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1. Impact of glucocorticoids on the incidence of lupus-related major organ damage: a systematic literature review and meta-regression analysis of longitudinal observational studies

Author

Ugarte Gil, Manuel Francisco, Mak, Anselm, Leong, Joanna, Dharmadhikari, Bhushan, Kow, Nien Yee, Reategui-Sokolova, Cristina, Elera-Fitzcarrald, Claudia, Aranow, Cinthia, Arnaud, Laurent, Askanase, Anca D., Bae, Sang-Cheol, Bernatsky, Sasha, Bruce, Ian N., Buyon, Jill, Costedoat-Chalumeau, Nathalie, Dooley, Mary Ann, Fortin, Paul R., Ginzler, Ellen M., Gladman, Dafna D., Hanly, John, Inanc, Murat, Isenberg, David, Jacobsen, Soren, James, Judith A., Jonsen, Andreas, Kalunian, Kenneth, Kamen, Diane L., Lim, Sung Sam, Morand, Eric, Mosca, Marta, Peschken, Christine, Pons-Estel, Bernardo A., Rahman, Anisur, Ramsey-Goldman, Rosalind, Reynolds, John, Romero-Diaz, Juanita, Ruiz-Irastorza, Guillermo, Sanchez-Guerrero, Jorge, Svenungsson, Elisabet, Urowitz, Murray, Vinet, Evelyne, van Vollenhoven, Ronald F., Voskuyl, Alexandre, Wallace, Daniel J., Petri, Michelle A., Manzi, Susan, Clarke, Ann Elaine, Cheung, Mike, Farewell, Vernon, and Alarcón, Graciela S.

Subjects
systematic review, Lupus, Glucocorticoids
Abstract

Objective: In systemic lupus erythematosus (SLE), disease activity and glucocorticoid (GC) exposure are known to contribute to irreversible organ damage. We aimed to examine the association between GC exposure and organ damage occurrence. Methods: We conducted a literature search (PubMed (Medline), Embase and Cochrane January 1966–October 2021). We identified original longitudinal observational studies reporting GC exposure as the proportion of users and/or GC use with dose information as well as the occurrence of new major organ damage as defined in the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index. Meta-regression analyses were performed. Reviews, case-reports and studies with

Published
2021

2. Osteopontin versus disease activity and damage accrual in recent-onset systemic lupus erythematosus: Results from the Systemic Lupus International Collaborating Clinics Inception Cohort

Author

Wirestam, Lina, Enocsson, Helena, Skogh, Thomas, Padyukov, Leonid, Jönsen, Andreas, Urowitz, Murray, Gladman, Dafna, Romero-Diaz, Juanita, Bae, Sang-Cheol, Fortin, Paul R, Sanchez-Guerrero, Jorge, Clarke, Ann, Bernatsky, Sasha, Gordon, Caroline, Hanly, John G, Wallace, Daniel, Isenberg, David, Rahman, Anisur, Merrill, Joan, Ginzler, Ellen, Alarcón, Graciela S, Chatham, W Winn, Petri, Michelle, Khamashta, Munther, Aranow, Cynthia, Mackay, Meggan, Dooley, Mary Anne, Manzi, Susan, Ramsey-Goldman, Rosalind, Nived, Ola, Steinsson, Kristjan, Zoma, Asad, Ruiz-Irastorza, Guillermo, Lim, Sam, Kalunian, Ken, Inanc, Murat, van Vollenhoven, Ronald, Ramos-Casals, Manuel, Kamen, Diane L, Jacobsen, SØren, Peschken, Christine, Askanase, Anca, Stoll, Thomas, Bruce, Ian N, Wetterö, Jonas, and Sjöwall, Christopher

Subjects
Adult, Male, Asia, Internationality, Adolescent, Enzyme-Linked Immunosorbent Assay, Severity of Illness Index, Article, Young Adult, Sex Factors, stomatognathic system, Reference Values, Humans, Lupus Erythematosus, Systemic, skin and connective tissue diseases, Child, Aged, Age Factors, Middle Aged, Europe, Cross-Sectional Studies, Logistic Models, Multivariate Analysis, North America, Disease Progression, Female, Osteopontin, Biomarkers, Follow-Up Studies
Abstract

In cross-sectional studies, elevated osteopontin (OPN) levels have been proposed to reflect, and/or precede, progressive organ damage and disease severity in systemic lupus erythematosus (SLE). We aimed, in a cohort of patients with recent-onset SLE, to determine whether raised serum OPN levels precede damage and/or are associated with disease activity or certain disease phenotypes.We included 344 patients from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort who had 5 years of followup data available. All patients fulfilled the 1997 American College of Rheumatology (ACR) criteria. Baseline sera from patients and from age- and sex-matched population-based controls were analyzed for OPN using ELISA. Disease activity and damage were assessed at each annual followup visit using the SLE Disease Activity Index 2000 (SLEDAI-2K) and the SLICC/ACR damage index (SDI), respectively.Compared to controls, baseline OPN was raised 4-fold in SLE cases (p0.0001). After relevant adjustments in a binary logistic regression model, OPN levels failed to significantly predict global damage accrual defined as SDI ≥ 1 at 5 years. However, baseline OPN correlated with SLEDAI-2K at enrollment into the cohort (r = 0.27, p0.0001), and patients with high disease activity (SLEDAI-2K ≥ 5) had raised serum OPN (p0.0001). In addition, higher OPN levels were found in patients with persistent disease activity (p = 0.0006), in cases with renal involvement (p0.0001) and impaired estimated glomerular filtration rate (p = 0.01).The performance of OPN to predict development of organ damage was not impressive. However, OPN associated significantly with lupus nephritis and with raised disease activity at enrollment, as well as over time.

Published
2019

3. Cerebrovascular Events in Systemic Lupus Erythematosus

Author

Hanly, John G., Li, Qiuju, Su, Li, Urowitz, Murray B., Gordon, Caroline, Bae, Sang-Cheol, Romero-Diaz, Juanita, Sanchez-Guerrero, Jorge, Bernatsky, Sasha, Clarke, Ann E., Wallace, Daniel J., Isenberg, David A., Rahman, Anisur, Merrill, Joan T., Fortin, Paul, Gladman, Dafna D., Bruce, Ian N., Petri, Michelle, Ginzler, Ellen M., Dooley, M. A., Steinsson, Kristjan, Ramsey-Goldman, Rosalind, Zoma, Asad A., Manzi, Susan, Nived, Ola, Jonsen, Andreas, Khamashta, Munther A., Alarcón, Graciela S., Chatham, Winn, van Vollenhoven, Ronald F., Aranow, Cynthia, Mackay, Meggan, Ruiz-Irastorza, Guillermo, Ramos-Casals, Manuel, Lim, S. Sam, Inanc, Murat, Kalunian, Kenneth C., Jacobsen, Soren, Peschken, Christine A., Kamen, Diane L., Askanase, Anca, Theriault, Chris, Farewell, Vernon, AII - Inflammatory diseases, Clinical Immunology and Rheumatology, AMS - Amsterdam Movement Sciences, and AII - Amsterdam institute for Infection and Immunity

