] were associated with more severe COVID-19 outcomes. Compared with no use of GC, patients using GC had a higher odds of poor outcome: 0-5 mg/d, OR =1.98 (1.33, 2.96); 5-10 mg/d, OR =2.88 (1.27, 6.56); >10 mg/d, OR =2.01 (1.26, 3.21) (Table 1).Table 1.Characteristics associated with more severe COVID-19 outcomes in SLE. (N=804)OR (95% CI)Age, years1.03 (1.01, 1.04)Sex, Male1.93 (1.21, 3.08)Race/Ethnicity, Non-White vs White1.47 (0.87, 2.50)RegionEuropeRef.North America0.67 (0.29, 1.54)South America0.67 (0.29, 1.54)Other1.93 (0.85, 4.39)Season, June 16th 2020-January 8th 2021 vs January-June 15th 20201.87 (1.17, 3.00)Glucocorticoids0 mg/dayRef.0-5 mg/day1.98 (1.33, 2.96)5-10 mg/day2.88 (1.27, 6.56)=>10 mg/day2.01 (1.26, 3.21)Medication CategoryAntimalarial onlyRef.No IS drugs2.29 (1.34, 3.91)Traditional IS drugs as monotherapy1.17 (0.77, 1.77)b/ts IS drugs as monotherapy1.00 (0.37, 2.71)Combination of traditional and b/ts IS1.00 (0.55, 1.82)Comorbidity BurdenNumber of Comorbidities (excluding renal and cardiovascular disease)1.39 (0.97, 1.99)Chronic renal disease2.34 (1.48, 3.70)Cardiovascular disease1.93 (1.34, 3.91)Disease Activity, Moderate/ high vs Remission/ low 2.24 (1.46, 3.43)IS: immunosuppressive. b/ts: biologics/targeted syntheticsConclusion:Increased age, male sex, glucocorticoid use, chronic renal disease, cardiovascular disease and moderate/high disease activity at time of COVID-19 diagnosis were associated with more severe COVID-19 outcomes in SLE. Potential limitations include possible selection bias (physician reporting), the cross-sectional nature of the data, and the assumptions underlying the outcomes modelling.Acknowledgements:The views expressed here are those of the authors and participating members of the COVID-19 Global Rheumatology Alliance and do not necessarily represent the views of the ACR, EULAR) the UK National Health Service, the National Institute for Health Research (NIHR), or the UK Department of Health, or any other organization.Disclosure of Interests:Manuel F. Ugarte-Gil Grant/research support from: Pfizer, Janssen, Graciela S Alarcon: None declared, Andrea Seet: None declared, Zara Izadi: None declared, Cristina Reategui Sokolova: None declared, Ann E Clarke Consultant of: AstraZeneca, BristolMyersSquibb, GlaxoSmithKline, Exagen Diagnostics, Leanna Wise: None declared, Guillermo Pons-Estel: None declared, Maria Jose Santos: None declared, Sasha Bernatsky: None declared, Lauren Mathias: None declared, Nathan Lim: None declared, Jeffrey Sparks Consultant of: Bristol-Myers Squibb, Gilead, Inova, Janssen, and Optum unrelated to this work., Grant/research support from: Amgen and Bristol-Myers Squibb, Zachary Wallace Consultant of: Viela Bio and MedPace, Grant/research support from: Bristol-Myers Squibb and Principia/Sanofi, Kimme Hyrich Speakers bureau: Abbvie, Grant/research support from: MS, UCB, and Pfizer, Anja Strangfeld Speakers bureau: AbbVie, MSD, Roche, BMS, Pfizer, Grant/research support from: AbbVie, BMS, Celltrion, Fresenius Kabi, Lilly, Mylan, Hexal, MSD, Pfizer, Roche, Samsung, Sanofi-Aventis, and UCB, Laure Gossec Consultant of: Abbvie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sanofi-Aventis, UCB, Grant/research support from: Lilly, Mylan, Pfizer, Loreto Carmona: None declared, Elsa Mateus Grant/research support from: Pfizer, Abbvie, Novartis, Janssen-Cilag, Lilly Portugal, Sanofi, Grünenthal S.A., MSD, Celgene, Medac, Pharmakern, GAfPA, Saskia Lawson-Tovey: None declared, Laura Trupin: None declared, Stephanie Rush: None declared, Gabriela Schmajuk: None declared, Patti Katz: None declared, Lindsay Jacobsohn: None declared, Samar Al Emadi: None declared, Emily Gilbert: None declared, Ali Duarte-Garcia: None declared, Maria Valenzuela-Almada: None declared, Tiffany Hsu: None declared, Kristin D’Silva: None declared, Naomi Serling-Boyd: None declared, Philippe Dieudé Consultant of: Boerhinger Ingelheim, Bristol-Myers Squibb, Lilly, Sanofi, Pfizer, Chugai, Roche, Janssen unrelated to this work, Grant/research support from: Bristol-Myers Squibb, Chugaii, Pfizer, unrelated to this work, Elena Nikiphorou: None declared, Vanessa Kronzer: None declared, Namrata Singh: None declared, Beth Wallace: None declared, Akpabio Akpabio: None declared, Ranjeny Thomas: None declared, Suleman