Late-onset systemic lupus erythematosus in Latin Americans: a distinct subgroup?

Catoggio, Luís J.; Soriano, Enrique R.; Imamura, Patricia M.; Wojdyla, Daniel; Jacobelli, S; Massardo, Loreto; Chacón-Díaz, Rosa; Guibert-Toledano, Marlene; Alvarellos, Alejandro; Saurit, Verónica; Manni, Jorge A.; Pascual‐Ramos, Virginia; Sauza, A W Silva de; Bonfá, Eloísa; Brenol, João Carlos Tavares; Ramírez, LA; Barile-Fabris, Leonor; Torre, Ignacio García-De La; Alarcón, Graciela S.; Pons-Estel, Bernardo A.

doi:10.1177/0961203314563134

Cited by 49 publications

(49 citation statements)

References 22 publications

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“…Less than 20% of SLE patients were reported to have pericarditis at first diagnosis 9, 23 . Myocarditis had also been observed in patients at diagnosis of SLE 23 , the prevalence of which was similar with our cohort. Pulmonary involvement, pleuritis, ILD, and pulmonary hypertension were observed within our patients, as also described by Catoggio et al 23 .…”

Section: Discussionsupporting

confidence: 90%

Clinical and biochemical manifestations of systemic lupus erythematosus at first diagnosis within Chinese patients

Xie

zhang

Wang

et al. 2019

Preprint

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Bankground: The objective of this paper was to describe the first symptoms associated with systemic lupus erythematosus (SLE), including clinical manifestations, laboratory findings, prognoses, differences between men and women at the time of first diagnosis of SLE. Methods : We enrolled 223 patients with initial diagnosis of SLE. Their initial symptoms, demographic, clinical and laboratory data，prognoses and causes of death were analyzed retrospectively. Clinical manifestations and laboratory profiles were compared between male and female patients. Results: Compared with female patients, male patients had an earlier age of onset, a higher incidence of neuropsychiatric involvements, a lower incidence of leukocytopenia , and a higher score of SLE Disease Activity Index (SLEDAI）at diagnosis. Fever and malar rash were most frequent presentations at onset of SLE. The most common clinical manifestation at first diagnosis was fever, followed by arthralgia, malar rash, Raynaud ’ s phenomenon, arthritis. The liver function abnormalities included increased ALT,AST,ALP and γ-GGT.ANA were found in 100% of patients, followed by anti-dsDNA(LIA) in 72.1%, anti-Ro60 in 67.8%, anti-Ro52 in 62.3%, anti-nucleosomes in 55.7%. Conclusions: We identified clinical and serological manifestations of Chinese SLE patients at first diagnosis. Male patients showed a distinctive manifestation including younger age of onset，a higher incidence of CNS manifestations, a higher score of SLEDAI compared to females.

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Section: Discussionsupporting

confidence: 90%

Clinical and biochemical manifestations of systemic lupus erythematosus at first diagnosis within Chinese patients

Xie

zhang

Wang

et al. 2019

Preprint

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“…SLE patients older than 65 years of age exhibited a higher incidence of incident respiratory failure, which is in contrast to the poor prognosis of young women [ 37 ] reported in a previous study [ 18 ]. A possible explanation may be that older patients in the SLE and non-SLE cohorts tended to have more primary complications, such as cardiovascular [ 11 ] and pulmonary lesions [ 38 ], resulting from the primary deterioration [ 38 , 39 ] of the patients in the SLE cohort; these primary complications may be risk factors for the onset of incident respiratory failure among older adults.…”

Section: Discussionmentioning

confidence: 99%

“…This finding suggests that poor control of the deterioration of an obstructed airway, occlusion of the pulmonary vessel, and atherosclerosis of the arterial system or coronary artery were crucial factors for incident respiratory failure in the SLE cohort. The recurrence of SLE exacerbation causes primary cumulative damage [ 39 ] to the lung parenchyma (e.g., pneumonia) [ 19 , 42 ], airway (e.g., airway obstruction [ 12 , 26 , 43 , 44 ]), and pulmonary vessel (e.g., pulmonary embolism) [ 13 , 45 ], thus resulting in hypoxemia and incident respiratory failure [ 29 ] in SLE patients without pre-existing comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Effect of Systemic Lupus Erythematosus on the Risk of Incident Respiratory Failure: A National Cohort Study

