Systemic Lupus Erythematosus Prevalence in Sweden in 2010: What Do National Registers Say?

Sjöwall, Christopher; Rönnblom, Lars; Jönsen, Andreas; Svenungsson, Elisabet

doi:10.1002/acr.22355

Cited by 35 publications

(36 citation statements)

References 13 publications

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“…Systemic lupus erythematosus was defined as at least two visits in the NPR (inpatient and outpatient non‐specialist care) with an SLE ICD code, with at least one SLE‐coded visit from a specialist (rheumatology, dermatology, nephrology, internal medicine, paediatrics). Previously in these register data we have demonstrated good face validity of our present SLE definition and found little misclassification when using supervised learning methods against nearly 1000 clinically confirmed cases from four rheumatology clinics in Sweden . If SLE were listed in the MBR or NPR before the baby's date of birth, the respective pregnancy was classified as maternal SLE exposed (i.e.…”

Section: Methodsmentioning

confidence: 64%

“…Systemic lupus erythematosus (SLE) is a chronic inflammatory systemic autoimmune disease that disproportionately affects women with a peak in incidence during their childbearing years. Using Swedish population registers, the prevalence of SLE among women ages 15–49 was approximately 100 per 100 000 in 2010 . Women with SLE have between a two‐ and fourfold higher risk of preeclampsia during pregnancy .…”

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confidence: 99%

“…Using Swedish population registers, the prevalence of SLE among women ages 15-49 was approximately 100 per 100 000 in 2010. 1 Women with SLE have between a two-and fourfold higher risk of preeclampsia during pregnancy. 2,3 Less is known about the risk of early-onset preeclampsia in SLE, which is associated with worse outcomes in mother and child and may be biologically distinct from later-onset preeclampsia.…”

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confidence: 99%

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Early‐onset Preeclampsia in Lupus Pregnancy

Simard

Arkema

Nguyen

et al. 2016

Paediatric Perinatal Epid

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Background Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease that occurs during childbearing years and has been associated with preeclampsia. However, little is known about preeclampsia of early onset, which is associated with severe adverse maternal and perinatal outcomes. Methods Using national population-based Swedish registers we identified women with SLE (≥2 visits with corresponding ICD-codes) and a sample without SLE who gave birth to singleton infants 2001-2012. Risk ratios (RR) and 95% confidence intervals (CI) for early-onset preeclampsia (defined by ICD-codes corresponding to preeclampsia registered at <34 weeks) in SLE women were calculated based on adjusted modified Poisson models for first, subsequent, and all pregnancies. Result Among 742 births to women with SLE and 10 484 births to non-SLE women there were 32 (4.3%) and 55 (0.5%) diagnoses of early-onset preeclampsia, respectively. SLE was associated with an increased risk of early-onset preeclampsia (RR 7.8, 95% CI 4.8, 12.9, all pregnancies). The association remained similar upon restriction to women without pregestational hypertension. Adjustment for antiphospholipid syndrome (APS)-proxy attenuated the association. RRs for early-onset preeclampsia were smaller for subsequent pregnancies (RR 4.7, 95% CI 2.0, 11.2) compared to first and all (see above). Conclusion Women with SLE are at increased risk of early-onset preeclampsia and this increased risk may be independent of the traditional risk factors pregestational hypertension, APS, BMI, or smoking. Women with SLE during pregnancy should be closely monitored for early-onset preeclampsia and future research needs to identify the non-traditional preeclampsia factors that might cause this serious outcome.

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Section: Methodsmentioning

confidence: 64%

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confidence: 99%

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confidence: 99%

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Early‐onset Preeclampsia in Lupus Pregnancy

Simard

Arkema

Nguyen

et al. 2016

Paediatric Perinatal Epid

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“…[6] NATURE AND NURTURE The prevalence of SLE varies between ethnic groups. In Sweden the prevalence rate is about 65-80 cases per 100,000 inhabitants [7,8]. The incidence is highest among women during childbearing years, with a female:male ratio of 9:1 [7,8].…”

Section: Sle Classificationmentioning

confidence: 99%

“…In Sweden the prevalence rate is about 65-80 cases per 100,000 inhabitants [7,8]. The incidence is highest among women during childbearing years, with a female:male ratio of 9:1 [7,8]. It is unknown why females are more susceptible to SLE, but estrogen is likely to contribute to systemic inflammation in SLE [9,10].…”

