Damage in the Multiethnic Malaysian Systemic Lupus Erythematosus (SLE) Cohort: Comparison with Other Cohorts Worldwide

Shaharir, Syahrul Sazliyana; Hussein, Heselynn; Sakthiswary, Rajalingham; Said, Mohd Fuaad; Gafor, Abdul Halim Abdul; Mohd, Rozita; Mustafar, Ruslinda

doi:10.1371/journal.pone.0166270

Cited by 37 publications

(59 citation statements)

References 38 publications

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“…Majority of the patients in our cohort were less than 40 years old with mean age at diagnosis of 25.68 ± 11.58 years old. Nonetheless, our finding was similar with previous study [ 12 ] which included 80 SLE patients and the authors found no association between the SDI with age and age at diagnosis.…”

Section: Discussionsupporting

confidence: 93%

“…The distribution of organ damage in our cohort was neuropsychiatric damage (18.1%) followed by musculoskeletal damage (12.8%) similar with past reports. [ 10 ] However, other reports [ 11 , 12 ] observed the commonest system affected was musculoskeletal with the most frequent complication being avascular necrosis followed by corticosteroid-induced osteoporosis. In addition, cutaneous lesion was the most frequent system affected found in Brazilian patients with SLE.…”

Section: Discussionmentioning

confidence: 99%

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SLICC damage index score in systemic lupus erythematosus patients and its associated factors

Ghazali¹,

Daud²,

Mohammad³

et al. 2018

Medicine

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The aims of this study were to determine damage index in systemic lupus erythematosus (SLE) patients based on Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (SDI) and to determine the laboratory and clinico-demographic factors affecting SDI.This is a retrospective cohort study of 94 SLE patients attending rheumatology clinics in 2 local hospitals in Kelantan, Malaysia. The patients were divided into 2 groups based on SDI score assigned by the attending physician, 0 (without damage) or ≥1 (with damage). Newly diagnosed SLE patients with disease duration less than 6 months were excluded.A total of 45 (47.9%) SLE patients showed damage by SDI score. Majority of the subjects had neuropsychiatric damages (21/94; 22.3%) followed by skin (12/94; 12.8%) and musculoskeletal (6/94; 6.4%) damage. SDI score was significantly associated with higher disease duration (6.2 ± 6.57 years vs 4.5 ± 3.7 years; P = .018), lower prednisolone dose (8.74 ± 10.89 mg vs 4.89 ± 3.81 mg; P < .001), hypertension (P = .007), and exposure to cyclophosphamide (P = .004). Hypertension (P = .020), exposure to cyclophosohamide (P = 0.013), and lower prednisolone dose (P = .023) were significantly associated with damage by multivariable analysis.Higher SDI score was significantly associated with exposure to cyclophosphamide, suggesting that lower cyclophosphamide doses or alternative therapeutic agents are recommended.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

SLICC damage index score in systemic lupus erythematosus patients and its associated factors

Ghazali¹,

Daud²,

Mohammad³

et al. 2018

Medicine

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“…Most of our LN patients had extra renal involvement with haematological manifestation being the commonest followed by musculoskeletal, cutaneous neurological and serositis and consistent with others. 18 As reported in the previous literature, we also demonstrated that high urine PCI, hypoalbuminaemia, C3 and C4 hypocomplementaemia, increased SLEDAI2K and SLICC-ACR were associated with disease activity. 13 Surprisingly, we found that ESR was not significantly different between patients with active and inactive LN.…”

