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202. Immunogenetic Risks of Anti-Cyclical Citrullinated Peptide Antibodies in a North American Native Population with Rheumatoid Arthritis and Their First-degree Relatives

Author

El-GABALAWY, HANI S., primary, ROBINSON, DAVID B., additional, HART, DONNA, additional, ELIAS, BRENDA, additional, MARKLAND, JANET, additional, PESCHKEN, CHRISTINE A., additional, SMOLIK, IRENE, additional, MONTES-ALDANA, GABRIELA, additional, SCHROEDER, MARLIS, additional, FRITZLER, MARVIN J., additional, CHEANG, MARY, additional, and OEN, KIEM, additional

Published
2009
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203. The 1000 Canadian Faces of Lupus: Determinants of Disease Outcome in a Large Multiethnic Cohort

Author

PESCHKEN, CHRISTINE A., primary, KATZ, STEVEN J., additional, SILVERMAN, EARL, additional, POPE, JANET E., additional, FORTIN, PAUL R., additional, PINEAU, CHRISTIAN, additional, SMITH, C. DOUGLAS, additional, ARBILLAGA, HECTOR O., additional, GLADMAN, DAFNA D., additional, UROWITZ, MURRAY, additional, ZUMMER, MICHEL, additional, CLARKE, ANN, additional, BERNATSKY, SASHA, additional, and HUDSON, MARIE, additional

Published
2009
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204. Reduced proportions of NKT cells are present in the relatives of lupus patients and are associated with autoimmunity

Author

Wither, Joan, primary, Cai, Yongchun, additional, Lim, Sooyeol, additional, McKenzie, Tamara, additional, Roslin, Nicole, additional, Claudio, Jaime O, additional, Cooper, Glinda S, additional, Hudson, Thomas J, additional, Paterson, Andrew D, additional, Greenwood, Celia MT, additional, Gladman, Dafna, additional, Pope, Janet, additional, Pineau, Christian A, additional, Smith, C Douglas, additional, Hanly, John G, additional, Peschken, Christine, additional, Boire, Gilles, additional, Investigators, CaNIOS, additional, and Fortin, Paul R, additional

Published
2008
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206. Health care utilization before and after intensive care unit admission in multiple sclerosis.

Author

Marrie, Ruth Ann, Bernstein, Charles N., Peschken, Christine A., Hitchon, Carol A., Chen, Hui, Fransoo, Randall, and Garland, Allan

Abstract

Objectives The incidence of intensive care unit (ICU) admission is elevated in the multiple sclerosis (MS) population but the reasons for this are incompletely understood, as are outcomes post-ICU admission. Among MS patients we examined the association between ICU admission and health care utilization in the year preceding admission, and compared health care utilization following ICU admission among persons with MS and persons from the general population. Methods We used population-based administrative data from Manitoba, Canada to identify 4237 MS cases of which 2547 were incident. We compared the incidence rates of ICU admission in the prevalent MS population according to health care utilization in the year before admission, adjusting for age, sex, comorbidity and socioeconomic status. Among incident cases of MS we compared rates of health care utilization after ICU admission to those in a matched general population cohort. We used generalized linear models adjusting for age, sex, socioeconomic status, region, comorbidity and utilization before admission. Results Of 4219 prevalent MS cases, 222 (5.3%) were admitted to the ICU. After adjustment, any hospitalization in the prior year conferred an 80% increased incidence, and physician visits in the highest tertile and prescription costs in the highest quartile in the prior year each conferred a more than two-fold increased incidence of admission. Among 2547 incident cases of MS, 109 (4.3%) were admitted to the ICU and 93 survived their admission. Thirty-eight percent of the MS population were re-hospitalized in the year following admission, similar to the matched population (33.8%). Seven percent of both populations were readmitted to the ICU. The MS population had more hospital days after ICU admission than the matched population (adjusted RR 3.11; 95% CI: 1.34–5.90). After adjustment the number of physician visits did not differ between populations. Conclusions The incidence of ICU admission is higher among persons with MS who have higher prior health care utilization. Health care utilization remains high after ICU admission. Efforts to prevent ICU admission in this population are needed. [ABSTRACT FROM AUTHOR]

Published
2015
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212. Association of Smoking With Cutaneous Manifestations in Systemic Lupus Erythematosus.