Bhana Consultant of: AbbVie, Horizon, Novartis, and Pfizer (all <$10,000) unrelated to this work, Wendy Costello: None declared, Rebecca Grainger Speakers bureau: Abbvie, Janssen, Novartis, Pfizer, Cornerstones, Jonathan Hausmann Consultant of: Novartis, Sobi, Biogen, all unrelated to this work (<$10,000), Jean Liew Grant/research support from: Pfizer outside the submitted work, Emily Sirotich Grant/research support from: Board Member of the Canadian Arthritis Patient Alliance, a patient run, volunteer based organization whose activities are largely supported by independent grants from pharmaceutical companies, Paul Sufka: None declared, Philip Robinson Speakers bureau: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer and UCB (all < $10,000), Consultant of: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer and UCB (all < $10,000), Pedro Machado Speakers bureau: Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Roche and UCB, all unrelated to this study (all < $10,000)., Consultant of: Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Roche and UCB, all unrelated to this study (all < $10,000), Milena Gianfrancesco: None declared, Jinoos Yazdany Consultant of: Eli Lilly and AstraZeneca unrelated to this project
Background:Tenosynovitis (TS) is a common, often clinically undetectable finding in Rheumatoid Arthritis (RA). Recent data showed TS on ultrasound (US) has a role in predicting outcome in early disease and flare in clinical remission. However data is limited on US measured TS in healthy subjects (HS), none specifically encompassing the older age range when RA commonly presents.Objectives:This OMERACT study aimed to determine prevalence of US measured tendon abnormalities in HS throughout the age range.Methods:Adult HS without: joint pain (VAS <10/100), hand osteoarthritis (ACR criteria), or inflammatory arthritis were recruited in 23 international centres from Aug 2017-Dec 2018. MCP, PIP and wrist joints were clinically examined. Bilateral digit flexor (DF) 1-5 and extensor carpi ulnaris (ECU) tendons were scanned for tenosynovial hypertrophy (TSH) and power Doppler (PD) signal and graded (OMERACT US scoring system1).A comparison cohort of DMARD-naive patients with RA (ACR-EULAR 2010 and/or 1987 criteria) at presentation was taken from the Birmingham Early Arthritis (BEACON) inception cohort, who underwent identical tendon US assessment. They were grouped into ≤12 and > 12 weeks from symptom onset.Results:Data from 899 HS and 144 RA patients were included. HS 18-39 y HS 40-59 y HS ≥60 y RA ≤12 RA > 12 5 groups p value RA ≤12 vs >12 p value n 40831118030114 Age, y (IQR) 29 (25-33)49 (44-55)68 (62-72)58 (52-69)53 (42-65)<0.0010.03 Female (%) 270 (66)270 (83)114 (62)20 (67)86 (75)<0.0010.2 DAS 28 CRP (IQR) ---5.4 (4.2-6.1)4.8 (4.1-5.7)-0.1 Tender joint* (IQR) 0 0 0 18 (10-23)17 (11-29)<0.0010.9 Swollen joint* (IQR) 0 0 0 8 (3-18)6 (3-9)<0.0010.1 DF 1-5 TSH gd ≥1 (%) 8 (0.2)9 (0.3)2 (0.1)54 (18)125 (11)<0.0010.06 DF 1-5 PD gd ≥1 (%) 3 (0.05)2 (0.06)0 49 (16)85 (8)<0.0010.02 ECU TSH gd ≥1 (%) 1 (0.1)11 (1.8)5 (1.4)13 (22)52 (23)<0.0010.8 ECU PD gd ≥1 (%) 0 0 0 12 (20)50 (22)<0.0010.7*RA had 66/68 joint countPrevalence of TSH and particularly PD abnormalities in HS was very low at all ages, and was all grade 1 except in one individual ECU tendon. ECU TSH grade≥1 was more common than DF grade≥1 in the older HS groups, and less common in the 18-39 age group (p=0.011). TSH and PD of grade ≥1 were common in RA patients, with DF PD abnormalities more common in early disease (p=0.02).Conclusion:Low prevalence of TSH or PD abnormalities in tendons of HS even in old age suggests US determined TS will be a robust tool in clinically managing RA.References:[1] Naredo E, D’Agostino MA, et al. Reliability consensus-based US score TS RA. ARD.2013;72(8):1328-34Disclosure of Interests:Jeanette Trickey: None declared, Ilfita Sahbudin: None declared, Alessandra Bortoluzzi: None declared, Annamaria Iagnocco: None declared, Carlos Pineda: None declared, Cesar Sifuentes-Cantú: None declared, Coziana Ciurtin: None declared, Cristina Reategui Sokolova: None declared, Daniela Fodor: None declared, Ellen-Margrethe Hauge: None declared, Esperanza Naredo Consultant for: Abbvie, Speakers bureau: AbbVie, Roche, Bristol-Myers Squibb, Pfizer...
