Risk factors for the flare of systemic lupus erythematosus and its influence on prognosis: a single-center retrospective analysis

Zeng, Xiaohong; Zheng, Liqin; Rui, Hong-Bing; Kang, Rihui; Chen, Junmin; Chen, Huaning; Liu, Jizan

doi:10.1186/s42358-021-00202-7

Cited by 14 publications

(10 citation statements)

References 39 publications

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“…However, previous studies investigating the risk factors of SLE flares did not evaluate the presence of anti-ENA Abs as a potential risk factor 24 – 30 . One recent study evaluated factors including autoantibody profile for association with the risk of SLE flares 31 but the known potential confounders such as age, sex, ethnicity, complements, renal involvement, disease activity, and use of hydroxychloroquine and immunosuppressants were not adjusted in that study 31 . In the present study, we used multivariable analysis to adjust for potential confounders (ethnicity was not adjusted because all patients included in our study were Korean).…”

Section: Discussionmentioning

confidence: 99%

Risk of systemic lupus erythematosus flares according to autoantibody positivity at the time of diagnosis

Kwon

Park

2023

Sci Rep

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To estimate the risk of systemic lupus erythematosus (SLE) flares based on the autoantibody positivity at the time of SLE diagnosis. This retrospective cohort study included 228 patients with newly diagnosed SLE. Clinical characteristics including autoantibody positivity at the time of diagnosis of SLE were reviewed. Flares were defined as a new British Isles Lupus Assessment Group (BILAG) A score or BILAG B score for at least one organ system. Multivariable Cox regression analyses were performed to estimate the risk of flares according to autoantibody positivity. Anti-dsDNA, anti-Sm, anti-U1RNP, anti-Ro, and anti-La antibodies (Abs) were positive in 50.0%, 30.7%, 42.5%, 54.8%, and 22.4% of the patients, respectively. The incidence rate of flares was 28.2/100 person-years. Multivariable Cox regression analysis, adjusted for potential confounders, revealed that anti-dsDNA Ab positivity (adjusted hazard ratio [HR]: 1.46, p = 0.037) and anti-Sm Ab positivity (adjusted HR: 1.81, p = 0.004) at the time of diagnosis of SLE were associated with higher risk of flares. To better delineate the flare risk, patients were categorized as double-negative, single-positive, double-positive for anti-dsDNA and anti-Sm Abs. Compared with double-negativity, double-positivity (adjusted HR: 3.34, p < 0.001) was associated with higher risk of flares, while anti-dsDNA Ab single-positivity (adjusted HR: 1.11, p = 0.620) or anti-Sm Ab single-positivity (adjusted HR: 1.32, p = 0.270) was not associated with higher risk of flares. Patients who are double-positive for anti-dsDNA and anti-Sm Abs at the time of the diagnosis of SLE are at higher risk of flares and may benefit from stringent monitoring and early preventive treatment.

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Section: Discussionmentioning

confidence: 99%

Risk of systemic lupus erythematosus flares according to autoantibody positivity at the time of diagnosis

Kwon

Park

2023

Sci Rep

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“…Providers must balance risk of flare versus risk of infection and other detrimental side effects and/or toxicities from lupus treatments (36). Of interest, one of the most prominently published risks of disease flare is lack of treatment compliance (36,37,(39)(40)(41). With the availability of hydroxychloroquine level testing and other digital and health coach resources (41,42), compliance monitoring may be a beneficial early intervention without escalating treatment, particularly for those patients with a positive FRI-11 below 76% threshold probability of imminent flare.…”

Section: Discussionmentioning

confidence: 99%

A Flare Risk Index Informed by Select Immune Mediators in Systemic Lupus Erythematosus

Munroe

Blankenship

DeFreese³

et al. 2023

Arthritis & Rheumatology

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Objective. Systemic lupus erythematosus (SLE) is marked by immune dysregulation linked to varied clinical disease activity. Using a unique longitudinal cohort of SLE patients, this study sought to identify optimal immune mediators informing an empirically refined flare risk index (FRI) reflecting altered immunity prior to clinical disease flare.Methods. Thirty-seven SLE-associated plasma mediators were evaluated by microfluidic immunoassay in 46 samples obtained in SLE patients with an imminent clinical disease flare (preflare) and 53 samples obtained in SLE patients without a flare over a corresponding period (pre-nonflare). SLE patients were selected from a unique longitudinal cohort of 106 patients with classified SLE (meeting the American College of Rheumatology 1997 revised criteria for SLE or the Systemic Lupus International Collaborating Clinics 2012 revised criteria for SLE). Autoantibody specificities, hybrid SLE Disease Activity Index (hSLEDAI) scores, clinical features, and medication usage were also compared at preflare (mean ± SD 111 ± 47 days prior to flare) versus pre-nonflare (99 ± 21 days prior to nonflare) time points. Variable importance was determined by random forest analysis with logistic regression subsequently applied to determine the optimal number and type of analytes informing a refined FRI.Results. Preflare versus pre-nonflare differences were not associated with demographics, autoantibody specificities, hSLEDAI scores, clinical features, nor medication usage. Forward selection and backward elimination of mediators ranked by variable importance resulted in 17 plasma mediator candidates differentiating preflare from pre-nonflare visits. A final combination of 11 mediators best informed a newly refined FRI, which achieved a maximum sensitivity of 97% and maximum specificity of 98% after applying decision curve analysis to define low, medium, and high FRI scores.Conclusion. We verified altered immune mediators associated with imminent disease flare, and a subset of these mediators improved the FRI to identify SLE patients at risk of imminent flare. This molecularly informed, proactive management approach could be critical in prospective clinical trials and the clinical management of lupus.