Author

Bourré-Tessier, Josiane, Peschken, Christine A., Bernatsky, Sasha, Joseph, Lawrence, Clarke, Ann E., Fortin, Paul R., Hitchon, Carol, Mittoo, Shikha, Smith, C. Douglas, Zummer, Michel, Pope, Janet, Tucker, Lori, Hudson, Marie, Arbillaga, Hector, Esdaile, John, Silverman, Earl, Chédeville, Gaelle, Huber, Adam M., Belisle, Patrick, and Pineau, Christian A.

Abstract

Objective To examine the association between smoking and cutaneous involvement in systemic lupus erythematosus (SLE). Methods We analyzed data from a multicenter Canadian SLE cohort. Mucocutaneous involvement was recorded at the most recent visit using the Systemic Lupus Erythematosus Disease Activity Index 2000 Update (rash, alopecia, and oral ulcers), Systemic Lupus International Collaborating Clinics/American College of Rheumatology (ACR) Damage Index (alopecia, extensive scarring, and skin ulceration), and the ACR revised criteria for SLE (malar rash, discoid rash, photosensitivity, and mucosal involvement). Multivariate logistic regression models were used to estimate the independent association between mucocutaneous involvement and cigarette smoking, age, sex, ethnicity, lupus duration, medications, and laboratory data. Results In our cohort of 1,346 patients (91.0% women), the mean ± SD age was 47.1 ± 14.3 years and the mean ± SD disease duration was 13.2 ± 10.0 years. In total, 41.2% of patients were ever smokers, 14.0% current smokers, and 27.1% past smokers. Active mucocutaneous manifestations occurred in 28.4% of patients; cutaneous damage occurred in 15.4%. Regarding the ACR criteria, malar rash was noted in 59.5%, discoid rash in 16.9%, and photosensitivity in 55.7% of patients. In the multivariate analysis, current smoking was associated with active SLE rash (odds ratio [OR] 1.63 [95% confidence interval (95% CI) 1.07, 2.48]). Having ever smoked was associated with ACR discoid rash (OR 2.36 [95% CI 1.69, 3.29]) and photosensitivity (OR 1.47 [95% CI 1.11, 1.95]), and with the ACR total cutaneous score (OR 1.50 [95% CI 1.22, 1.85]). We did not detect any associations between previous smoking and active cutaneous manifestations. No association was found between smoking and cutaneous damage or mucosal ulcers. No interaction was seen between smoking and antimalarials. Conclusion Current smoking is associated with active SLE rash, and ever smoking with the ACR total cutaneous score. This provides additional motivation for smoking cessation in SLE. [ABSTRACT FROM AUTHOR]

Published
2013
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213. Influence of ethnicity on childhood-onset systemic lupus erythematosus: Results from a multiethnic multicenter Canadian cohort.

Author

Levy, Deborah M., Peschken, Christine A., Tucker, Lori B., Chédeville, Gaëlle, Huber, Adam M., Pope, Janet E., and Silverman, Earl D.

Abstract

Objective To determine the influence of ethnicity and sociodemographic factors on disease characteristics of the Canadian pediatric lupus population. Methods Childhood-onset systemic lupus erythematosus (SLE) patients at 4 pediatric centers in Halifax, Montreal, Toronto, and Vancouver were consecutively recruited. Sociodemographics and disease data were collected. Patients were categorized by their primary self-selected ethnicity, and exploratory cluster analyses were examined for disease expression by ethnicity. Results We enrolled 213 childhood-onset SLE patients, and ethnicity data were available for 206 patients: white (31%), Asian (30%), South Asian (15%), black (10%), Latino/Hispanic (4%), Aboriginal (4%), and Arab/Middle Eastern (3%). The frequency of clinical classification criteria (malar rash, arthritis, serositis, and renal disease) and autoantibodies significantly differed among ethnicities. Medications were prescribed equally across ethnicities: 76% were taking prednisone, 86% antimalarials, and 56% required additional immunosuppressants. Cluster analysis partitioned into 3 main groups: mild (n = 50), moderate (n = 82), and severe (n = 68) disease clusters. Only 20% of white patients were in the severe cluster compared to 51% of Asian and 41% of black patients ( P = 0.03). However, disease activity indices and damage scores were similar across ethnicities. Conclusion Canadian childhood-onset SLE patients reflect our multiethnic population, with differences in disease manifestations, autoantibody profiles, and severity of disease expression by ethnicity. [ABSTRACT FROM AUTHOR]

Published
2013
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215. Barriers to Healthcare in a Multiethnic Cohort of Systemic Lupus Erythematosus (SLE) Patients: Patient and Physician Perceptions.