Introducción. En pacientes con lupus eritematoso sistémico (LES) existe incremento de infecciones debido a la propia enfermedad, al uso de inmunosupresores y corticoides. Objetivo. Identificar los factores asociados a infecciones serias en pacientes lúpicos en un hospital de referencia nacional. Estudio retrospectivo, analítico, de casos y controles en el Servicio de Reumatología del Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú. Métodos. Se analizó el registro de pacientes hospitalizados en el periodo de estudio, los casos fueron pacientes en los que se demostró la etiología de la primera infección durante su hospitalización. Los controles fueron pacientes lúpicos hospitalizados sin infecciones en el mismo periodo de estudio. Se analizaron variables asociadas al desarrollo de infecciones. Resultados. 61 pacientes de 390 hospitalizados desarrollaron infecciones durante su hospitalización. 48 desarrollaron 1 solo evento infeccioso (en 40 se demostró etiología). Los casos tuvieron mayor actividad, daño y comorbilidad en comparación con los controles. En el análisis univariado, el salario (p=0,031), el uso de inmunosupresores a la admisión (previo: p=0,004 y actual: p=0,004), el uso de glucocorticoides (<30 días: p=0,015 y >30-360 días: p=0,028), la actividad (p=0,029) y el daño (p=0,026) producido por la enfermedad, y el tiempo de hospitalización (p=0,045) tuvieron asociación estadísticamente significativa. En el análisis multivariado, los días de hospitalización se asociaron al desarrollo de infecciones. Conclusiones. Existió asociación entre días de hospitalización y el desarrollo de infecciones serias en pacientes lúpicos durante el periodo de estudio.
Background:Work disability in patients with systemic lupus erythematosus (SLE) is common but the factors associated with it in Low and Middle Income Countries have been scarcely evaluated(1).Objectives:To determine the prevalence of and the factors associated with work disability in SLE patients.Methods:We studied 239 consecutive (1997 American College of Rheumatology (ACR) criteria) patients from a Peruvian SLE cohort from October 2017 to December 2018. Work disability was measured from a single self-report questionnaire. Data were collected and included sociodemographic information, clinical lupus features including disease activity [Systemic Lupus Erythematosus Disease Activity Index 2000 update (SLEDAI-2K)], damage [Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI)], as well as Health-Related Quality of Life (LupusQoL), and medication use. Work disability was defined by patients’ self-report of not being able to work because of SLE. Univariable analysis comparing those patients with work disability and those who remained working were performed with the Mann Whitney U test for continuous variables and the Chi-square test for dichotomous variables. For the multivariable analyses, binary logistic regression with backward elimination was used to determine which factors remained associated with work disability.Results:Of 239 patients, 194 patients were working at least for at least some time since diagnosis, 181 (93.0%) were female, they had a mean age at diagnosis of 34.5 (12.3) years, and a mean disease duration of 11.5 (7.4) years, their mean SLEDAI was 2.53 (3.7) and their mean SDI was 1.2 (1.5). Twenty-eight patients changed their activities at work due to SLE and 51 (26.6%) stopped working after their diagnosis; 21 of them (41.1%) stopped working because of SLE. One hundred and forty-three were working at the time of the evaluation. In the multivariate analyses, those work- disabled due to SLE were more likely to have higher SDI: OR=1.650 (CI95%: 1.134-2.403) p=0.009, and lower HRQoL in two domains, planning: OR=0.975 (CI 95%: 0.954-0.996) p=0.020 and body image OR=0.977 (CI95%: 0.956, 0.998), p=0.032.Conclusion:Work disability due to SLE is associated with higher damage accrual and a poorer HRQoL.References:[1] Mak A. The economic burden of systemic lupus erythematosus in Asia: the current state. Sing Lau C, editor. Lupus. 2010Oct14;19(12):1442–6.Disclosure of Interests:None declared
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