1. Persistent Disease Activity Remains a Burden for Patients with Systemic Lupus Erythematosus.
- Author
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Peschken CA, Wang Y, Abrahamowicz M, Pope J, Silverman E, Sayani A, Iczkovitz S, Ross J, Zummer M, Tucker L, Pineau C, Levy D, Hudson M, Hitchon CA, Huber AM, Smith CD, Avina-Zubieta A, Arbillaga H, Chédeville G, Wynant W, and Fortin PR
- Subjects
- Adult, Canada epidemiology, Cross-Sectional Studies, Female, Follow-Up Studies, Humans, Linear Models, Lupus Erythematosus, Systemic drug therapy, Lupus Erythematosus, Systemic mortality, Male, Middle Aged, Prednisone therapeutic use, Prevalence, Prognosis, Prospective Studies, Young Adult, Disease Progression, Lupus Erythematosus, Systemic epidemiology, Lupus Erythematosus, Systemic physiopathology, Severity of Illness Index
- Abstract
Objective: Persistent systemic lupus erythematosus (SLE) disease activity is associated with increased morbidity and mortality. In a multicenter cohort of patients with prevalent SLE, we described persistence, patterns, and predictors of change in disease activity over time., Methods: Based on SLE Disease Activity Index (SLEDAI)-2K scores at cohort entry, patients were classified into 4 groups: low (score < 4; LOW), moderate (4 to < 6; MOD), moderately high (6 to ≤ 10; MHIGH), and very high (> 10; VHIGH). Multivariable linear and longitudinal mixed linear regression models were used to identify predictors of change over time in SLEDAI-2K., Results: There were 2019 participants, with declining followup data over 5 years (1326, 580, 274, 186, and 148 patients, respectively). At cohort entry, mean (± SD) age was 42 (± 17) years, disease duration 11 (± 10) years, and 90% were female. The 4 groups included 44% LOW (n = 891), 20% MOD (n = 400), 22% MHIGH (n = 442), and 14% VHIGH (n = 286); therefore, 36% had clinically important SLE activity. The proportion of patients in the LOW group at entry who moved to a higher activity level varied from 30% (167/557) at 1 year, to 49% (41/83) at 3 years, and 54% (30/56) at 5 years. Among 181 patients with MOD to VHIGH entry activity and 3 years of followup, 116 (64.1%) remained active. In all analyses, only higher SLEDAI-2K at cohort entry remained a significant predictor of higher SLEDAI-2K in subsequent years., Conclusion: Higher SLEDAI-2K at study entry was the single major independent predictor of higher SLEDAI-2K over time, reflecting frequent persistence of active disease, even in patients with longstanding disease. This highlights gaps in the optimal treatment of SLE.
- Published
- 2019
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