Please use this identifier to cite or link to this item:
https://repository.monashhealth.org/monashhealthjspui/handle/1/29232
Title: | High disease activity status suggests more severe disease and damage accrual in systemic lupus erythematosus. | Authors: | Koelmeyer R.;Nim H.T.;Nikpour M.;Sun Y.B.;Kao A.;Guenther O.;Morand E. ;Hoi A. | Monash Health Department(s): | Rheumatology | Institution: | (Koelmeyer, Morand, Hoi) Monash Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, VIC, Australia (Nim) Faculty of Information Technology, Monash University, Clayton, VIC, Australia (Nikpour) Department of Medicine, University of Melbourne, Fitzroy, VIC, Australia (Nikpour) Rheumatology, St Vincent Hospital Melbourne, Fitzroy, VIC, Australia (Sun, Guenther) Global Evidence and Value Development, Merck Healthcare KGaA, Darmstadt, Germany (Kao) Global Clinical Development, EMD Serono Research and Development Institute, Darmstadt, Germany (Morand, Hoi) Department of Rheumatology, Monash Health, Clayton, VIC, Australia | Issue Date: | 10-Jun-2020 | Copyright year: | 2020 | Publisher: | BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com) | Place of publication: | United Kingdom | Publication information: | Lupus Science and Medicine. 7 (1) (no pagination), 2020. Article Number: e000372. Date of Publication: 27 May 2020. | Journal: | Lupus Science and Medicine | Abstract: | Objective Disease severity in SLE is an important concept related to disease activity, treatment burden and prognosis. We set out to evaluate if high disease activity status (HDAS), based on ever attainment of a Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) disease activity score of >=10, is an indicator for disease severity in SLE. Methods Using prospectively collected data, we assessed the association of HDAS with sociodemographic and disease characteristics and adverse clinical outcomes using logistic regression or generalised estimating equations. Results Of 286 patients with SLE, who were observed for a median (range) of 5.1 years (1-10.8 years), 43.7% experienced HDAS at least once during the observational period. Autoantibody positivity, particularly anti-dsDNA and anti-Sm positivity, were associated with increased likelihood of HDAS. Age >=45 years at diagnosis was associated with reduced likelihood of HDAS (p=0.002). Patients with HDAS had higher Physician Global Assessment score (>1: OR 8.1, p<0.001) and were more likely to meet criteria for flare (mild/moderate flare: OR 4.4, p<0.001; severe flare: OR 17.2, p<0.001) at the time of experiencing HDAS. They were also more likely to have overall higher disease activity, as defined by time-adjusted mean SLEDAI-2K score in the highest quartile (OR 11.7, 95% CI 5.1 to 26.6; p>0.001), higher corticosteroid exposure (corticosteroid dose in highest quartile: OR 7.7, 95% CI 3.9 to 15.3; p<0.001) and damage accrual (OR 2.3, 95% CI 1.3 to 3.9; p=0.003) when compared with non-HDAS patients. Conclusions HDAS is associated with more severe disease, as measured by higher disease activity across time, corticosteroid exposure and damage accrual. The occurrence of HDAS may be a useful prognostic marker in the management of SLE.Copyright © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1136/lupus-2019-000372 | ISSN: | 2053-8790 (electronic) | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/29232 | Type: | Article | Subjects: | SLEDAI social status *systemic lupus erythematosus/dt [Drug Therapy] autoantibody/ec [Endogenous Compound] azathioprine/dt [Drug Therapy] beta2 glycoprotein 1 antibody/ec [Endogenous Compound] cardiolipin antibody/ec [Endogenous Compound] corticosteroid/dt [Drug Therapy] cyclophosphamide/dt [Drug Therapy] double stranded DNA antibody/ec [Endogenous Compound] hydroxychloroquine/dt [Drug Therapy] La antibody/ec [Endogenous Compound] leflunomide/dt [Drug Therapy] lupus anticoagulant/ec [Endogenous Compound] mercaptopurine/dt [Drug Therapy] methotrexate/dt [Drug Therapy] mycophenolic acid/dt [Drug Therapy] neutrophil cytoplasmic antibody/ec [Endogenous Compound] phospholipid antibody/ec [Endogenous Compound] prednisolone/dt [Drug Therapy] rheumatoid factor/ec [Endogenous Compound] ribonucleoprotein antibody/ec [Endogenous Compound] Sm antibody/ec [Endogenous Compound] *high disease activity status adult article clinical feature clinical outcome comparative study corticosteroid therapy demography *disease activity disease activity score disease severity female human major clinical study male middle aged observational study physician priority journal scoring system SLEDAI social status systemic lupus erythematosus autoantibody azathioprine beta2 glycoprotein 1 antibody cardiolipin antibody corticosteroid cyclophosphamide double stranded DNA antibody hydroxychloroquine La antibody leflunomide lupus anticoagulant mercaptopurine methotrexate mycophenolic acid neutrophil cytoplasmic antibody phospholipid antibody prednisolone rheumatoid factor ribonucleoprotein antibody Sm antibody high disease activity status corticosteroid therapy disease activity disease activity score physician disease severity female human major clinical study male middle aged observational study physician priority journal adult SLEDAI social status *systemic lupus erythematosus / *drug therapy scoring system Article clinical feature clinical outcome comparative study corticosteroid therapy demography *disease activity disease activity score |
Type of Clinical Study or Trial: | Observational study (cohort, case-control, cross sectional or survey) |
Appears in Collections: | Articles |
Show full item record
Items in Monash Health Research Repository are protected by copyright, with all rights reserved, unless otherwise indicated.