Search

Systemic lupus erythematosus (SLE) is prevalent in Asia and carries a variable prognosis among patients across the Asia-Pacific region, which could relate to access to health care, tolerability of medications, and adherence to therapies. Because many aspects of SLE are unique among patients from this region, the Asia-Pacific League of Associations for Rheumatology developed the first set of consensus recommendations on the management of SLE. A core panel of 13 rheumatologists drafted a set of statements through face-to-face meeting and teleconferences. A literature review was done for each statement to grade the quality of evidence and strength of recommendation. 29 independent specialists and three patients with SLE were then recruited for a modified Delphi process to establish consensus on the statements through an online voting platform. A total of 34 consensus recommendations were developed. Panellists agreed that patients with SLE should be referred to a specialist for the formulation of a treatment plan through shared decision making between patients and physicians. Remission was agreed to be the goal of therapy, but when it cannot be achieved, a low disease activity state should be aimed for. Patients should be screened for renal disease, and hydroxychloroquine is recommended for all Asian people with SLE. Major organ manifestations of SLE should be treated with induction immunosuppression and subsequently maintenance; options include cyclophosphamide, mycophenolate mofetil, azathioprine, and calcineurin inhibitors, in combination with glucocorticoids. Biologics, combination regimens, plasma exchange, and intravenous immunoglobulins should be reserved for cases of refractory or life-threatening disease. Anticoagulation therapy with warfarin is preferred to the direct oral anticoagulants for thromboembolic SLE manifestations associated with a high-risk antiphospholipid antibody profile.Copyright © 2021 Elsevier Ltd

Objective: To determine longitudinal associations between Physician Global Assessment (PGA) and patient-reported outcomes (PROs) in patients with systemic lupus erythematosus (SLE). Method(s): Patients attending a rheumatology clinic between 2013 and 2017 completed specific (SLEQOL) and generic (SF36) health-related quality of life (HRQoL) surveys and rated their global rating of change (GRC) at each visit. PGA, SLEDAI-2K and SLE Flare Index (SFI) were also captured on all visits. Generalised estimating equations (GEE) methods were used to examine longitudinal associations of PGA with PROs and clinical indicators. Result(s): 337 patients were followed for a median [IQR] of 3.2 [1.6, 3.4] years (2,059 visits). High PGA (>1) was strongly associated with high SLEDAI-2K scores, the presence of flares and poor PROs. Odd ratios (OR) [95% CI] of PGA > 1 in patients with SLEDAI-2K >4 & <10 and SLEDAI-2K >=10, compared to SLEDAI-2K <= 4, were 3.46 [2.36, 5.08], p < 0.001 and 6.39 [4.30, 9.49], p < 0.001, respectively. OR [95% CI] of PGA > 1 in patients with mild-to-moderate or severe flares were 2.09 [1.62, 2.71], p < 0.001 and 4.42 [3.21, 6.07], p < 0.001, respectively. Mental components of both SLEQOL (mood, self-image) and SF36 (MCS) surveys demonstrated significant associations with high PGA. After adjusting for SLEDAI-2K, one-point increase in PGA was associated with reductions in SLEQOL total score and SF36-MCS by 2.33 (regression coefficient (RC) [95% CI] = -2.33 [-3.77, -0.88], p = 0.002), and 4.16 (RC [95% CI] = -4.16 [-5.19, -3.13], p < 0.001) points, respectively. Associations of some physical components (SLEQOL-symptoms, and SF36-PCS) with PGA attenuated when adjusted for SLEDAI-2K. Patients who rated low scores of GRC, which indicate health deterioration, were twice as likely to have PGA > 1 (OR [95%CI] 1.99 [1.25, 3.16], p = 0.004). Conclusion(s): High PGA was strongly associated with poor mental health, high disease activity and flares. This study confirms the

Systemic lupus erythematosus (SLE) is a more common autoimmune rheumatic disease in the Asia-Pacific region. The prognosis of SLE remains unsatisfactory in some Asian countries because of delayed diagnosis, limited access to medications, increased complications and issues of tolerability and adherence to treatment. The Asia-Pacific League of Associations for Rheumatology SLE special interest group has recently published a set of consensus recommendations on the management of SLE for specialists, family physicians, specialty nurses, and other healthcare professionals in the Asia-Pacific region. This article reports a systematic literature review of the infective complications of SLE in Asia and evidence for prevention of these infections by pre-emptive antimicrobial therapy and vaccination.Copyright © 2021 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

