High Impact of Antiphospholipid Syndrome on Irreversible Organ Damage and Survival of Patients With Systemic Lupus Erythematosus

Ruiz‐Irastorza, Guillermo; Egurbide, Maria-Victoria; Ugalde, Jesus M.; Aguirre, Carmelo Ibáñez

doi:10.1001/archinte.164.1.77

Cited by 207 publications

(163 citation statements)

References 26 publications

Supporting

Mentioning

146

Contrasting

Unclassified

Order By: Relevance

“…Recent studies have also shown that the antiphospholipid syndrome with thrombotic complications in SLE is a major adverse factor for irreversible organ damage and survival (26). In large cohort studies, the lupus anticoagulant has been shown to be a significant risk factor for myocardial infarction (20) and stroke (27) in both Caucasian and non-Caucasian patients with SLE.…”

mentioning

confidence: 99%

Incidence and risk factors of thromboembolism in systemic lupus erythematosus: A comparison of three ethnic groups

Mok

Tang

et al. 2005

Arthritis & Rheumatism

220

173

View full text Add to dashboard Cite

Objective. To compare the incidence and risk factors for thromboembolic events in systemic lupus erythematosus (SLE) patients of different ethnic backgrounds.Methods. SLE patients who were newly diagnosed or were referred within 6 months of diagnosis between 1996 and 2002 were prospectively followed up for the occurrence of thromboembolic events. Cumulative hazard and risk factors for thromboembolism were evaluated and compared among patients of different ethnic origins.Results. We studied 625 patients who fulfilled the American College of Rheumatology criteria for SLE (89% women): 258 Chinese, 140 African Americans, and 227 Caucasians. The mean ؎ SD age at SLE diagnosis was 35.7 ؎ 14 years. After a followup of 3,094 patientyears, 48 arterial events and 40 venous events occurred in 83 patients. The overall incidence of arterial and venous thromboembolism was 16/1,000 patient-years and 13/1,000 patient-years, respectively. The cumulative hazard of arterial events at 60 months after the diagnosis of SLE was 8.5%, 8.1%, and 5.1% for the Chinese, African Americans, and Caucasians, respectively. The corresponding cumulative risk of venous events was 3.7%, 6.6%, and 10.3%, respectively (P ‫؍‬ 0.008 for Chinese versus Caucasians, by log rank test). Smoking, obesity, antiphospholipid antibodies, and use of antimalarial agents and exogenous estrogens were less frequent in the Chinese patients. In Cox regression models, low levels of high-density lipoprotein (HDL) cholesterol, Chinese ethnicity, oral ulcers, and serositis predicted arterial events, whereas male sex, low levels of HDL cholesterol, antiphospholipid antibodies, non-Chinese ethnicity, obesity, renal disease, and hemolytic anemia predicted venous events.Conclusion. There are ethnic differences in the incidence of arterial and venous thromboembolism in patients with SLE that cannot be fully explained by the clinical factors studied. Further evaluation of other genetic and immunologic factors is warranted.Premature atherosclerosis is a major cause of mortality and late morbidity in patients with systemic lupus erythematosus (SLE) (1-3). In several cohort studies, it was found that atherosclerotic cardiovascular and cerebrovascular diseases are more common causes of late deaths than active SLE itself (1,(4)(5)(6). More recent studies have demonstrated that subclinical coronary heart disease and carotid plaque were present in a significantly higher proportion of SLE patients than in age-and sex-matched control subjects with similar risk factors (7,8). The etiology of accelerated atherosclerosis in SLE is multifactorial and cannot be fully explained by traditional risk factors (9).Compared with individuals without SLE, the risk of myocardial infarction in SLE patients is 2-50 times higher, and the risk of stroke is 2-10 times higher (2,9,10). The prevalence of symptomatic coronary heart disease in SLE patients has been reported to be 6-20%, The Hopkins Lupus Cohort is supported by NIH grants R01-AR-43727 and M01-RR-00052 (to the outpatient Clinical Research Center).

show abstract

mentioning

confidence: 99%

Incidence and risk factors of thromboembolism in systemic lupus erythematosus: A comparison of three ethnic groups