Author

Law, Genevieve, Pope, Janet, Lalani, Sheliza, Silverman, Earl, Cooper, Glinda, Fortin, Paul, Zummer, Michel, Smith, C. Douglas, Petty, Ross, Tucker, Lori, Albert, Lori, Huber, Adam, Ramsey, Susanne, Arbillaga, Hector, Chedéville, Gaëlle, Hudson, Marie, and Peschken, Christine

Subjects
SYSTEMIC lupus erythematosus, AUTOIMMUNE diseases, MEDICAL care, MEDICAL care costs, RHEUMATOLOGISTS, RHEUMATOLOGY, RHEUMATISM treatment, PHYSICIAN-patient relations, DIAGNOSIS, PHYSIOLOGY
Abstract

Objective: Barriers to medical care may influence health status. It is unclear whether problems with access can predict clinical outcomes in lupus. This study aimed to determine whether care barriers are associated with increased disease activity and damage in a multi-center, multiethnic SLE cohort. We also compared concordance between care barriers as reported by the patient and lupus specialist. Methods: Data from SLE patients in 12 Canadian centers collected at annual visits, including demographics, treatment, disease activity and damage were analyzed. Results: 654 patients were enrolled with ethnic groups being Caucasian [CC] (64%), Aboriginal [ABO] (9%), Asian [AS] (21%), and Black [BLK] (6%). 50.8% had at least one barrier to care including travel to a rheumatologist (32.0%), waiting to see a rheumatologist and cost of medications. Access to medication and costs were signifi cantly associated with co-morbidity (p < 0.001, p = 0.04). There were signifi cant associations between ethnicity and any physician perceived care barrier (p < 0.001), mostly in Aboriginal. Doctors identifi ed half of patients who had access to medication problems (p = 0.003) and the relationship between doctors and patients identifying similar care barriers was weak (r = 0.09). A lower total household income signifi cantly predicted the presence of any care barrier (p < 0.001). Conclusions: Despite access to a lupus specialist many care barriers were identifi ed, although we found few associations between care barriers and patient outcomes. The cost of medication was related to SLE disease activity; however, we cannot determine if this was cause or effect. Care barriers identifi ed by lupus patients are signifi cantly underestimated by physicians. [ABSTRACT FROM AUTHOR]

Published
2009

216. Consensus Statements for the Use of Administrative Health Data in Rheumatic Disease Research and Surveillance

Author

BERNATSKY, SASHA, LIX, LISA, O’DONNELL, SIOBHAN, LACAILLE, DIANE, Hudson, M., Markland, J., Docherty, P., Fritzler, M., Jones, N., Kaminska, E., Khalidi, N., Ligier, S., Masetto, A., Mathieu, J.P., Robinson, D., Smith, D., Sutton, E., Abu-Hakim, M., LeClercq., S., Lix, Lisa, O’Donnell, Siobhan, Badley, Elizabeth, Hanly, John, Hawker, Gillian, Henderson, Jaime, Lim, Sam, Peschken, Christine, Stringer, Elizabeth, Svenson, Larry, Labrecque, Jeremy, Widdifield, Jessica, Bernatsky, Sasha, Askling, Johan, Bergeron, Louise, Dixon, Will, Kopec, Jacek, Paterson, Michael, Raymond, Collette, Solomon, Daniel, Suissa, Samy, Vinet, Evelyne, Lacaille, Diane, Avina-Zubieta, Antonio, Fortin, Paul, Hudson, Marie, Jean, Sonia, Rahme, Elham, Solomon, Daniel, Whitehead, Gordon, Barber, Claire, Kuriya, Bindee, Labrecque, Jeremy, Leong, Aaron, and Sirois, Caroline