Abstract

To determine the frequency, associations and outcomes of cerebrovascular events (CerVEs) in a multi-ethnic/racial, prospective, SLE disease inception cohort. Patients were assessed annually for 19 neuropsychiatric (NP) events including 5 types of CerVEs: (i) Stroke; (ii) Transient ischemia; (iii) Chronic multifocal ischemia; (iv) Subarachnoid/intracranial hemorrhage; (v) Sinus thrombosis. Global disease activity (SLEDAI-2K), SLICC/ACR damage index (SDI) and SF-36 scores were collected. Time to event, linear and logistic regressions and multi-state models were used as appropriate. Of 1,826 SLE patients, 88.8% were female, 48.8% Caucasian, mean±SD age 35.1±13.3 years, disease duration 5.6±4.2 months and follow-up 6.6±4.1 years. CerVEs were the fourth most frequent NP event: 82/1,826 (4.5%) patients had 109 events, 103/109 (94.5%) were attributed to SLE and 44/109 (40.4%) were identified at enrollment. The predominant events were stroke [60/109 (55.0%)] and transient ischemia [28/109 (25.7%)]. CerVEs were associated with other NP events attributed to SLE (HR (95% CI): (3.16; 1.73-5.75) (p

Published
2018

4. Mood Disorders in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study

Author

Hanly, John G., Su, Li, Urowitz, Murray B., Romero-Diaz, Juanita, Gordon, Caroline, Bae, Sang-Cheol, Bernatsky, Sasha, Clarke, Ann E., Wallace, Daniel J., Merrill, Joan T., Isenberg, David A., Rahman, Anisur, Ginzler, Ellen M., Petri, Michelle, Bruce, Ian N., Dooley, M. A., Fortin, Paul, Gladman, Dafna D., Sanchez-Guerrero, Jorge, Steinsson, Kristjan, Ramsey-Goldman, Rosalind, Khamashta, Munther A., Aranow, Cynthia, Alarcón, Graciela S., Fessler, Barri J., Manzi, Susan, Nived, Ola, Sturfelt, Gunnar K., Zoma, Asad A., van Vollenhoven, Ronald F., Ramos-Casals, Manuel, Ruiz-Irastorza, Guillermo, Lim, S. Sam, Kalunian, Kenneth C., Inanc, Murat, Kamen, Diane L., Peschken, Christine A., Jacobsen, Soren, Askanase, Anca, Theriault, Chris, Thompson, Kara, Farewell, Vernon, Su, Li [0000-0003-0919-3462], Farewell, Vernon [0000-0001-6704-5295], and Apollo - University of Cambridge Repository

Subjects
Adult, Male, Internationality, Mood Disorders, Incidence, Black People, Hispanic or Latino, Middle Aged, Article, White People, Cohort Studies, Asian People, Disease Progression, Quality of Life, Humans, Lupus Erythematosus, Systemic, Regression Analysis, Female, Prospective Studies, Autoantibodies
Abstract

OBJECTIVE: To examine the frequency, characteristics, and outcome of mood disorders, as well as clinical and autoantibody associations, in a multiethnic/racial, prospective inception cohort of patients with systemic lupus erythematosus (SLE). METHODS: Patients were assessed annually for mood disorders (4 types, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and 18 other neuropsychiatric events. Global disease activity scores (SLE Disease Activity Index 2000 [SLEDAI-2K]), damage scores (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]), and Short Form 36 subscales, mental and physical component summary scores were collected. Time to event, linear and ordinal regressions, and multi-state models were used as appropriate. RESULTS: Among the 1,827 patients with SLE, 88.9% were female, and 48.9% were Caucasian. The mean ± SD age of the patients was 35.1 ± 13.3 years, disease duration was 5.6 ± 4.8 months, and the length of followup was 4.7 ± 3.5 years. During the course of the study, 863 (47.2%) of the 1,827 patients had 1,627 neuropsychiatric events. Mood disorders occurred in 232 (12.7%) of 1,827 patients, and 98 (38.3%) of 256 mood disorder events were attributed to SLE. The estimated cumulative incidence of any mood disorder after 10 years was 17.7% (95% confidence interval 15.1, 20.2%). A greater risk of mood disorder was associated with concurrent neuropsychiatric events (P ≤ 0.01), and a lower risk was associated with Asian race/ethnicity (P = 0.01) and treatment with immunosuppressive drugs (P = 0.003). Mood disorders were associated with lower mental health and mental component summary scores but not with the SLEDAI-2K, SDI, or lupus autoantibodies. Among the 232 patients with depression, 168 (72.4%) were treated with antidepressants. One hundred twenty-six (49.2%) of 256 mood disorders resolved in 117 (50.4%) of 232 patients. CONCLUSION: Mood disorders, the second most frequent neuropsychiatric event in patients with SLE, have a negative impact on health-related quality of life and improve over time. The lack of association with global SLE disease activity, cumulative organ damage, and lupus autoantibodies emphasizes the multifactorial etiology of mood disorders and a role for non-lupus-specific therapies.

Published
2015

5. Factors associated with damage accrual in patients with systemic lupus erythematosus: results from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort

Author

Bernatsky, Sasha, Ramsey-Goldman, Rosalind, Bae, Sang-Cheol, Rahman, Anisur, Mackay, Meggan, Wallace, Daniel J, Dooley, Mary Anne, Hanly, John G, Sturfelt, Gunnar K, Ginzler, Ellen M, O'Keeffe, Aidan G, Manzi, Susan, Merrill, Joan T, Fortin, Paul R, Ramos-Casals, Manuel, Alarcón, Graciela S, Aranow, Cynthia, Nived, Ola, Steinsson, Kristjan, Bruce, Ian N, Petri, Michelle, Khamashta, Munther A, Sanchez-Guerrero, Jorge, Clarke, Ann E, Gordon, Caroline, Fessler, Barri J, Su, Li, Gladman, Dafna D, Isenberg, David A, Zoma, Asad A, Romero-Diaz, Juanita, and Farewell, Vern

Abstract

Background and aimsWe studied damage accrual and factors determining development and progression of damage in an international cohort of systemic lupus erythematosus (SLE) patients.MethodsThe Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort recruited patients within 15 months of developing four or more 1997 American College of Rheumatology (ACR) criteria for SLE; the SLICC/ACR damage index (SDI) was measured annually. We assessed relative rates of transition using maximum likelihood estimation in a multistate model. The Kaplan–Meier method estimated the probabilities for time to first increase in SDI score and Cox regression analysis was used to assess mortality.ResultsWe recruited 1722 patients; mean (SD) age 35.0 (13.4) years at cohort entry. Patients with damage at enrolment were more likely to have further worsening of SDI (SDI 0 vs ≥1; p

Published
2015
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6. Impact of early disease factors on metabolic syndrome in systemic lupus erythematosus: data from an international inception cohort

Author

Alarcón, Graciela S, Parker, Ben, Clarke, Ann E, Sanchez-Guerrero, Jorge, Manzi, Susan, Gordon, Caroline, Rahman, Anisur, Sturfelt, Gunnar K, Urowitz, Murray B, Donn, Rachelle, Fortin, Paul R, Petri, Michelle, Ginzler, Ellen M, Isenberg, David A, Wallace, Daniel J, Ramos-Casals, Manuel, Fessler, Barri J, Merrill, Joan T, Dooley, Mary Anne, Khamashta, Munther A, Lunt, Mark, Bernatsky, Sasha, Ramsey-Goldman, Rosalind, Steinsson, Kristjan, Hanly, John G, Gladman, Dafna D, Aranow, Cynthia, Romero-Diaz, Juanita, Mackay, Meggan, Bae, Sang-Cheol, Zoma, Asad A, and Nived, Ola

Abstract

BackgroundThe metabolic syndrome (MetS) may contribute to the increased cardiovascular risk in systemic lupus erythematosus (SLE). We examined the association between MetS and disease activity, disease phenotype and corticosteroid exposure over time in patients with SLE.MethodsRecently diagnosed (1, higher disease activity, increasing age and Hispanic or Black African race/ethnicity were independently associated with MetS over the first 2 years of follow-up in the cohort.ConclusionsMetS is a persistent phenotype in a significant proportion of patients with SLE. Renal lupus, active inflammatory disease and damage are SLE-related factors that drive MetS development while antimalarial agents appear to be protective from early in the disease course.