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“…Factors associated with relapse in patients with SLE have been reported in many studies, including the increased anti-double-stranded deoxyribonucleic acid, B lymphocyte stimulator, renal organ involvement, deficiency of hydroxychloroquine, premature discontinuation, and poor compliance [ 22 , 33 - 35 ]. Consistent with the factors above, we found that patients with LN had a higher risk associated with relapse, among which 49.1% (55/112) of the patients self-discontinued the treatment.…”

Section: Discussionmentioning

confidence: 99%

Health Care–Seeking Behaviors, Disease Progression, Medications, Knowledge of, and Attitudes Toward Systemic Lupus Erythematosus in China: Cross-sectional Survey Study

Dai¹,

Huang²,

Yuan³

et al. 2023

JMIR Public Health Surveill

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Background Systemic lupus erythematosus (SLE) is a systemic autoimmune disease involving multiple organs throughout the body. The health care–seeking behaviors, disease progression of SLE, and patients' knowledge of and attitudes toward SLE have not been characterized in China. Objective The aim of this study was to depict the health care–seeking behaviors, disease progression, and medications in patients with SLE and to examine the factors associated with their disease flares, knowledge, and attitudes toward SLE in China. Methods We conducted a cross-sectional survey in 27 provinces in China. Descriptive statistical methods were used to depict the demographic characteristics, health care–seeking behaviors, medications, and health status. Multivariable logistic regression models were used to identify the factors associated with disease flares, medication changes, and attitudes toward SLE. An ordinal regression model was used to examine the factors associated with the knowledge of the treatment guidelines. Results We recruited 1509 patients with SLE, and 715 had lupus nephritis (LN). Approximately 39.96% (603/1509) of the patients with SLE were primarily diagnosed with LN, and 12.4% (112/906) developed LN (mean time 5.2 years) from non-LN. Patients whose registered permanent residences or workplaces in other cities from the same province and adjacent provinces seeking health care accounted for 66.9% (569/850) and 48.8% (479/981) of the patients with SLE in the provincial capital cities, respectively. Mycophenolate mofetil was the most commonly used immunosuppressive drug in patients without LN (185/794, 23.3%) and patients with LN (307/715, 42.9%). Femoral head necrosis (71/228, 31.1%) and hypertension (99/229, 43.2%) were the most common adverse event (AE) and chronic disease during treatment, respectively. Change of hospitals for medical consultation (odds ratio [OR] 1.90, 95% CI 1.24-2.90) and development of 1 chronic disease (OR 3.60, 95% CI 2.04-6.24) and AE (OR 2.06, 95% CI 1.46-2.92) and more were associated with disease flares. A pregnancy plan (OR 1.58, 95% CI 1.18-2.13) was associated with changes in medication. Only 242 (16.03%) patients with SLE were familiar with the treatment guidelines, and patients with LN tended to be more familiar with the disease (OR 2.20, 95% CI 1.81-2.68). After receiving treatment, 891 (59.04%) patients changed their attitudes toward SLE from fear to acceptance, and patients with college education or higher (OR 2.09, 95% CI 1.10-4.04) were associated with a positive attitude toward SLE. Conclusions A large proportion of patients seeking health care in the provincial capital cities of China migrated from other cities. Persistent monitoring of potential AEs and chronic diseases during SLE treatment and managing patients who changed hospitals for medical consultation are essential for controlling disease flares. Patients had insufficient knowledge about SLE treatment guidelines and would benefit from health education to maintain a positive attitude toward SLE.

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Risk factors for the flare of systemic lupus erythematosus and its influence on prognosis: a single-center retrospective analysis

Cited by 14 publications

References 39 publications

Risk of systemic lupus erythematosus flares according to autoantibody positivity at the time of diagnosis

Risk of systemic lupus erythematosus flares according to autoantibody positivity at the time of diagnosis

A Flare Risk Index Informed by Select Immune Mediators in Systemic Lupus Erythematosus

Health Care–Seeking Behaviors, Disease Progression, Medications, Knowledge of, and Attitudes Toward Systemic Lupus Erythematosus in China: Cross-sectional Survey Study

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