Abstract

Objective.Administrative data are increasingly being used for research and surveillance about rheumatic diseases. However, literature reviews have revealed a lack of consistency in methods for conducting observational rheumatic disease studies, a situation that can lead to findings that cannot be compared. Our purpose was to develop best-practice consensus statements about the use of administrative data for rheumatic disease research and surveillance in Canada.Methods.We convened 52 decision makers, epidemiologists, clinicians, and researchers to a 2-day workshop. Prior to this, participants formed working groups to examine 3 best-practice categories: case definitions, epidemiology methods, and comorbidity and outcomes measurement. The groups conducted systematic or scoping reviews on key topics. At the workshop, evidence from the reviews was presented and consensus-building techniques were used to develop the best-practice statements. The statements were presented, discussed, revised (as needed), and then subjected to voting.Results.Thirteen best-practice consensus statements were developed and endorsed by consensus. For the first category, these consensus statements addressed validation techniques for rheumatic disease case definitions and case ascertainment bias. The consensus statements for epidemiology methods focused on confounding and drug exposure measurement. For comorbidity and outcomes measurement, consensus statements were developed for multiple conditions, including osteoporosis and fragility fractures, cancer, infections, cardiovascular disease, and renal disease. Strengths and limitations of administrative data were identified in relation to each topic.Conclusion.Our best-practice consensus statements are consistent with other recent guidelines, including those for rheumatic disease biologics registries, but address additional issues specific to administrative data. Continuing work focuses on disseminating these consensus statements to multiple audiences.

Published
2013
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217. Medication Use in Systemic Lupus Erythematosus

Author

BERNATSKY, SASHA, PESCHKEN, CHRISTINE, FORTIN, PAUL R., PINEAU, CHRISTI A., UROWITZ, MURRAY B., GLADMAN, DAFNA D., POPE, JANET E., HUDSON, MARIE, ZUMMER, MICHEL, SMITH, C. DOUGLAS, ARBILLAGA, HECTOR O., and CLARKE, ANN E.

Abstract

OBJECTIVE: To evaluate factors affecting therapeutic approaches used in clinical practice for the management of systemic lupus erythematosus (SLE), in a multicenter cohort. METHODS: We combined data from 10 clinical adult SLE cohort registries in Canada. We used multivariate generalized estimating equation methods to model dichotomized outcomes, running separate regressions where the outcome was current exposure of the patient to specific medications. Potential predictors of medication use included demographic (baseline age, sex, residence, race/ethnicity) and clinical factors (disease duration, time-dependent damage index scores, and adjusted mean SLE Disease Activity Index-2K scores). The models also adjusted for clustering by center. RESULTS: Higher disease activity and damage scores were each independent predictors of exposure to nonsteroid immunosuppressive agents, and for exposure to prednisone. This was not definitely demonstrated for antimalarial agents. Older age at diagnosis was independently and inversely associated with exposure to any of the agents studied (immunosuppressive agents, prednisone, and antimalarial agents). An additional independent predictor of prednisone exposure was black race/ethnicity (adjusted RR 1.46, 95% CI 1.18, 1.81). For immunosuppressive exposure, an additional independent predictor was race/ethnicity, with greater exposure among Asians (RR 1.39, 95% CI 1.02, 1.89) and persons identifying themselves as First Nations/Inuit (2.09, 95% CI 1.43, 3.04) than among whites. All of these findings were reproduced when adjustment for disease activity was limited to renal involvement. CONCLUSION: Ours is the first portrayal of determinants of clinical practice patterns in SLE, and offers interesting real-world insights. Further work, including efforts to determine how differing clinical approaches may influence outcome, is in progress.

Published
2011

218. The Use of Micronutrient Supplements Is Not Associated with Better Quality of Life and Disease Activity in Canadian Patients with Systemic Lupus Erythematosus

Author

AGHDASSI, ELAHEH, MORRISON, STACEY, LANDOLT-MARTICORENA, CAROLINA, SU, JIANDONG, PINEAU, CHRISTIAN A., GLADMAN, DAFNA, UROWITZ, MURRAY, POPE, JANET, PESCHKEN, CHRISTINE, DACOSTA, DEBORAH, WITHER, JOAN, and FORTIN, PAUL R.