Published
2015
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7. 25-hydroxyvitamin D and cardiovascular disease in patients with systemic lupus erythematosus: data from a large international inception cohort

Author

LERTRATANAKUL, APINYA, WU, PEGGY, DYER, ALAN, UROWITZ, MURRAY, GLADMAN, DAFNA, FORTIN, PAUL, BAE, SANG-CHEOL, GORDON, CAROLINE, CLARKE, ANN, BERNATSKY, SASHA, HANLY, JOHN G., ISENBERG, DAVID, RAHMAN, ANISUR, MERRILL, JOAN, WALLACE, DANIEL J., GINZLER, ELLEN, KHAMASHTA, MUNTHER, BRUCE, IAN, NIVED, OLA, STURFELT, GUNNAR, STEINSSON, KRISTJAN, MANZI, SUSAN, DOOLEY, MARY ANNE, KALUNIAN, KENNETH, PETRI, MICHELLE, ARANOW, CYNTHIA, FONT, JOSEP, van VOLLENHOVEN, RONALD, STOLL, THOMAS, and RAMSEY-GOLDMAN, ROSALIND

Subjects
Adult, Male, Aging, Clinical Sciences, Lupus, Cardiovascular, Autoimmune Disease, Article, Risk Factors, Clinical Research, Lupus Erythematosus, Systemic, Humans, Psychology, Registries, Vitamin D, Nutrition, Lupus Erythematosus, Incidence, Prevention, Inflammatory and immune system, Systemic, Middle Aged, Vitamin D Deficiency, Heart Disease, Good Health and Well Being, Cardiovascular Diseases, Public Health and Health Services, Female
Abstract

ObjectiveAn association between 25-hydroxyvitamin D (25[OH]D; vitamin D) deficiency and increased cardiovascular (CV) risk factors and CV disease (CVD) has been shown in general population studies. Vitamin D deficiency has been noted in systemic lupus erythematosus (SLE), and CVD is a major cause of morbidity and mortality in SLE. The objectives of this study were to estimate the associations of 25(OH)D levels with CV risk factors and to determine whether low baseline 25(OH)D levels predict future CV events in patients participating in an international inception cohort.MethodsData were collected on 890 participants, including demographics, SLE activity and damage assessments, CV risk factors and events, medications, laboratory assessments of 25(OH)D levels, and inflammatory markers. Multiple logistic and Cox regressions were used to estimate the associations of baseline 25(OH)D levels with baseline CV risk factors and CVD events. The models were adjusted for age, sex, race, season, and country, with and without body mass index.ResultsPatients in the higher quartiles of 25(OH)D were less likely to have hypertension and hyperlipidemia and were more likely to have lower C-reactive protein levels and lower Systemic Lupus Erythematosus Disease Activity Index 2000 scores at baseline when compared with the first quartile. Vitamin D levels were not independently associated with CVD event incidence; however, hazard ratios for CVD event incidence decreased with successively higher quartiles.ConclusionLower baseline 25(OH)D levels are associated with higher risk for CV risk factors and more active SLE at baseline. There may be a trend toward a lower likelihood of CVD events in those with higher baseline 25(OH)D levels.

Published
2014

8. Lymphoma risk in systemic lupus: effects of disease activity versus treatment

Author

Witte, Torsten, Jacobsen, Soren, Barr, Susan G, Petri, Michelle A, Wallace, Daniel J, Yelin, Edward, Manzi, Susan, Criswell, Lindsey A, Sturfelt, Gunnar K, Ruiz-Irastorza, Guillermo, Kamen, Diane L, Rahman, Anisur, Costenbader, Karen H, Joseph, Lawrence, Dooley, Mary Anne, Bae, Sang-Cheol, Romero-Diaz, Juanita, Edworthy, Steven M, Peschken, Christine A, Fortin, Paul R, Aranow, Cynthia, Boivin, Jean-Francois, Gladman, Dafna D, Isenberg, David, Gordon, Caroline, Nived, Ola, Urowitz, Murray B, Ramsey-Goldman, Rosalind, Blanco, Irene, Ginzler, Ellen M, Bernatsky, Sasha, and Askanase, Anca

Subjects
immune system diseases, hemic and lymphatic diseases, skin and connective tissue diseases
Abstract

To examine disease activity versus treatment as lymphoma risk factors in systemic lupus erythematosus (SLE).

Published
2014
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9. 25-Hydroxyvitamin D and Cardiovascular Disease in Patients With Systemic Lupus Erythematosus: Data From a Large International Inception Cohort: Vitamin D 25(OH)D and CVD in SLE Patients

Author

Fortin, Paul, Sturfelt, Gunnar, Kalunian, Kenneth, Stoll, Thomas, Dyer, Alan, Rahman, Anisur, Merrill, Joan, Gordon, Caroline, Ramsey-Goldman, Rosalind, Steinsson, Kristjan, Gladman, Dafna, Bruce, Ian, Font, Josep, Bernatsky, Sasha, Khamashta, Munther, Nived, Ola, Manzi, Susan, Clarke, Ann, Wu, Peggy, Bae, Sang-Cheol, Wallace, Daniel J., Urowitz, Murray, Petri, Michelle, Hanly, John G., Isenberg, David, Ginzler, Ellen, Aranow, Cynthia, Dooley, Mary Anne, and Lertratanakul, Apinya

Subjects
skin and connective tissue diseases
Abstract

An association between 25-hydroxyvitamin D (25[OH]D; vitamin D) deficiency and increased cardiovascular (CV) risk factors and CV disease (CVD) has been shown in general population studies. Vitamin D deficiency has been noted in systemic lupus erythematosus (SLE), and CVD is a major cause of morbidity and mortality in SLE. The objectives of this study were to estimate the associations of 25(OH)D levels with CV risk factors and to determine whether low baseline 25(OH)D levels predict future CV events in patients participating in an international inception cohort.

