A multicenter study of outcome in systemic lupus erythematosus.

198

We compared the frequency of clinical features of systemic lupus erythematosus (SLE) and determined survival in 113 patients with younger-onset lupus (age <55 at clinical diagnosis) and 25 patients with olderonset disease (age 155 at diagnosis). The most striking difference was in the racial distribution; 59% of the younger patients were black, compared with only 20% of the oldeponset patients (I' < 0.001). Major manifestations of lupus (including clinically evident renal disease, central nervous system involvement, cutaneous involvement, and hemocytopenia) occurred with similar frequency in both age groups. Antibodies to DNA were detectable equally often in both groups, but hypocomplementemia was more common in the younger patients. Five-year survival in the younger-onset group (79%) was similar to that of the older-onset group (72%); there was a tendency toward relatively improved survival in patients in the latter group when compared with the expected survival of appropriately matched control populations. Major significant differences in racial distribution included 1) a higher incidence of serositis in older whites and in blacks regardless of age, and 2 ) more frequent hypocomplementemia in younger patients ' within both racial groups.

Section: Discussionsupporting

confidence: 85%

Clinical features of systemic lupus erythematosus

Ballou

Khan

Kushner

1982

198

“…In contrast, cognitive impairment has not always been associated with excess morbidity (19)(20)(21). Although some studies have shown increased mortality in patients with NP disease (22)(23)(24)(25)(26), others have not (7,15,27,28).…”

Section: Discussionmentioning

confidence: 99%

Neuropsychiatric events at the time of diagnosis of systemic lupus erythematosus: An international inception cohort study

Hanly

Urowitz

Sánchez‐Guerrero

et al. 2007

269

217

Objective. To describe the prevalence, characteristics, attribution, and clinical significance of neuropsychiatric (NP) events in an international inception cohort of systemic lupus erythematosus (SLE) patients.Methods. The study was conducted by the Systemic Lupus International Collaborating Clinics (SLICC). Patients were enrolled within 15 months of fulfilling the American College of Rheumatology (ACR) SLE classification criteria. All NP events within a predefined enrollment window were identified using the ACR case definitions of 19 NP syndromes. Decision rules were derived to determine the proportion of NP disease attributable to SLE. Clinical significance was determined using the Short Form 36 (SF-36) Health Survey and the SLICC/ACR Damage Index (SDI).Results. A total of 572 patients (88% female) were recruited, with a mean ؎ SD age of 35 ؎ 14 years. The mean ؎ SD disease duration was 5.2 ؎ 4.2 months. Within the enrollment window, 158 of 572 patients (28%) had at least 1 NP event. In total, there were 242 NP events that encompassed 15 of 19 NP syndromes. The proportion of NP events attributed to SLE varied from 19% to 38% using alternate attribution models and occurred in 6.1-11.7% of patients. Those with NP events, regardless of attribution, had lower scores on the SF-36 and higher SDI scores compared with patients with no NP events.Conclusion. Twenty-eight percent of SLE patients experienced at least 1 NP event around the time of diagnosis of SLE, of which only a minority were attributed to SLE. Regardless of attribution, the occurrence of NP events was associated with reduced quality of life and increased organ damage.Nervous system involvement as part of systemic lupus erythematosus (SLE) is well recognized, although the prevalence is highly variable among studies (1-7). A wide range of neuropsychiatric (NP) manifestations have been described, which span common features such Dr. Hanly

“…Supportive of the hypothesis that DR4 may be protective against hypertension are some data suggesting that black patients with SLE are less likely to have arthritis (25,26), and more likely to have nephritis (27)(28)(29), than are white SLE patients. However, most such data are of equivocal statistical (and clinical) significance, and may be largely explained b y demographic factors other than race (25).…”

Section: Discussionmentioning

confidence: 99%

Arthritis and hypertension in patients with systemic lupus erythematosus

Kaplan

Ginzler

Feldman

1992

Self Cite

Objective. The purpose of this study was to test the hypothesis that patients with systemic lupus erythematosus (SLE) who have, as part of their disease, persistent rheumatoid-like arthritis are less likely to be hypertensive than are other patients with SLE. Methods. A retrospective chart analysis of 662 patients with SLE seen in a university clinic was performed.Results. Data analysis revealed that hypertension and persistent arthritis were inversely correlated, particularly in those patients without nephritis and particularly in black patients.Conclusion. We conclude that rheumatoid-like arthritis in patients with SLE is protective against hypertension, and speculate that this protection is conferred by a higher frequency of the DR4 allele.In 1954, Turner and Lansbury (1) noted that low diastolic blood pressure appeared to be a feature of rheumatoid arthritis (RA). That is, not only were both mean systolic and diastolic pressures substantially lower than those in several large comparison groups, but, more strikingly, diastolic pressure showed no increase with age between the third and eighth decades