Mok

Tang

et al. 2005

Arthritis & Rheumatism

220

173

View full text Add to dashboard Cite

show abstract

“…3 The effect APS may exert on mortality, however, has been more rarely investigated. 11,12 There are studies which have associated survival with the age at the diagnosis of SLE. 3,5,[11][12][13] Being diagnosed after the age of 50 years has been associated with poor survival.…”

Section: Discussionmentioning

confidence: 99%

“…11,12 There are studies which have associated survival with the age at the diagnosis of SLE. 3,5,[11][12][13] Being diagnosed after the age of 50 years has been associated with poor survival. 3 Ruiz-Irastorza et al 11 have identified older age at the time of diagnosis as an independent risk factor for mortality.…”

Section: Discussionmentioning

confidence: 99%

“…3,5,[11][12][13] Being diagnosed after the age of 50 years has been associated with poor survival. 3 Ruiz-Irastorza et al 11 have identified older age at the time of diagnosis as an independent risk factor for mortality. In another study in an attempt to minimize the effect of age on mortality, an age-matched control group was included, and, in conclusion, death risk in late-onset SLE patients was detected to be higher than that in adult-onset SLE patients.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Survival Analysis of Turkish Patients With Systemic Lupus Erythematosus: Older Age at Diagnosis Affects Mortality

Teke

Korkmaz

2017

Arch Rheumatol

View full text Add to dashboard Cite

Objectives: This study aims to determine the rate, causes, and risk factors of mortality in Turkish systemic lupus erythematosus (SLE) patients and whether age at diagnosis has an effect on mortality or not. Patients and methods:We retrospectively analyzed the data from 221 patients (10 males, 211 females; mean age 41.5±13.5 years; range 18 to 74 years) who were followed-up due to the diagnosis of SLE in our department between January 1998 and March 2016. Detailed clinical findings, organ involvements, autoantibodies, and complement levels of the patients were recorded. Results: Of the entire group, 19 patients (8.6%) died. Mortality incidence rate was 1.05/100 patient-years. Most frequent causes of death were infections, ischemic cardiovascular and cerebrovascular diseases. Through univariate analysis, older age at diagnosis and a short duration of follow-up were identified as the only factors with an influence on mortality (p=0.004 and p=0.002, respectively). Beyond the mentioned factors, organ involvements in SLE, autoantibodies or antiphospholipid antibody syndrome were not found to have a relationship with mortality. Further analysis conducted on late-onset, defined as the patient age of 50 or above at diagnosis, versus adult-onset, defined as the diagnosis at an age of younger than 50 years, revealed a remarkably shorter survival in patients diagnosed after age of 50 (p=0.003). Cumulative five-year, 10-year, and 15-year survivals of patients were 91.9%, 90%, and 88.2%, respectively. Conclusion: We identified older age at diagnosis as an effective factor on mortality. SLE patients who are diagnosed at an older age should be more closely and meticulously followed-up than those diagnosed earlier in terms of their mortality risk.

show abstract

“…Although aPL increases the risk of vascular events and death in SLE (32)(33)(34)(35)(36), the role of aPL in the development of atherosclerosis in humans remains controversial (37,38). Antiphospholipid antibodies crossreact with antibodies against oxidized low-density lipoprotein (LDL) (39,40) and may enhance its uptake by macrophages (41), which represents the initial step of atherosclerotic plaque formation (42).…”

mentioning

confidence: 99%

Untitled

2016

Eur J Rheumatol

View full text Add to dashboard Cite

High Impact of Antiphospholipid Syndrome on Irreversible Organ Damage and Survival of Patients With Systemic Lupus Erythematosus

Abstract: Antiphospholipid syndrome with thrombotic manifestations is a major predictor of irreversible organ damage and death in patients with SLE.

Cited by 207 publications

References 26 publications

Incidence and risk factors of thromboembolism in systemic lupus erythematosus: A comparison of three ethnic groups

Incidence and risk factors of thromboembolism in systemic lupus erythematosus: A comparison of three ethnic groups

Survival Analysis of Turkish Patients With Systemic Lupus Erythematosus: Older Age at Diagnosis Affects Mortality

Untitled

Contact Info

Product

Resources

About