Published
2014
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10. The classification of glomerulonephritis in systemic lupus erythematosus revisited

Author

Weening, Jan J., D'agati, Vivette D., Schwartz, Melvin M., Seshan, Surya V., Alpers, Charles E., Appel, Gerald B., Balow, James E., Bruijn, J.A.N. A., Cook, Terence, Ferrario, Franco, Fogo, Agnes B., Ginzler, Ellen M., Hebert, L.E.E., Hill, Gary, Hill, Prue, Jennette, J. Charles, Kong, Norella C., Lesavre, Philippe, Lockshin, Michael, Looi, Lai-Meng, Makino, Hirofumi, Moura, Luiz A., Nagata, Michio, ON Behalf of the International Society of Nephrology and Renal Pathology Society Working Group on the Classification Oflupus Nephritis, and Other departments

Subjects
Systemic disease, Pathology, medicine.medical_specialty, Biopsy, Lupus nephritis, Mesangial hypercellularity, Kidney, Focal Glomerulonephritis, Immunopathology, medicine, Humans, Lupus Erythematosus, Systemic, Lupus erythematosus, business.industry, Glomerulonephritis, General Medicine, medicine.disease, Connective tissue disease, Lupus Nephritis, Renal pathology, classification, Nephrology, Immunology, business, lupus erythematosus, glomerulonephritis
Abstract

The classification of glomerulonephritis in systemic lupus erythematosus revisited.The currently used classification reflects our understanding of the pathogenesis of the various forms of lupus nephritis, but clinicopathologic studies have revealed the need for improved categorization and terminology. Based on the 1982 classification published under the auspices of the World Health Organization (WHO) and subsequent clinicopathologic data, we propose that class I and II be used for purely mesangial involvement (I, mesangial immune deposits without mesangial hypercellularity; II, mesangial immune deposits with mesangial hypercellularity); class III for focal glomerulonephritis (involving

Published
2004

11. Cerebrovascular Events in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study

Author

Hanly, John G, Li, Qiuju, Su, Li, Urowitz, Murray B, Gordon, Caroline, Bae, Sang-Cheol, Romero-Diaz, Juanita, Sanchez-Guerrero, Jorge, Bernatsky, Sasha, Clarke, Ann E, Wallace, Daniel J, Isenberg, David A, Rahman, Anisur, Merrill, Joan T, Fortin, Paul, Gladman, Dafna D, Bruce, Ian N, Petri, Michelle, Ginzler, Ellen M, Dooley, MA, Steinsson, Kristjan, Ramsey-Goldman, Rosalind, Zoma, Asad A, Manzi, Susan, Nived, Ola, Jonsen, Andreas, Khamashta, Munther A, Alarcón, Graciela S, Chatham, Winn, Van Vollenhoven, Ronald F, Aranow, Cynthia, Mackay, Meggan, Ruiz-Irastorza, Guillermo, Ramos-Casals, Manuel, Lim, S Sam, Inanc, Murat, Kalunian, Kenneth C, Jacobsen, Soren, Peschken, Christine A, Kamen, Diane L, Askanase, Anca, Theriault, Chris, and Farewell, Vernon

Subjects
Adult, Male, Cerebrovascular Disorders, Young Adult, Quality of Life, Humans, Lupus Erythematosus, Systemic, Female, Prospective Studies, Middle Aged, skin and connective tissue diseases, 3. Good health
Abstract

OBJECTIVE: To determine the frequency, characteristics, and outcomes of cerebrovascular events (CerVEs), as well as clinical and autoantibody associations in a multiethnic/racial inception cohort of patients with systemic lupus erythematosus (SLE). METHODS: A total of 1,826 patients were assessed annually for 19 neuropsychiatric (NP) events, including 5 types of CerVEs: 1) stroke, 2) transient ischemia, 3) chronic multifocal ischemia, 4) subarachnoid/intracranial hemorrhage, and 5) sinus thrombosis. Global disease activity (Systemic Lupus Erythematosus Disease [SLE] Activity Index 2000), damage scores (SLE International Collaborating Clinics/American College of Rheumatology Damage Index), and Short Form 36 (SF-36) scores were collected. Time to event, linear and logistic regressions, and multistate models were used as appropriate. RESULTS: CerVEs were the fourth most frequent NP event: 82 of 1,826 patients had 109 events; of these events, 103 were attributed to SLE, and 44 were identified at the time of enrollment. The predominant events were stroke (60 of 109 patients) and transient ischemia (28 of 109 patients). CerVEs were associated with other NP events attributed to SLE, non-SLE-attributed NP events, African ancestry (at US SLICC sites), and increased organ damage scores. Lupus anticoagulant increased the risk of first stroke and sinus thrombosis and transient ischemic attack. Physician assessment indicated resolution or improvement in the majority of patients, but patients reported sustained reduction in SF-36 summary and subscale scores following a CerVE. CONCLUSION: CerVEs, the fourth most frequent NP event in SLE, are usually attributable to lupus. In contrast to good physician-reported outcomes, patients reported a sustained reduction in health-related quality of life following a CerVE.

12. Economic Evaluation of Damage Accrual in an International SLE Inception Cohort

Author

Barber, Megan, Bruce, Ian N., Urowitz, Murray, Hanly, John G., Su, Li, Romero-Diaz, Juanita, Gordon, Caroline, Bae, Sang-Cheol, Bernatsky, Sasha, Wallace, Daniel J., Merrill, Joan T., Isenberg, David A., Rahman, Anisur, Ginzler, Ellen M., Petri, Michelle, Dooley, Mary Anne, Fortin, Paul R., Gladman, Dafna D., Sanchez-Guerrero, Jorge, Steinsson, Kristjan, Ramsey-Goldman, Rosalind, Khamashta, M., Aranow, Cynthia, Alarcon, Graciela S., Fessler, Barri J., Manzi, Susan, Nived, Ola, Jonsen, Andreas, Zoma, Asad, Vollenhoven, Ronald F., Manuel Ramos-Casals, Ruiz-Irastorza, Guillermo, Lim, S. Sam, Kalunian, Kenneth C., Inanc, Murat, Kamen, Diane L., Peschken, Christine A., Jacobsen, Soren, Askanase, Anca, Buyon, Jill P., Theriault, Chris, Farewell, Vernon, and Clarke, Ann E.

13. Mood Disorders in Systemic Lupus Erythematousus (SLE): Results from an International, Inception Cohort Study

Author

Hanly, John G., Su, Li, Urowitz, Murray, Romero-Diaz, Juanita, Gordon, Caroline, Bae, Sang-Cheol, Bernatsky, Sasha R., Clarke, Ann E., Wallace, Daniel J., Merrill, Joan T., Isenberg, David A., Rahman, Anisur, Ginzler, Ellen M., Fortin, Paul, Gladman, Dafna D., Sanchez-Guerrero, Jorge, Petri, Michelle A., Bruce, Ian, Dooley, Mary Anne, Ramsey-Goldman, Rosalind, Aranow, Cynthia, Alarcon, Graciela S., Fessler, Barri J., Steinsson, Kristjan, Nived, Ola, Sturfelt, Gunnar K., Manzi, Susan, Khamashta, Munther A., Vollenhoven, Ronald F., Zoma, Asad, Ramos-Casals, Manuel, Guillermo Ruiz-Irastorza, Lim, S. Sam, Stoll, Thomas, Inanc, Murat, Kalunian, Kenneth C., Kamen, Diane L., Maddison, Peter, Peschken, Christine A., Jacobsen, Soren, Askanase, Anca, Buyon, Jill P., Theriault, Chris, Thompson, Kara, and Farewell, Vernon

Subjects
Clinical Sciences, Immunology, Public Health and Health Services, Arthritis & Rheumatology

