Systemic lupus erythematosus. Treatment-related complications superimposed on chronic disease

Klippel, John H.

doi:10.1001/jama.263.13.1812

Cited by 22 publications

(15 citation statements)

References 25 publications

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“…A person with SLE may experience a wide range of symptoms over time, such as joint pain, fever, hair loss, fatigue, skin rashes, sun sensitivity, headaches, and breathlessness [1,2]. More than half will develop structural and functional abnormalities in one or more vital organs [1,3,4]. Current individualized treatment regimes encompassing anti-inflammatories, corticosteroids, cytotoxic therapies, and an antimalarial (hydroxychloroquine) can also lead to complications such as osteoporosis, weight gain, and retinal damage [3].…”

Section: Introductionmentioning

confidence: 99%

Persistence of unmet need for care among people with systemic lupus erythematosus: a longitudinal study

2008

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Section: Introductionmentioning

confidence: 99%

Persistence of unmet need for care among people with systemic lupus erythematosus: a longitudinal study

2008

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“…During the early part of the 10-year study period, there is some unevenness in the lines, depicting differences in prednisone-alone and combination-therapy treatment costs. For , 1990, and 1991, combination-therapy costs exceed prednisone-alone costs mainly because of the expense of cyclophosphamide. During 1992, however, the decreased need for dialysis and for kidney transplantation saves $1.52 million.…”

Section: Resultsmentioning

confidence: 99%

“…Whether the savings in drug costs would be offset by costs associated with management of renal failure is uncertain. Moreover, in this analysis, we did not consider costs associated with complications of drug therapy (24). The complications of corticosteroids that would be most relevant would include infections, influences on bone such as osteonecrosis and osteoporosis, premature coronary vascular disease, and cataracts.…”

Section: Discussionmentioning

confidence: 99%

The economic impact of treatment of severe lupus nephritis with prednisone and intravenous cyclophosphamide

McInnes

Schuttinga

Sanslone

et al. 1994

Arthritis & Rheumatism

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Objective. It has been reported that outcomes are improved in patients with severe lupus nephritis treated with combined prednisone and intravenous cyclophosphamide, compared with those treated with prednisone alone. These findings motivated this analysis of the economic impact of the combined therapy.Methods. The annual expected incidence of severe lupus nephritis in the year 1988 in the US was estimated to be 1,130. A hypothetical patient cohort of this size was used as the model for the present analysis; the costs of treatment with prednisone alone and with combined prednisone and intravenous cyclophosphamide were calculated and compared. The analysis took into account the expected rate of renal failure with each therapeutic approach, as well as age, sex, and the economic value of working years gained.Results. Although the treatment costs are higher for the combination therapy, the analysis revealed overall savings due to a reduced need for kidney dialysis or transplantation, and the economic value of working capacity gained. Savings attributable to patient care costs were $50.8 million; those attributable to working capacity gained were $42.3 million.Conclusion. This analysis indicates that over a

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“…The reactivation of latent infection and new infection may both be possible routes [17,48]. The complications of AVN, cellular immune defect by steroid use and alcoholic liver disease may induce a disturbance of the osseous arterioles and even microvascular tamponade, which then colonises a Salmonella infection following an episode of bacteraemia [49,50]. They have additive predisposing effects for Salmonella septic arthritis.…”

Section: Discussionmentioning

confidence: 99%

Salmonella septic arthritis in systemic lupus erythematosus and other systemic diseases

Chen

Luo

et al. 1998

Clin Rheumatol

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Salmonella infection is an important problem in immunocompromised patients. The synovium is a particular metastatic focus of Salmonella infection and can result in many disabilities of life. Systemic lupus erythematosus (SLE) patients were highly susceptible to Salmonella infection. In the past 6 years, 41 patients with Salmonella septic arthritis have been treated in our hospital. Eleven patients had an underlying systemic disease of SLE which presented with a distinctive clinical course. Alcoholic liver disease (six cases) was another common underlying systemic disease. The most frequent predisposing articular factor was avascular necrosis (16 cases). The hip joint was the most commonly involved site. Salmonella group B was the most common serotype (30/41). Seventy-three per cent (8/11) of the SLE group had involvement of two or more joints compared with only three out of 30 patients in the non-SLE group. The sex differentiation shows a predominance of young females (10/11) in the SLE group and middle-aged males in the non-SLE group. Moreover, in the SLE group, all 11 patients shared the risk of lupus nephritis and steroid use. Ten patients had Salmonella group B bacteraemia and five had urinary tract infections simultaneously. In the non-SLE group, there were 10 patients with a history of steroid use, three with antecedent enteritis, 12 with bacteraemia, and three with necrotising fasciitis. Seven patients in each of the groups had a recurrent course. However, three patients in the non-SLE group had died during the episode of septic arthritis.

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Systemic lupus erythematosus. Treatment-related complications superimposed on chronic disease

Cited by 22 publications

References 25 publications

Persistence of unmet need for care among people with systemic lupus erythematosus: a longitudinal study

Persistence of unmet need for care among people with systemic lupus erythematosus: a longitudinal study

The economic impact of treatment of severe lupus nephritis with prednisone and intravenous cyclophosphamide

Salmonella septic arthritis in systemic lupus erythematosus and other systemic diseases

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