Abstract

OBJECTIVE: Associations between the use of micronutrient supplements (MS) and disease activity, quality of life (QOL), and healthcare resource utilization were studied in a Canadian population of patients with systemic lupus erythematosus (SLE). METHODS: QOL was assessed by the Medical Outcomes Study 36-item Short Form. Healthcare resource utilization and disease activity/damage were determined. RESULTS: Of the 259 subjects studied, 53% were MS users and 34% used only calcium/vitamin D. MS users had a higher Systemic Lupus International Collaborating Clinics score and utilized more healthcare resources. Disease activity and QOL were similar between MS users and nonusers. CONCLUSION: MS are frequently used by patients with SLE and are not associated with concomitant benefit on QOL. MS users utilized more healthcare resources.

Published
2010

219. Clinical Features and Prognosis of Late-onset Systemic Lupus Erythematosus: Results from the 1000 Faces of Lupus Study

Author

LALANI, SHELIZA, POPE, JANET, de LEON, FAYE, and PESCHKEN, CHRISTINE

Abstract

OBJECTIVE: There is controversy whether older-onset systemic lupus erythematosus (SLE) is associated with a different, more benign disease course than in younger-onset SLE. Our objective was to characterize the clinical features and prognosis of late-onset SLE in a large, multicenter cohort. METHODS: We studied adult-onset lupus in the 1000 Canadian Faces of Lupus cohort (n = 1528) of whom 10.5% had onset at age ≥ 50 years versus a control group with onset at < 50 years. RESULTS: Disease duration was different in early- and late-onset groups (15 yrs in early vs 9.3 yrs in late; p < 0.001). Caucasians were represented more in the later-onset SLE group (55.6% vs 74.5%), while Asians and Blacks were more prevalent in the younger group. Younger-onset SLE subjects fulfilled more American College of Rheumatology criteria for SLE (< 50 yrs: 5.98 ± 1.68; ≥ 50 yrs: 5.24 ± 1.44; p < 0.0001). Despite an equal prevalence of anti-dsDNA, the younger-onset group more often had positive anti-Smith autoantibody, ribonucleoprotein, and hypocomplementemia, and more nephritis, rash, and cytopenias than the older-onset group. However, disease activity and damage accrual were higher in the older-onset group. The older patients received less prednisone and immunosuppressives (current and ever-use). As expected, comorbidity was higher in the older-onset SLE group. CONCLUSION: This study suggests that older age-onset SLE is not benign. There may be an interaction between lupus and age in which, although there is less lupus nephritis in the elderly, more disease activity and damage are present.

Published
2010

220. Arthritis in Aboriginal Manitobans: Evidence for a High Burden of Disease

Author

Barnabe, Cheryl, Elias, Brenda, Bartlett, Judith, Roos, Leslie, and Peschken, Christine

Abstract

OBJECTIVE: To evaluate the relative burden of arthritis and patterns of care in Aboriginal Manitobans, using multiple data sets to ensure a representative picture. METHODS: Arthritis burden and healthcare utilization was ascertained using 3 separate data sources. Physician claims for 3 common ICD-9 musculoskeletal diagnoses were abstracted from the Population Health Research Data Repository for First Nations (FN) Manitobans and compared to all other Manitobans. Self-reported arthritis rates were obtained from the Manitoba First Nations Regional Longitudinal Health Survey (MFN Survey), which surveyed FN persons living on-reserve. Data on ethnicity and diagnoses were abstracted from the Arthritis Centre research database, which contains records of all patients seen at the Arthritis Centre. RESULTS: Twice as many FN Manitobans had physician claims for rheumatoid arthritis, degenerative arthritis, and unspecified arthropathy compared to all other Manitobans. MFN Survey data identified a self-reported arthritis rate of 21.0% and a rheumatoid arthritis (RA) rate of 3.0%. Data for 687 Aboriginal patients and 4135 Caucasian patients were abstracted from the Arthritis Centre database. Aboriginal patients seen in the Arthritis Centre were 2 to 4 times more likely to have a diagnosis of inflammatory disease, and less than half as likely to have noninflammatory disease. CONCLUSION: The data highlight the increased burden of arthritis in Aboriginal Manitobans, and draw attention to large gaps in our knowledge of how, why, and when Aboriginals access medical care.