14. Incidence and Predictors of Atherosclerotic Vascular Events in a Multicentre Inception SLE Cohort

Author

Urowitz, Murray, Gladman, Dafna, Su, Jiandong, Farewell, Vernon, Sanchez-Guerrero, Jorge, Romero-Diaz, Juanita, Bae, Sang-Cheol, Fortin, Paul, Nived, Ola, Clarke, Ann E., Bernatsky, Sasha, Gordon, Caroline, Hanly, John, Wallace, Daniel J., Isenberg, David A., Rahman, Anisur, Merrill, Joan, Ginzler, Ellen M., Alarcon, Graciela, Petri, Michelle, Bruce, Ian, Khamashta, Munther A., Aranow, Cynthia, Manzi, Susan, Dooley, M. A., Ramsey-Goldman, Rosalind, Jonsen, Andreas, Steinsson, Kristjan, Zoma, Asad, Guillermo Ruiz-Irastorza, Lim, S. Sam, Kalunian, Kenneth C., Inanc, Murat, Vollenhoven, Ronald, Ramos, Manuel, Kamen, Diane, Jacobsen, Soren, Peschken, Christine, Askanase, Anca, and Stoll, Thomas

15. Prediction of Organ Damage Accrual in Systemic Lupus Erythematosus Using a Frailty Index

Author

Legge, Alexandra, Kirkland, Susan, Rockwood, Kenneth, Andreou, Pantelis, Bae, Sang-Cheol, Gordon, Caroline, Romero-Diaz, Juanita, Sanchez-Guerrero, Jorge, Wallace, Daniel J., Bernatsky, Sasha, Clarke, Ann E., Merrill, Joan, Ginzler, Ellen M., Fortin, Paul, Gladman, Dafna, Urowitz, Murray, Bruce, Ian, Isenberg, David A., Rahman, Anisur, Alarcon, Graciela, Petri, Michelle, Khamashta, Munther A., Dooley, M. A., Ramsey-Goldman, Rosalind, Manzi, Susan, Steinsson, Kristjan, Zoma, Asad A., Aranow, Cynthia, Mackay, Meggan, Guillermo Ruiz-Irastorza, Lim, S. Sam, Inanc, Murat, Vollenhoven, Ronald F., Jonsen, Andreas, Nived, Ola, Ramos-Casals, Manuel, Kamen, Diane, Kalunian, Kenneth C., Jacobsen, Soren, Peschken, Christine, Askanase, Anca, and Hanly, John G.

16. Clinical associations of the metabolic syndrome in systemic lupus erythematosus: data from an international inception cohort

Author

Romero-Diaz, Juanita, Fortin, Paul R., Kalunian, Kenneth C., Isenberg, David A., Manzi, Susan, Bae, Sang Cheol, Ramsey-Goldman, Rosalind, Inanc, Murat, Sanchez-Guerrero, Jorge, MacKay, Meggan, Lunt, Mark, Dooley, Mary Anne, Van Vollenhoven, Raymond F., Merrill, Joan T., Fessler, Barri J., Kamen, Diane L., Steinsson, Kristjan, Sturfelt, Gunnar K., Hanly, John G., Wallace, Daniel J., Rahman, Anisur, Khamashta, Munther A., Aranow, Cynthia, Clarke, Ann E., Nived, Ola, Bruce, Ian N., Gordon, Caroline, Gladman, Dafna D., Petri, Michelle, Parker, Ben, Lim, Sam, Peschken, Christine A., Alarcón, Graciela S., Ramos-Casals, Manuel, Ruiz-Irastorza, Guillermo, Urowitz, Murray B., Zoma, Asad A., Ginzler, Ellen M., and Bernatsky, Sasha

Subjects
3. Good health
Abstract

BackgroundThe metabolic syndrome (MetS) may contribute to increased cardiovascular risk in systemic lupus erythematosus (SLE). We aimed to examine the association of demographic factors, lupus phenotype and therapy exposure with the presence of MetS.MethodsThe Systemic Lupus International Collaborating Clinics Registry for Atherosclerosis inception cohort enrolled recently diagnosed (

17. The Initial Presentation of Cerebrovascular Disease Attributed to Lupus Is Most Frequent Early in the Disease Course: Results from an International, Inception Cohort Study

Author

Hanly, John G., Li, Qiuju, Su, Li, Urowitz, Murray, Romero-Diaz, Juanita, Gordon, C., Bae, Sang-Cheol, Bernatsky, Sasha R., Clarke, Ann, Wallace, Daniel J., Merrill, Joan T., Isenberg, David A., Rahman, Anisur, Ginzler, Ellen M., Petri, Michelle, Bruce, Ian N., Dooley, Mary Anne, Fortin, Paul, Gladman, Dafna D., Sanchez-Guerrero, Jorge, Steinsson, Kristjan, Ramsey-Goldman, Rosalind, Khamashta, Munther, Aranow, Cynthia, Alarcon, Graciela S., Fessler, Barri J., Manzi, Susan, Nived, Ola, Sturfelt, Gunnar K., Zoma, Asad, Vollenhoven, Ronald F., Ramos-Casals, Manuel, Guillermo Ruiz-Irastorza, Lim, S. Sam, Kalunian, Kenneth C., Inanc, Murat, Kamen, Diane L., Peschken, Christine A., Jacobsen, Soren, Askanase, Anca, Theriault, Chris, and Farewell, Vernon

18. Mood Disorders in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study

Author

Hanly, John G, Su, Li, Urowitz, Murray B, Romero-Diaz, Juanita, Gordon, Caroline, Bae, Sang-Cheol, Bernatsky, Sasha, Clarke, Ann E, Wallace, Daniel J, Merrill, Joan T, Isenberg, David A, Rahman, Anisur, Ginzler, Ellen M, Petri, Michelle, Bruce, Ian N, Dooley, MA, Fortin, Paul, Gladman, Dafna D, Sanchez-Guerrero, Jorge, Steinsson, Kristjan, Ramsey-Goldman, Rosalind, Khamashta, Munther A, Aranow, Cynthia, Alarcón, Graciela S, Fessler, Barri J, Manzi, Susan, Nived, Ola, Sturfelt, Gunnar K, Zoma, Asad A, Van Vollenhoven, Ronald F, Ramos-Casals, Manuel, Ruiz-Irastorza, Guillermo, Lim, S Sam, Kalunian, Kenneth C, Inanc, Murat, Kamen, Diane L, Peschken, Christine A, Jacobsen, Soren, Askanase, Anca, Theriault, Chris, Thompson, Kara, and Farewell, Vernon

Subjects
Adult, Male, Internationality, Mood Disorders, Incidence, Black People, Hispanic or Latino, Middle Aged, White People, 3. Good health, Cohort Studies, Asian People, Disease Progression, Quality of Life, Humans, Lupus Erythematosus, Systemic, Regression Analysis, Female, Prospective Studies, Autoantibodies
Abstract