Section: Discussionsupporting

confidence: 87%

Regulatory T cells (CD4+CD25+FOXP3+) in lupus nephritis

et al. 2018

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Background: Systemic lupus erythromatosus (SLE) is an autoimmune disease with 20–65% of patients developing lupus nephritis (LN). Studies have reported 10% of LN patients will end up with end stage renal disease and their mortality rate is higher compared to patients without LN. Abnormality of regulatory T cells (Tregs) level is thought to be a potential factor for this LN development. The aim of study was to evaluate the percentage of Tregs in LN patients.Methods: This was a comparative cross sectional study involving LN patients and age and gender matched controls with a 2:1 ratio. The patients were grouped into active and inactive LN based on their lupus activity index; complement levels, ANA, dsDNA antibodies, ESR, SLE Disease Activity Index (SLEDAI2K) score and also urine PCI (uPCI>0.05 for active group). Disease history, demographic data, routine blood test, peripheral blood for differentials count were taken and recorded. Peripheral blood mononuclear cells were stained with CD4, CD25 and Foxp3 antibodies and percentage of Tregs was analysed using BD fluorescence-activated cell sorting (FACS) cytometer. We compared demographic and laboratory parameters between healthy controls and LN patients as well as active and inactive LN patients.Results: A total of 34 LN patients (32 females, 2 males) were recruited. Their mean age and disease duration were 37.97±11.14 years and 110.95±65.07 months respectively. Thirteen matched controls with mean age 35.23±7.89 years were enrolled. There was no demographic difference between 2 groups of LN patients. Tregs were significantly lower in active LN compared to inactive LN and healthy control (0.44±0.37% vs. 1.89±0.46% vs. 3.12±0.56% of the CD4+, P<0.001). C3 and C4 complement fragments were significantly reduced in patients with active disease (C3; 50.92±28.43 vs. 76.31±25.63, P=0.011) and (C4; 11.17±8.41 vs. 16.70±6.50 P=0.044). Proteinuria was significantly higher while serum albumin levels were significantly lower in active patients compared to inactive patients and healthy control (urine PCI; 0.25(0.15-0.3) vs. 0.03(0.01-0.05) vs. 0.01, P<0.001) and (albumin; 29.89±6.87 vs. 36.87±3.58 vs. 40.62±1.89mmol/L, P<0.001). We found positive inversely correlation between Tregs with SLEDAI2K (r = -0.572, P=0.011) and proteinuria (r = -0.451, P=0.007).Conclusions: Tregs, C3 and C4 complements, and albumin were significantly lower while proteinuria was significantly higher in active LN. There was positive inversely correlation between the percentage of Tregs with SLEDAI2K score and proteinuria.

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“…Ethnic differences are known to account for the variability in disease susceptibility and expression in SLE [ 15 , 16 ]. The objectives of this study are to evaluate the pattern of damage and to identify the risk factors for accumulated damage in our group of childhood-onset SLE.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for damage in childhood-onset systemic lupus erythematosus in Asians: a case control study

Sit

Chan

2018

Pediatr Rheumatol

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BackgroundAccumulated damage is an important prognostic factor in systemic lupus erythematous. However, the pattern of disease damage and its risk factors have not been well studied in childhood-onset systemic lupus erythematosus (cSLE) in Asia. The objectives are to evaluate the pattern of damage and to identify the risk factors for accumulated damage in an Asian group of cSLE.MethodsA retrospective chart review was conducted on a group of 59 patients with cSLE. Patient demographics and clinical variables were first collected at diagnosis. Over the course of their disease, clinical variables considered as risk factors for damage were also collected. Damage was measured using the Systemic Lupus International Collaborating Clinics/ American College of Rheumatology Damage Index (SDI) for each patient at their last encounter. Based on their SDI scores, patients were then dichotomized to two groups: a group with presence of disease damage (SDI ≥1) and a group with absence of disease damage (SDI score = 0). Clinical variables including age at diagnosis, gender, ethnicity, disease duration, disease manifestations, laboratory values at diagnosis, disease activity at diagnosis and last encounter, major organ involvement, number of lupus flares, major infection, and intensity of immunosuppressive medications were compared between the two groups. Growth failure and estimated glomerular filtration rate (eGFR) were also analysed as secondary outcomes.ResultsAfter a median disease duration and follow up of 7.8 years, 39 patients (66.1%) had no disease damage while 20 patients (33.9%) had acquired disease damage. Disease damage most frequently occurred in the ocular (15.3%), neuropsychiatric (11.9%) and musculoskeletal (11.9%) domains. The most frequent forms of damage were cataracts (11.9%), and avascular necrosis (unilateral and bilateral combined 10.2%). After controlling for other variables, presence of neuropsychiatric manifestations remained the only statistically significant risk factor for damage. The rate of growth failure in our group of patients was 16%. Patients who experienced growth failure were significantly younger at disease diagnosis. The median age of diagnosis was 10 for those who experienced growth failure, whereas the median age of diagnosis was 13 for those who did not experience growth failure. Despite a high rate of renal involvement in the group (79.7%), renal damage was only seen in 3.2% of the patients. 91.5% of the studied group had normal eGFR of ≥90 ml/min/1.73m2 at their last follow up.ConclusionThis group of patients had a low rate of damage accrual, with one of the lowest rates in renal damage when compared to other cohorts reported. The presence of neuropsychiatric manifestations was identified as the most significant risk factor for disease damage, while the most frequent forms of damage were cataracts and avascular necrosis, which were both related to prolonged steroid use. Despite the limitations of this study, it highlights the need for larger prospective studies to understand the relatio...

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Damage in the Multiethnic Malaysian Systemic Lupus Erythematosus (SLE) Cohort: Comparison with Other Cohorts Worldwide

Cited by 37 publications

References 38 publications

SLICC damage index score in systemic lupus erythematosus patients and its associated factors

SLICC damage index score in systemic lupus erythematosus patients and its associated factors

Regulatory T cells (CD4+CD25+FOXP3+) in lupus nephritis

Risk factors for damage in childhood-onset systemic lupus erythematosus in Asians: a case control study

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