Identification of clinical predictors of flare in systemic lupus erythematosus patients: a 24-month prospective cohort study

Abstract

Objective. SLE has a relapsingremitting course with disease activity flares over time. This study aims to identify clinical predictors of SLE flares.Methods. This prospective cohort study over 24 months included all SLE patients on follow-up at one academic lupus clinic. Flare was defined as an increase in SLEDAI-2K score 54 points. Baseline clinical and demographic parameters were compared using survival analysis for time-to-flare outcome with univariate log-rank tests. Variables with significant differences were further evaluated as predictors with multivariate Cox regression models adjusting for potential confounding or contributing factors and hazard ratio (HR) calculation.Results. A total of 202 SLE patients were included. Over the follow-up period, 1083 visits were documented and 16.8% of patients presented with flares. In multivariate analysis, the following parameters emerged as flare predictors: SLE diagnosis up to 25 years of age (HR = 2.14, P = 0.03), lupus nephritis previous to baseline visit (HR = 4.78, P < 0.0001) and immunosuppressor treatment for severe SLE (HR = 3.22, P < 0.001). Baseline disease activity, disease duration and treatment with prednisone or HCQ were not predictive factors. Conclusion.Patients with an SLE diagnosis before age 25 years, lupus nephritis or immunosuppressor treatment for severe SLE present greater HRs for flares, suggesting the need for tighter clinical monitoring. Current immunosuppressive strategies seem to be inefficient in providing flare prevention.

Classification of Systemic Lupus Erythematosus: Systemic Lupus International Collaborating Clinics Versus American College of Rheumatology Criteria. A Comparative Study of 2,055 Patients From a Real‐Life, International Systemic Lupus Erythematosus Cohort

“…In our study we aimed to include a multicenter representative sample of the real-life SLE population participating in interventional and observational studies in Spain and Portugal (7)(8)(9). The large population included in this study is also likely to be representative of the general population of SLE patients, as most individuals with a clinical suspicion of SLE regardless of disease severity are likely to be referred to the participating centers in these countries.…”

“…For the original derivation and validation work, SLE patients and control subjects with a relevant non-SLE diagnosis were selected from highly specialized lupus clinics, and the "gold standard" SLE clinical diagnosis was established by an expert committee reviewing abstracted patient scenarios (5). In our study we aimed to include a multicenter representative sample of the real-life SLE population participating in interventional and observational studies in Spain and Portugal (7)(8)(9). The large population included in this study is also likely to be representative of the general population of SLE patients, as most individuals with a clinical suspicion of SLE regardless of disease severity are likely to be referred to the participating centers in these countries.…”

Flares in systemic lupus erythematosus: diagnosis, risk factors and preventive strategies

“…Nonetheless, it is estimated that approximately 20-25% of SLE patients will flare within 1-2 years and 40-66% within 5-10 years after achievement of a low disease activity or remission status. 48,[62][63][64][65] Seventy to eighty percent of the flares are of mild or moderate severity, with the remaining 20-30% be classified as severe. The most frequently involved organs are the mucocutaneous, musculoskeletal (arthritis), hematological, renal (30-40%) and immunology.…”

“…To this end, a number of predictive parameters have been described ( Table 3). 2,48,[62][63][64]67,[71][72][73][74] Specifically, demographic characteristics associated with increased risk for flares include African-American ethnicity (OR 1.8 compared to Caucasian ethnicity), disease onset ≤25 years (hazard ratio [HR] 2.1), and male gender. 63,64,72 Patients with history of major organ disease, particularly nephritis (HR 4.8) and cytopenia, are also at higher risk.…”

Systemic lupus erythematosus: An update for ophthalmologists

“…Lupus nephritis is not only an indicator of disease severity but is also identified as a clinical predictor of flare ups 58 . It ranges from mild, `background` glomerulonephritis to chronic kidney disease (CKD), with 10-30% progressing to end stage CKD within 15 years.…”