OBJECTIVE: To examine the frequency, characteristics, and outcome of mood disorders, as well as clinical and autoantibody associations, in a multiethnic/racial, prospective inception cohort of patients with systemic lupus erythematosus (SLE). METHODS: Patients were assessed annually for mood disorders (4 types, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and 18 other neuropsychiatric events. Global disease activity scores (SLE Disease Activity Index 2000 [SLEDAI-2K]), damage scores (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]), and Short Form 36 subscales, mental and physical component summary scores were collected. Time to event, linear and ordinal regressions, and multi-state models were used as appropriate. RESULTS: Among the 1,827 patients with SLE, 88.9% were female, and 48.9% were Caucasian. The mean ± SD age of the patients was 35.1 ± 13.3 years, disease duration was 5.6 ± 4.8 months, and the length of followup was 4.7 ± 3.5 years. During the course of the study, 863 (47.2%) of the 1,827 patients had 1,627 neuropsychiatric events. Mood disorders occurred in 232 (12.7%) of 1,827 patients, and 98 (38.3%) of 256 mood disorder events were attributed to SLE. The estimated cumulative incidence of any mood disorder after 10 years was 17.7% (95% confidence interval 15.1, 20.2%). A greater risk of mood disorder was associated with concurrent neuropsychiatric events (P ≤ 0.01), and a lower risk was associated with Asian race/ethnicity (P = 0.01) and treatment with immunosuppressive drugs (P = 0.003). Mood disorders were associated with lower mental health and mental component summary scores but not with the SLEDAI-2K, SDI, or lupus autoantibodies. Among the 232 patients with depression, 168 (72.4%) were treated with antidepressants. One hundred twenty-six (49.2%) of 256 mood disorders resolved in 117 (50.4%) of 232 patients. CONCLUSION: Mood disorders, the second most frequent neuropsychiatric event in patients with SLE, have a negative impact on health-related quality of life and improve over time. The lack of association with global SLE disease activity, cumulative organ damage, and lupus autoantibodies emphasizes the multifactorial etiology of mood disorders and a role for non-lupus-specific therapies.

19. Risk Factors for Cerebrovascular Events in Systemic Lupus Erythematosus: Results from an International, Inception Cohort Study

Author

Hanly, John G., Li, Qiuju, Su, Li, Urowitz, Murray, Romero-Diaz, Juanita, Gordon, Caroline, Bae, Sang-Cheol, Bernatsky, Sasha, Clarke, Ann E., Wallace, Daniel J., Merrill, Joan T., Isenberg, David A., Rahman, Anisur, Ginzler, Ellen M., Fortin, Paul R., Gladman, D., Sanchez-Guerrero, Jorge, Petri, Michelle, Bruce, Ian N., Dooley, Mary Anne, Ramsey-Goldman, Rosalind, Aranow, Cynthia, Alarcon, Graciela S., Steinsson, Kristjan, Sturfelt, Gunnar K., Nived, Ola, Manzi, Susan, Khamashta, M., Vollenhoven, Ronald F., Zoma, Asad, Guillermo Ruiz-Irastorza, Lim, S. Sam, Inanc, Murat, Kalunian, Kenneth C., Kamen, Diane L., Peschken, Christine A., Jacobsen, Soren, Askanase, Anca, Theriault, Chris, Farewell, Vernon, and Ramos-Casals, Manuel

20. The Prevalence of Anti-DFS70 Antibodies in an International Inception Cohort of Systemic Lupus Erythematosus

Author

Choi, May, Hanly, John G., Urowitz, Murray, Romero-Diaz, Juanita, Gordon, Caroline, Bae, Sang-Cheol, Bernatsky, Sasha, Wallace, Daniel J., Merrill, Joan T., Isenberg, David A., Rahman, Anisur, Ginzler, Ellen M., Fortin, Paul R., Gladman, Dafna, Sanchez-Guerrero, Jorge, Petri, Michelle, Bruce, Ian N., Dooley, Mary Anne, Ramsey-Goldman, Rosalind, Aranow, Cynthia, Alarcon, Graciela S., Steinsson, Kristjan, Nived, Ola, Sturfelt, Gunnar K., Manzi, Susan, Khamashta, Munther, Vollenhoven, Ronald F., Zoma, Asad, Ruiz-Irastorza, Guillermo, Lim, S. Sam, Stoll, Thomas, Inanc, Murat, Kalunian, Kenneth C., Kamen, Diane L., Maddison, Peter, Peschken, Christine A., Jacobsen, Soren, Askanase, Anca, Buyon, Jill P., Chatham, W. Winn, Manuel Ramos-Casals, Pierre, Yvan St, Clarke, Ann E., and Fritzler, Marvin J.

21. Outcome of Lupus Nephritis and Impact on Health Related Quality of Life: Results from an International, Prospective, Inception Cohort Study

Author

Hanly, John G., O Keeffe, Aidan, Su, Li, Urowitz, Murray B., Romero-Diaz, Juanita, Gordon, Caroline, Bae, Sang-Cheol, Bernatsky, Sasha R., Clarke, Ann E., Wallace, Daniel J., Merrill, Joan T., Isenberg, David A., Rahman, Anisur, Ginzler, Ellen M., Fortin, Paul, Gladman, Dafna D., Sanchez-Guerrero, Jorge, Petri, Michelle A., Bruce, Ian, Dooley, Mary Anne, Ramsey-Goldman, Rosalind, Aranow, Cynthia, Alarcon, Graciela S., Fessler, Barri, Steinsson, Kristjan, Nived, Ola, Sturfelt, Gunnar, Manzi, Susan, Khamashta, Munther A., Vollenhoven, Ronald F., Zoma, Asad, Ramos-Casals, Manuel, Guillermo Ruiz-Irastorza, Lim, S. Sam, Stoll, Thomas, Inanc, Murat, Kalunian, Kenneth C., Kamen, Diane L., Maddison, Peter, Peschken, Christine A., Jacobsen, Soren, Askanase, Anca, Buyon, Jill P., Theriault, Chris, Thompson, Kara, and Farewell, Vernon

22. Glucocorticosteroid Usage and Major Organ Damage in Patients with Systemic Lupus Erythematosus - Meta-analyses of Observational Studies Published Between 1979 and 2018

Author

Anselm Mak, Cheung, Mike W. L., Wai Yee Joanna Leong, Bhushan Dharmadhikari, Nien Yee Kow, Michelle Petri, Susan Manzi, Ann Clarke, Cynthia Aranow, Laurent Arnaud, Anca Askanase, Sang-Cheol Bae, Sasha Bernatsky, Ian Bruce, Jill Buyon, Winn Chatham, W., Nathalie Costedoat-Chalumeau, Dooley, M. A., Paul Fortin, Ginzler, Ellen M., Dafna Gladman, Caroline Gordon, Hanly, John G., Murat Inanc, Isenberg, David A., Søren Jacobsen, Judith James, Andreas Jönsen, Kalunian, Kenneth C., Diane Kamen, Sam Lim, S., Eric Morand, Christine Peschken, Pons-Estel, Bernardo A., Anisur Rahman, Rosalind Ramsey-Goldman, Juanita Romero-Diaz, Guillermo Ruiz-Irastorza, Jorge Sanchez-Guerrero, Kristjan Steinsson, Elisabet Svenungsson, Murray Urowitz, Ronald van Volllenhoven, Evelyn Vinet, Alexandre Voskuyl, Wallace, Daniel J., and Graciela Alarcón

23. Economic Evaluation of Lupus Nephritis in an International Inception Cohort: Comparing the Hospitalization, Medication, Dialysis, and Procedure Costs of Those with and without Nephritis