Published
2008

221. Familial Seropositive Rheumatoid Arthritis in North American Native Families: Effects of Shared Epitope and Cytokine Genotypes

Author

Oen, Kiem, Robinson, David, Nickerson, Peter, Katz, Steven, Cheang, Mary, Peschken, Christine, Canvin, Janice, Hitchon, Carol, Schroeder, Marial-Louise, and El-Gabalawy, Hani

Abstract

OBJECTIVE: A number of North American native (NAN) populations have high prevalence rates of both rheumatoid arthritis (RA) and the shared epitope (SE). We examined the phenotype and familial incidence of RA in a NAN population, and investigated how the SE and cytokine genes may affect disease risk within affected families. METHODS: NAN patients with seropositive RA or polyarthritis rheumatoid factor (RF) positive juvenile idiopathic arthritis (JIA) were identified from clinical databases. Patients were recruited consecutively as they presented for clinic visits. Family pedigrees were constructed and consenting relatives were interviewed and examined. The risk of RA within families was calculated by multiple logistic regression. Input variables were the SE and cytokine genotypes. Probands and affected relatives were entered as the affected group, and unaffected relatives within families as the unaffected group. Results were confirmed among unrelated subjects, i.e., unrelated patients and unaffected relatives of other probands. RESULTS: The familial prevalence of RA was 0.50 (95% confidence intervals 0.30, 0.70) among 28 families studied. The interleukin 10 (IL-10) promoter – 1082G/A genotype decreased the odds of RA relative to the A/A genotype in affected families (OR 0.247, 95% CI 0.081, 0.751; p = 0.014) and among unrelated subjects (OR 0.203, 95% CI 0.064, 0.640; p = 0.006). The G/G genotype yielded an OR of 0.093 (95% 0.013, 0.676; p = 0.019) among unrelated subjects. The SE had no effect in these calculations. CONCLUSION: There was a high familial prevalence of RA in this NAN cohort. In susceptible NAN families, the risk of RA was reduced by IL-10 genotypes, whereas the SE did not affect risk. Study of healthy NAN controls is required to determine if these conclusions apply to this NAN population as a whole.

Published
2005

223. 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

224. 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.

226. 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.

227. 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

229. GRADE-Based Recommendations for the Diagnosis and Monitoring of Systemic Lupus Erythematosus in Canada

Author

Keeling, Stephanie, Alabdurubalnabi, Zainab, Avina-Zubieta, J. Antonio, Barr, Susan, Bergeron, Louise, Bernatsky, Sasha, Bourre-Tessier, Josiane, Clarke, Ann E., Baril-Dionne, Alexandra, Dutz, Jan, Ensworth, Stephanie, Fifi-Mah, Aurore, Fortin, Paul R., Gladman, Dafna D., Haaland, Derek, Hanly, John G., Hiraki, Linda T., Hussein, Sara, Legault, Kimberly, Levy, Deborah M., Lim, Lily, Matsos, Mark, Mcdonald, Emily, Medina-Rosas, Jorge, Pardo, Jordi Pardo, Peschken, Christine A., Pineau, Christian, Pope, Janet E., Rader, Tamara, Reynolds, Jennifer, Silverman, Earl, Suitner, Manon, Tselios, Konstantinos, Urowitz, Murray, Zahi Touma, Vinet, Evelyne, and Santesso, Nancy

230. 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

231. 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.

233. 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 (

234. 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

235. 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.

236. 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

237. 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.

238. 'Lupus Headache': Results From a Prospective, International, Inception Cohort Study

Author

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

240. 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

243. Construction and Validation of a Frailty Index As a Novel Health Measure in Systemic Lupus Erythematosus

Author

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

244. 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.

245. 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

246. 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

247. 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.

248. Genetics of Age at Diagnosis in Systemic Lupus Erythematosus

Author

Carlomagno, Raffaella, Liao, Fangming, Cao, Jingjing, Gladman, Dafna, Klein-Gitelman, Marisa, Knight, Andrea, Levy, Deborah, Onel, Karen, Paterson, Andrew, Peschken, Christine, Pope, Janet, Zahi Touma, Urowitz, Murray, Webber, Declan, Wither, Joan, Silverman, Earl, and Hiraki, Linda

249. 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

250. 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

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