Section: Sle Classificationmentioning

confidence: 99%

Biomarkers of disease activity and organ damage in systemic lupus erythematosus

Wirestam¹

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Jag tror att när vi går igenom tiden att allt det bästa inte hänt än Håkan Hellström ABSTRACTSystemic lupus erythematosus (SLE) is a systemic inflammatory disease. Clinically, the distinction between ongoing inflammation attributed to SLE, and organ damage due to medication or co-morbidities remains challenging. In addition, SLE is a heterogeneous disease where the various disease phenotypes complicate the search for biomarkers that adequately reflect disease activity and/or signs of increasing organ damage. The aim of the thesis was to investigate and evaluate potential new biomarkers of disease activity and/or organ damage in SLE patients.High mobility group box protein-1 (HMGB1) is a nuclear non-histone protein that can shuttle to the cytoplasm, become secreted extracellularly, and participate in systemic inflammation.Administration of monoclonal anti-HMGB1 antibodies has been reported both to attenuate and intensify disease in animal models of arthritis and lupus. In Paper I of the thesis, circulating anti-HMGB1 was found in 23% of the SLE patients and correlated with disease activity variables. The biological role of these autoantibodies remains to be elucidated.As a consequence of massive circulating levels of cellular debris and immune complexes, SLE patients have insufficient capacity to remove such material via the reticuloendothelial system. Pentraxin 3 (PTX3) may possibly protect against lupus flares due to classical complement activation, opsonization of apoptotic cells, and cytokine induction. In Paper II, circulating PTX3 was found to be inhibited or exhausted by interferon (IFN)-α, a key cytokine of SLE pathogenesis, and serum levels of PTX3 in SLE patients were inversely related to IFN-α levels.Suppressed PTX3 levels may contribute to a vicious circle resulting in impaired waste clearance, autoantigen exposure and autoantibody production, and sustained disease activity.Osteopontin (OPN), a protein known to influence cell signaling and apoptosis, has been proposed as a marker of organ damage in pediatric lupus. In a Swedish cross-sectional study, circulating OPN levels were found to be raised in SLE (Paper III). In patients with recent-onset disease, OPN reflected disease activity, while in established disease, OPN appeared to mirror damage accrual and cardiovascular damage. In Paper IV, OPN was instead analyzed in an international longitudinal multi-center study based on patients with recent-onset SLE and follow-up data. OPN turned out to be a poor predictor of organ damage, but significant associations were observed between OPN and disease activity both at disease onset, as well as over 5 years of follow-up.In conclusion, increased anti-HMGB1 antibody and decreased PTX3 levels could potentially sustain the impaired waste-disposal. Of the molecules analyzed in this thesis, OPN seems to be the best marker of disease activity. Further studies of these proteins may help to better understand SLE pathogenesis and to optimize treatment of patients.

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Epidemiology and Damage Accrual of Systemic Lupus Erythematosus in Central Sweden: A Single‐Center Population‐Based Cohort Study Over 14 Years From Östergötland County

Arkema

Saleh

Sjöwall

2023

ACR Open Rheumatology

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ObjectiveVariations in prevalence and incidence of systemic lupus erythematosus (SLE) within a geographically defined area of central Sweden over a time period of 14 years were examined. Longitudinal differences in disease activity, laboratory test results, and damage accrual were investigated.MethodsAdults (aged ≥18 years) residing in Östergötland County between 2008 and 2021 (mean adult population: 357,000 citizens) with confirmed SLE were identified and followed prospectively until death, December 31, 2021, or emigration. We estimated annual incidence per 100,000 inhabitants stratified by sex and age. Linear regression with year of diagnosis as the outcome assessed whether each clinical measurement at diagnosis varied over time.ResultsPrevalence on December 31, 2021, was 71.5 of 100,000 (87% female). One hundred twenty‐six new cases were identified during the study period, yielding a mean annual incidence of 3.0 of 100,000 inhabitants; this was higher in females (4.8/100,000) than in males (1.2/100,000). Mean age at diagnosis was 43.7 years (SD 17.3). Age at diagnosis and disease activity measures increased over the calendar year of diagnosis (P < 0.05) whereas disease manifestations, including lupus nephritis, did not vary significantly. Accrual of organ damage was demonstrated over time since diagnosis and stratified by sex, lupus nephritis, and corticosteroid‐related damage. Approximately 40% developed damage within 5 years.ConclusionSLE prevalence and incidence estimates remained constant over 14 years, and disease phenotypes at SLE onset were similar. SLE was diagnosed also among older individuals with a smaller female‐to‐male ratio. Estimates of prevalence and incidence were comparable to previous Scandinavian reports but lower than observed in registry data from the US and the UK.

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Systemic Lupus Erythematosus Prevalence in Sweden in 2010: What Do National Registers Say?

Cited by 35 publications

References 13 publications

Early‐onset Preeclampsia in Lupus Pregnancy

Early‐onset Preeclampsia in Lupus Pregnancy

Biomarkers of disease activity and organ damage in systemic lupus erythematosus

Epidemiology and Damage Accrual of Systemic Lupus Erythematosus in Central Sweden: A Single‐Center Population‐Based Cohort Study Over 14 Years From Östergötland County

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