Author

Barber, Megan, Hanly, John G., O Keeffe, Aidan, Su, Li, Urowitz, Murray, St Pierre, Yvan, Romero-Diaz, Juanita, Gordon, C., Bae, Sang-Cheol, Bernatsky, Sasha, Wallace, Daniel J., Merrill, Joan T., Isenberg, David A., Rahman, Anisur, Ginzler, Ellen M., Fortin, Paul R., Gladman, Dafna D., Sanchez-Guerrero, Jorge, Petri, Michelle, Bruce, Ian N., Dooley, Mary Anne, Ramsey-Goldman, Rosalind, Aranow, Cynthia, Alarcon, Graciela S., Chatham, W. Winn, Steinsson, Kristjan, Nived, Ola, Sturfelt, Gunnar K., Manzi, Susan, Khamashta, Munther, Vollenhoven, Ronald F., Zoma, Asad, Ramos-Casals, Manel, Guillermo Ruiz-Irastorza, Lim, S. Sam, Stoll, Thomas, Inanc, Murat, Kalunian, Kenneth C., Kamen, Diane L., Maddison, Peter, Peschken, Christine A., Jacobsen, Soren, Askanase, Anca, Buyon, Jill P., Theriault, Chris, Thompson, Kara, Farewell, Vernon, and Clarke, Ann E.

24. Cancer in an SLE Inception Cohort: Smoking May out-Perform Tumor Markers As a Risk Predictor

Author

Bernatsky, Sasha, Urowitz, Murray, Hanly, John G., Clarke, Ann E., Fritzler, Marvin J., Gordon, Caroline, Romero-Diaz, Juanita, Alarcon, Graciela S., Bae, Sang-Cheol, Petri, Michelle, Merrill, Joan T., Wallace, Daniel J., Fortin, Paul R., Gladman, Dafna D., Isenberg, David A., Rahman, Anisur, Manzi, Susan, Nived, Ola, Sturfelt, Gunnar K., Peschken, Christine A., Sanchez-Guerrero, Jorge, Guillermo Ruiz-Irastorza, Aranow, Cynthia, Vollenhoven, Ronald F., Zoma, Asad, Steinsson, Kristjan, Khamashta, Munther A., Ginzler, Ellen M., Askanase, Anca, Kalunian, Kenneth C., Dooley, Mary Anne, Lim, S. Sam, Kamen, Diane L., Jacobsen, Soren, Ramos-Casals, Manuel, Inanc, Murat, Lee, Jennifer L. F., and Ramsey-Goldman, Rosalind

25. Factors associated with damage accrual in patients with systemic lupus erythematosus: results from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort

Author

Bruce, Ian N, O'Keeffe, Aidan G, Farewell, Vern, Hanly, John G, Manzi, Susan, Su, Li, Gladman, Dafna D, Bae, Sang-Cheol, Sanchez-Guerrero, Jorge, Romero-Diaz, Juanita, Gordon, Caroline, Wallace, Daniel J, Clarke, Ann E, Bernatsky, Sasha, Ginzler, Ellen M, Isenberg, David A, Rahman, Anisur, Merrill, Joan T, Alarcón, Graciela S, Fessler, Barri J, Fortin, Paul R, Petri, Michelle, Steinsson, Kristjan, Dooley, Mary Anne, Khamashta, Munther A, Ramsey-Goldman, Rosalind, Zoma, Asad A, Sturfelt, Gunnar K, Nived, Ola, Aranow, Cynthia, Mackay, Meggan, Ramos-Casals, Manuel, Van Vollenhoven, Ronald F, Kalunian, Kenneth C, Ruiz-Irastorza, Guillermo, Lim, Sam, Kamen, Diane L, Peschken, Christine A, Inanc, Murat, and Urowitz, Murray B

Subjects
Inflammation, Adult, Male, Health Status, Kaplan-Meier Estimate, Middle Aged, Systemic Lupus Erythematosus, 3. Good health, Cohort Studies, Young Adult, Outcomes research, Disease Progression, Ethnicity, Quality of Life, Corticosteroids, Humans, Lupus Erythematosus, Systemic, Female, Longitudinal Studies, Prospective Studies, Proportional Hazards Models
Abstract

BACKGROUND AND AIMS: We studied damage accrual and factors determining development and progression of damage in an international cohort of systemic lupus erythematosus (SLE) patients. METHODS: The Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort recruited patients within 15 months of developing four or more 1997 American College of Rheumatology (ACR) criteria for SLE; the SLICC/ACR damage index (SDI) was measured annually. We assessed relative rates of transition using maximum likelihood estimation in a multistate model. The Kaplan-Meier method estimated the probabilities for time to first increase in SDI score and Cox regression analysis was used to assess mortality. RESULTS: We recruited 1722 patients; mean (SD) age 35.0 (13.4) years at cohort entry. Patients with damage at enrolment were more likely to have further worsening of SDI (SDI 0 vs ≥1; p

26. Outcomes After Hydroxychloroquine Reduction or Discontinuation in a Multinational Inception Cohort of Systemic Lupus

Author

Almeida-Brasil, Celline, Hanly, John, Urowitz, Murray, Clarke, Ann, Ramsey-Goldman, Rosalind, Gordon, Caroline, Petri, Michelle, Ginzler, Ellen M., Wallace, Daniel J., Bae, Sang-Cheol, Romero-Diaz, Juanita, Dooley, Mary Ann, Peschken, Christine A., Isenberg, David, Rahman, Anisur, Manzi, Susan, Jacobsen, Soren, Lim, S. Sam, Vollenhoven, Ronald, Nived, Ola, Jonsen, Andreas, Kamen, Diane, Aranow, Cynthia, Guillermo Ruiz-Irastorza, Sanchez-Guerrero, Jorge, Gladman, Dafna, Fortin, Paul, Alarcon, Graciela, Merrill, Joan, Kalunian, Kenneth, Ramos-Casals, Manuel, Steinsson, Kristjan, Zoma, Asad, Askanase, Anca, Khamashta, Munther, Bruce, Ian, Inanc, Murat, and Bernatsky, Sasha

27. Is ANA-status at Disease Inception Associated with Long-term Damage Accrual and Direct and Indirect Health Care Costs in the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort?

Author

Choi, May, Barber, Megan, Fritzler, Marvin, Hanly, John G., Urowitz, Murray, St-Pierre, Yvan, Romero-Diaz, Juanita, Gordon, Caroline, Bae, Sang-Cheol, Bernatsky, Sasha, Wallace, Daniel J., Isenberg, David A., Rahman, Anisur, Ginzler, Ellen M., Petri, Michelle, Bruce, Ian, Fortin, Paul, Gladman, Dafna, Sanchez-Guerrero, Jorge, Ramsey-Goldman, Rosalind, Khamashta, Munther A., Aranow, Cynthia, Mackay, Meggan, Alarcon, Graciela, Manzi, Susan, Nived, Ola, Jonsen, Andreas, Zoma, Asad, Vollenhoven, Ronald, Ramos-Casals, Manuel, Guillermo Ruiz-Irastorza, Lim, S. Sam, Kalunian, Kenneth C., Inanc, Murat, Kamen, Diane, Peschken, Christine, Jacobsen, Soren, Askanase, Anca, Farewell, Vernon, and Clarke, Ann E.

