SLE disease patterns in a Danish population-based lupus cohort: an 8-year prospective study

Abstract

In 1995 all systemic lupus erythematosus (SLE) patients in the county of Funen were retrieved from four separate and independent sources as part of an 8-year prospective study to determine the pattern of disease activity and damage accumulation in a community based lupus cohort of predominantly Scandinavian ancestry. Incident cases were subsequently identified by surveillance of these sources. Established and new cases underwent annual, structured interviews, clinical examination and blood sampling. The Systemic Lupus Erythematosus Diseases Activity Index SLEDAI and Systemic Lupus International Collaborating Clinics SLICC scores were calculated. Flares were defined as modified - SLEDAI >or= 4. The annual flare rate in definite SLE (D-SLE) was 0.21 (95%CI 0.18-0.24) versus 0.03 (95%CI 0.01-0.07) in incomplete SLE (I-SLE). Forty-three per cent of the entire study population had no disease exacerbations. Infections requiring hospital admission and thrombocytopenia were significantly more frequent among patients with relapsing disease (p < 0.04-0.01). Patients with flares had slightly shorter disease duration and were younger at disease onset than patients with a quiescent course. The most recently diagnosed patients had the lowest annual rate of damage accrual. According to flare rate, two major subsets of almost equal size were identified - one having a long quiescent course, the other exhibiting relapses alternating with remissions. An increased risk of flares was associated with short disease duration and younger age at disease onset, infections requiring hospital admission and thrombocytopenia. Temporal damage increment was the lowest in the most recently diagnosed patients.

The number of flares patients experience impacts on damage accrual in systemic lupus erythematosus: data from a multiethnic Latin American cohort

“…It is also worth pointing out that the rate of flares we have observed in our patients is consistent with the rates observed by investigators from Denmark (17 per 100 patient-years),45 Padova, Italy (19 per 100 patient-years)46 and Hong Kong (24 per 100 patient-years),47 but lower that the ones reported from Germany (124 per 100 patient-years),48 and higher than the rates reported in Rome, Italy (7 per 100 patient-years) 49. Other definitions of flares have yielded higher rates of flares (65–194 per 100 patient-years) in patients with lupus.…”

Prolonged remission in Caucasian patients with SLE: prevalence and outcomes

“…In our cohort, 100% of patients were Caucasian and this could also contribute to the better outcome in terms of remission compared with other studies 8 9 12–15. The exclusion of patients with different ethnicity can partially explain why our patients had a lower prevalence of glomerulonephritis and vasculitis and took a lower cumulative dose of corticosteroids 14 15…”

Validation and evaluation of the German Brief Index of Lupus Damage (BILD) – a self-reported instrument to record damage in systemic lupus erythematosus

“…The two validation studies of the LDIQ showed mean SDI scores of 1.53 and 1.94 that are comparable to the SDI in our population, as did a Danish population examined by Laustrup et al with an SDI between 1.5 and 2 (disease duration >8 years). 13 16 showed considerably higher or lower SDI values. Therefore our cohort reflects an ordinary patient composition with respect to acquired damage.…”