et al. 2016

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PurposeWe conducted a nationwide cohort study to investigate the relationship between systemic lupus erythematosus (SLE) and the risk of incident respiratory failure.MethodsFrom the National Health Insurance Research Database, we identified 11 533 patients newly diagnosed with SLE and 46 132 controls without SLE who were randomly selected through frequency-matching according to age, sex, and index year. Both cohorts were followed until the end of 2011 to measure the incidence of incident respiratory failure, which was compared between the 2 cohorts through a Cox proportional hazards regression analysis.ResultsThe adjusted hazard ratio (aHR) of incident respiratory failure was 5.80 (95% confidence interval [CI] = 5.15–6.52) for the SLE cohort after we adjusted for sex, age, and comorbidities. Both men (aHR = 3.44, 95% CI = 2.67–4.43) and women (aHR = 6.79, 95% CI = 5.93–7.77) had a significantly higher rate of incident respiratory failure in the SLE cohort than in the non-SLE cohort. Both men and women aged <35 years (aHR = 31.2, 95% CI = 21.6–45.2), 35–65 years; (aHR = 6.19, 95% CI = 5.09–7.54) and ≥65 years (aHR = 2.35, 95% CI = 1.92–2.87) had a higher risk of incident respiratory failure in the SLE cohort. Moreover, the risk of incident respiratory failure was higher in the SLE cohort than the non-SLE cohort, for subjects with (aHR = 2.65, 95% CI = 2.22–3.15) or without (aHR = 9.08, 95% CI = 7.72–10.7) pre-existing comorbidities. In the SLE cohort, subjects with >24 outpatient visits and hospitalizations per year had a higher incident respiratory failure risk (aHR = 21.7, 95% CI = 18.0–26.1) compared with the non-SLE cohort.ConclusionPatients with SLE are associated with an increased risk of incident respiratory failure, regardless of their age, sex, and pre-existing comorbidities; especially medical services with higher frequency.

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“…11 Childhood-onset SLE (cSLE) usually displays worse outcomes and more severe disease compared to adult-onset patients, 12 while patients with late-onset lupus typically have lower disease activity and a milder disease course. 13,14 In this study, we sought to assess and describe the phenotype of lupus systematically at the time of presentation and throughout the disease course in a newly established cohort, the 'Attikon' lupus cohort, consisting exclusively of Caucasians. To this end, we recorded clinical manifestations, treatment, damage accrual and co-morbidities.…”

Section: Introductionmentioning

confidence: 99%

Evolving phenotype of systemic lupus erythematosus in Caucasians: low incidence of lupus nephritis, high burden of neuropsychiatric disease and increased rates of late-onset lupus in the ‘Attikon’ cohort

Nikolopoulos

Kostopoulou

Pieta

et al. 2020

Lupus

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Objective This study aimed to analyse the phenotype of systemic lupus erythematosus (SLE) at first presentation and during follow-up in a newly established SLE cohort based at ‘Attikon’ University Hospital. The hospital combines primary, secondary and tertiary care for the region of Western Attica, Greece. Methods This study comprised a mixed prevalent and incident cohort of 555 Caucasian patients diagnosed with SLE according to American College of Rheumatology 1997 criteria and/or the Systemic Lupus Erythematosus International Collaborating Clinics (SLICC) 2012 criteria. Demographic and clinical characteristics, patterns of severity, treatments and SLICC damage index were recorded for each patient at the time of diagnosis and at last evaluation. Results The mean age at lupus diagnosis was 38.3 years (standard deviation = 15.6 years), with a median disease duration at last follow-up of two years (interquartile range 1-11). At initial presentation, the most common ‘classification’ manifestations were arthritis (73.3%), acute cutaneous lupus (65%) and unexplained fever (25%), while among symptoms not included in any criteria set, Raynaud’s phenomenon (33%) was the most common. Kidney and neuropsychiatric involvement as presenting manifestations were present in 10.3% and 11.5% cases, respectively. Irreversible damage accrual was present in 17.8% within six months of disease diagnosis, attributed mainly to thrombotic and neuropsychiatric disease. At last evaluation, 202 (36.4%) patients had developed severe disease, of whom more than half were treated with pulse cyclophosphamide. Conclusion In this cohort of Caucasian patients, lupus nephritis is not as common as in older cohorts, while neuropsychiatric disease is emerging as a major frontier in lupus prevention and care. These data may help to document changes in the natural history and treatment of SLE over time and may have implications for its early recognition and management.

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Late-onset systemic lupus erythematosus in Latin Americans: a distinct subgroup?

Cited by 49 publications

References 22 publications

Clinical and biochemical manifestations of systemic lupus erythematosus at first diagnosis within Chinese patients

Clinical and biochemical manifestations of systemic lupus erythematosus at first diagnosis within Chinese patients

Effect of Systemic Lupus Erythematosus on the Risk of Incident Respiratory Failure: A National Cohort Study

Evolving phenotype of systemic lupus erythematosus in Caucasians: low incidence of lupus nephritis, high burden of neuropsychiatric disease and increased rates of late-onset lupus in the ‘Attikon’ cohort

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