Systemic lupus erythematosus (SLE) is a more common autoimmune rheumatic disease in the Asia Pacific region. Epidemiological studies have revealed differences in the manifestations and prognosis of the disease among regional ethnicities and populations. To date, the prognosis of SLE remains unsatisfactory in some Asian countries because of limited patient access to medical care and inadequate provider access to educational or practice support. To describe the unique characteristics of the disease in the region and to address the information discrepancy in the area, the Asia-Pacific League of Associations for Rheumatology (APLAR) SLE special interest group has recently published 34 consensus recommendations on the management of SLE for specialists, family physicians, specialty nurses, and other healthcare professionals in the Asia Pacific region. Herein, along with this consensus statement, we detail the infective complications of SLE in Asia and evidence for the prevention of these infections through preemptive antimicrobial therapy and vaccination.

Background: The utility of generic health-related quality of life (HRQoL) questionnaires in patients with systemic lupus erythematosus (SLE) is uncertain. We compared the performance of generic (SF36) and specific (SLEQOL) HRQoL surveys by examining their associations with the Global Rating of Change (GRC) and SLE clinical indicators. Method(s): The study included SLE patients who attended a single-center rheumatology clinic between 2013 and 2017. Patients completed both specific (SLEQOL) and generic (SF36) surveys and rated their GRC compared to the previous visit using a 7-point Likert scale on the same day of routine visits. Based on GRC scores, patients' change in HRQoL was categorized as "no change," "deterioration," or "improvement." Disease activity (SLEDAI-2K), flare, and lupus low disease activity state (LLDAS) were assessed at each visit, and organ damage (SDI) was determined annually. Pairwise correlations between SLEQOL and SF36 components were examined, and associations between GRC status and SLE disease indicators were compared using generalized estimating equations (GEE). Result(s): Three hundred thirty-seven patients with 2062 visits were included in the analysis. SLEQOL correlated significantly with SF36. Patients reported improvements in HRQoL in 58%, deterioration in 15%, and "no change" in 27% of all visits. Compared to the "no change" group, mean SF36 and SLEQOL scores were significantly lower in the deterioration group and higher in the improvement group. The magnitude of changes observed with SLEQOL and SF36 in the deterioration and improvement groups was similar. Patients in LLDAS had significantly higher mean scores in both SLEQOL and SF36. In contrast, patients with active disease, especially those with cutaneous, renal, central nervous system, and musculoskeletal activity, had significantly lower SLEQOL and SF36. Flare and organ damage were also associated with lower SLEQOL and SF36-PCS (physical component) but not with SF36-MCS (mental co

Background/Purpose: To determine the correlation between SLE-specific and generic patient reported outcomes measures (PROs), and to examine their associations with patients' global rating of change (GRC) in their health-related quality of life (HRQoL), and Lupus Low Disease Activity State (LLDAS). Method(s): SLE patients who full-filled either the 1997 ACR or the 2012 SLICC classification criteria, and attended a rheumatology clinic in Thailand between 2013 and 2017, were recruited for this study. They completed the SLEQoL-TH and SF36-TH surveys (Thai versions), and rated their GRC compared to their previous visit using a 7-point Likert scale (GRC -7 to +7) on the same day of clinic visits. Based on GRC scores, patients were categorised as 'no change' (-1 to +1), 'deterioration' (-2 to -7) or 'improvement' (+2, to +7) in HRQoL. SLE disease activity was determined by the SLEDAI-2K. Physician global assessment (PGA) of disease activity was rated 0-3. LLDAS was defined as described (Franklyn K. Ann Rheum Dis 2016). Correlation between SLEQoL-TH and SLF36-TH was examined using Person's correlation coefficients. Associations of GRC and LLDAS with SLEQoL-TH/SF36-TH surveys were examined using generalised estimating equations. Result(s): 337 patients (2,062 visits) were included. Median [inter-quartile range (IQR)] values of patients' age at enrolment, disease duration, and study duration was 37 [28, 48] years, 7 [3, 13] years, and 3.18 [1.55, 3.46] years, respectively. 56% of patients experienced at least one flare. Median [IQR] time adjusted mean (TAM) -SLEDAI and TAM-PGA scores were 3.5 [2.0, 5.6] and 0.4 [0.3, 0.7], respectively. During the study, 81% of patients achieved LLDAS at least once, and were in LLDAS in approximately 50%. TAM SLEQoL-TH score, and SF36-TH physical component summary (PCS) and mental component summary (MCS), were 89.8 [81.7, 94.9], 46.8 [42.0, 52.1] and 49.4 [42.9, 55.0], respectively. SLEQoL-TH total scores correlated significantly with both SF