28. Retinal Toxicity in a Multinational Inception Cohort of Systemic Lupus Patients on Hydroxychloroquine

Author

Almeida-Brasil, Celline, Hanly, John, Urowitz, Murray, Clarke, Ann, Ramsey-Goldman, Rosalind, Gordon, Caroline, Petri, Michelle, Ginzler, Ellen M., Wallace, Daniel J., Bae, Sang-Cheol, Romero-Diaz, Juanita, Dooley, Mary Ann, Peschken, Christine A., Isenberg, David, Rahman, Anisur, Manzi, Susan, Jacobsen, Soren, Lim, S. Sam, Vollenhoven, Ronald, Nived, Ola, Jonsen, Andreas, Kamen, Diane, Aranow, Cynthia, Guillermo Ruiz-Irastorza, Sanchez-Guerrero, Jorge, Gladman, Dafna, Fortin, Paul, Alarcon, Graciela, Merrill, Joan, Kalunian, Kenneth, Ramos-Casals, Manuel, Steinsson, Kristjan, Zoma, Asad, Askanase, Anca, Khamashta, Munther, Bruce, Ian, Inanc, Murat, and Bernatsky, Sasha

29. Economic Evaluation of Lupus Nephritis in the Systemic Lupus International Collaborating Clinics Inception Cohort Using a Multistate Model Approach

Author

Barber, Megan RW, Hanly, John G, Su, Li, Urowitz, Murray B, St Pierre, Yvan, Romero-Diaz, Juanita, Gordon, Caroline, Bae, Sang-Cheol, Bernatsky, Sasha, Wallace, Daniel J, Isenberg, David A, Rahman, Anisur, Ginzler, Ellen M, Petri, Michelle, Bruce, Ian N, Fortin, Paul R, Gladman, Dafna D, Sanchez-Guerrero, Jorge, Ramsey-Goldman, Rosalind, Khamashta, Munther A, Aranow, Cynthia, Mackay, Meggan, Alarcón, Graciela S, Manzi, Susan, Nived, Ola, Jönsen, Andreas, Zoma, Asad A, Van Vollenhoven, Ronald F, Ramos-Casals, Manuel, Ruiz-Irastorza, Guillermo, Lim, S Sam, Kalunian, Kenneth C, Inanc, Murat, Kamen, Diane L, Peschken, Christine A, Jacobsen, Soren, Askanase, Anca, Theriault, Chris, Farewell, Vernon, and Clarke, Ann E

Subjects
Adult, Cohort Studies, Male, Young Adult, Models, Economic, Humans, Female, Health Care Costs, Middle Aged, urologic and male genital diseases, Lupus Nephritis, 3. Good health
Abstract

OBJECTIVE: Little is known about the long-term costs of lupus nephritis (LN). The costs were compared between patients with and without LN using multistate modeling. METHODS: Patients from 32 centers in 11 countries were enrolled in the Systemic Lupus International Collaborating Clinics inception cohort within 15 months of diagnosis and provided annual data on renal function, hospitalizations, medications, dialysis, and selected procedures. LN was diagnosed by renal biopsy or the American College of Rheumatology classification criteria. Renal function was assessed annually using the estimated glomerular filtration rate (GFR) or estimated proteinuria. A multistate model was used to predict 10-year cumulative costs by multiplying annual costs associated with each renal state by the expected state duration. RESULTS: A total of 1,545 patients participated; 89.3% were women, the mean ± age at diagnosis was 35.2 ± 13.4 years, 49% were white, and the mean followup duration was 6.3 ± 3.3 years. LN developed in 39.4% of these patients by the end of followup. Ten-year cumulative costs were greater in those with LN and an estimated glomerular filtration rate (GFR) 60 ml/minute) or with LN and estimated proteinuria >3 gm/day ($84,040 versus $20,499 if no LN and estimated proteinuria

30. Peripheral Nervous System Disease in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study

Author

Hanly, John G, Li, Qiuju, Su, Li, Urowitz, Murray B, Gordon, Caroline, Bae, Sang-Cheol, Romero-Diaz, Juanita, Sanchez-Guerrero, Jorge, Bernatsky, Sasha, Clarke, Ann E, Wallace, Daniel J, Isenberg, David A, Rahman, Anisur, Merrill, Joan T, Fortin, Paul R, Gladman, Dafna D, Bruce, Ian N, Petri, Michelle, Ginzler, Ellen M, Dooley, MA, Steinsson, Kristjan, Ramsey-Goldman, Rosalind, Zoma, Asad A, Manzi, Susan, Nived, Ola, Jonsen, Andreas, Khamashta, Munther A, Alarcón, Graciela S, Svenungsson, Elisabet, Van Vollenhoven, Ronald F, Aranow, Cynthia, Mackay, Meggan, Ruiz-Irastorza, Guillermo, Ramos-Casals, Manuel, Lim, S Sam, Inanc, Murat, Kalunian, Kenneth C, Jacobsen, Soren, Peschken, Christine A, Kamen, Diane L, Askanase, Anca, Theriault, Chris, and Farewell, Vernon

Subjects
Adult, Male, Lupus Vasculitis, Central Nervous System, Mononeuropathies, Age Factors, Peripheral Nervous System Diseases, Middle Aged, Severity of Illness Index, Cranial Nerve Diseases, 3. Good health, Cohort Studies, Young Adult, Multivariate Analysis, Humans, Lupus Erythematosus, Systemic, Female, Proportional Hazards Models
Abstract

OBJECTIVE: To determine the frequency, clinical characteristics, associations, and outcomes of different types of peripheral nervous system (PNS) disease in a multiethnic/multiracial, prospective inception cohort of systemic lupus erythematosus (SLE) patients. METHODS: Patients were evaluated annually for 19 neuropsychiatric (NP) events including 7 types of PNS disease. SLE disease activity, organ damage, autoantibodies, and patient and physician assessment of outcome were measured. Time to event and linear regressions were used as appropriate. RESULTS: Of 1,827 SLE patients, 88.8% were female, and 48.8% were white. The mean ± SD age was 35.1 ± 13.3 years, disease duration at enrollment was 5.6 ± 4.2 months, and follow-up was 7.6 ± 4.6 years. There were 161 PNS events in 139 (7.6%) of 1,827 patients. The predominant events were peripheral neuropathy (66 of 161 [41.0%]), mononeuropathy (44 of 161 [27.3%]), and cranial neuropathy (39 of 161 [24.2%]), and the majority were attributed to SLE. Multivariate Cox regressions suggested longer time to resolution in patients with a history of neuropathy, older age at SLE diagnosis, higher SLE Disease Activity Index 2000 scores, and for peripheral neuropathy versus other neuropathies. Neuropathy was associated with significantly lower Short Form 36 (SF-36) physical and mental component summary scores versus no NP events. According to physician assessment, the majority of neuropathies resolved or improved over time, which was associated with improvements in SF-36 summary scores for peripheral neuropathy and mononeuropathy. CONCLUSION: PNS disease is an important component of total NPSLE and has a significant negative impact on health-related quality of life. The outcome is favorable for most patients, but our findings indicate that several factors are associated with longer time to resolution.

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