Background and aims To compare specific health-related quality of life (HR-QoL) questionnaire (SLE-QoL) with a generic HRQoL questionnaire (SF-36) and to examine their sensitivity to changes defined by the global rating for change (GRC). Methods Patients attending a single-centre lupus clinic in Thailand completed both validated SLE-QoL and SF-36 questionnaires, and rated their global change in QoL compared to previous visit using a 7-point Likert scale (GRC). Patients were grouped into either 'no change' (control group), 'deterioration' or 'improvement' categories (GRC status). Physician global assessment (PGA, 0-3) scores were collected for clinician- assessed disease activity. Associations between GRC status and SLE-QoL/SF-36 scores were examined using generalised estimating equations. Cohen's d effect sizes were estimated to compare mean changes in SLE-QoL and SF-36 scores. Results The analysis included 248 patients with 1265 visits. Patients reported improvement in ~59%, deterioration in ~16% and no change in QoL in ~25% of visits. PGA demonstrated statistically significant (p<0.01), negative correlations with GRC (r=-0.49), SLE-QOL (r=-0.49), SF-36PCS (r=-0.50) and SF-36MCS (r=-0.36) scores. In contrast, SLEQoL scores correlated positively and significantly (p<0.01) with SF-36PCS (r=0.56) and SF-36MCS (r=0.60) scores. Compared to control group, mean scores of SF-36PCS, SF- 36MCS and SLE-QoL surveys were significantly lower in the deterioration group (mean change -4.96,-3.21, and -6.51, respectively, p<0.01) but SF-36PCS and SLE-QoL were significantly higher in the improvement group (mean change 1.22 and 1.35 respectively, p<0.01). Cohen's d effect sizes were similar for both questionnaires. Conclusions Both SLE-QoL and SF-36 demonstrated similar, strong associations with GRC-based deterioration or improvement.

Objective: To examine the associations of patient reported out-comes (PROs) with LLDAS. Method(s): SLE patients attending a rheumatology clinic in Thailand between 2013 and 2017 completed specific (SLE-QoL) and generic (SF36) health-related quality of life (HR-QoL) surveys, and rated their global change (GRC) in QoL compared to their previous visit using a 7-point Likert scale. Patients' changes in QoL were categorised as 'no change' (-1 to +1), 'deterioration' (-2 to-7) or 'improvement' (+2, to +7). LLDAS was defined as described (Franklyn K, et al. Ann Rheum Dis 16; 75: 1615). Associations of PROs (SLE-QoL, SF36 and GRC) with LLDAS were examined using generalised estimating equations. Result(s): 337 patients (2062 visits) were included in the study. Patients' median age [inter-quartile range (IQR)] and study duration were 37 [28, 48] years and 1162 [567, 1246] days, respectively. 81% of patients achieved LLDAS at least once during the study period. SLE-QoL and SF36 survey components were significantly correlated (P < 0.01). Patients who were in LLDAS had statistically significantly higher scores in both SLE-QoL and SF36 surveys when compared to patients who were not. Patients reported improvement in 58%, deterioration in 15% and no change in QoL in 27% of all visits. Compared to the no change group, QoL deterioration was significantly associated with reduced odds of subsequently achieving LLDAS (OR 0.53, 95%CI: 0.39-0.72, P < 0.001), but QoL improvement was not associated with increased odds of achieving LLDAS. Conclusion(s): LLDAS is associated with improved HR-QoL, and improving QoL predicts LLDAS attainment.