Lupus最新文献

Objectives: This study aims to estimate the annual medical costs of systemic lupus erythematosus (SLE) in New Zealand (NZ).

Methods: SLE patients were linked to the Australia and New Zealand Dialysis and Transplant Registry, Pharmaceutical Collection, National Minimum Dataset, National Non-Admitted Patients Collection and Mortality Collection. National direct medical costs of SLE in 2006-2021 and annual costs per patient were estimated. Generalized linear model was used to examine the impact of various factors on medical costs, including ethnicity, gender, age, socioeconomic status and presence of end-stage kidney disease (ESKD).

Results: The annual national costs of SLE were stable over time, around NZ$12 million. The average costs were NZ$8,324 (US$5,277, €5,011) per patient per year, with the costs for patients with ESKD being nine times higher than patients without ESKD (NZ$47,143 vs NZ$5,091). The costs per patient for Māori and Pacific were both around twice the costs for European/Others (NZ$13,124 and NZ$11,842 vs NZ$6,153), but the difference attenuated after adjustment for ESKD and other factors. Among patients without ESKD, Asian, males and patients living in the most deprived areas were associated with higher costs. For patients with ESKD, Māori and patients living in the most deprived areas had higher costs.

Conclusions: The annual national costs of SLE were stable over time. The increase in pharmaceutical costs were offset by decrease in hospitalisation costs. Costs for patients with ESKD were nine times higher than costs for patients without ESKD. Interventions for slowing the disease progression and preventing ESKD can reduce medical costs.

Objectives: To investigate the trends in immunomodulator use and pregnancy outcomes among pregnant women with systemic lupus erythematosus (SLE), a condition requiring medication to maintain disease activity.

Methods: This descriptive study used data from the National Health Information Database in Korea from 2002 to 2018. We included 5,044 pregnancies initiated between 2005 and 2017 in 3,120 SLE patients. Annual trends in SLE therapy, drug utilisation patterns during the preconception and pregnancy periods, and pregnancy outcomes were analysed.

Results: Pregnancy compatible immunosuppressant (PC-IS) and hydroxychloroquine use during the first trimester were 10.7% and 41.4%, respectively. Most SLE medications exhibited a decline in usage from the preconception period to the first trimester. A prescription rate of 0.9% for pregnancy incompatible immunosuppressants (PIC-IS) was observed during the first trimester, and the incidence of live births, stillbirths, and abortions remained consistent from 2005 to 2017.

Conclusions: Insufficient usage of hydroxychloroquine and PC-IS, along with a reduction in PIC-IS usage primarily during early pregnancy rather than before conception, highlights the unmet need for preconceptional family planning with appropriate medication management strategies in SLE pregnancies.

Objective: To test the ability of the 2019 EULAR/ACR Classification Criteria for SLE score to predict lupus related hospitalization and overall cost of hospitalization.

Methods: 217 University of Kentucky patient records that met our preliminary inclusion criteria, 44 patients were selected by a random number generator algorithm for a thorough chart review to collect data needed for calculation of the 2019 EULAR/ACR Classification Criteria for SLE score. Total hospitalization cost was calculated by using hospital adjusted expenses per inpatient day data, which estimates the expense incurred by the hospital to provide services and thus removes the variability of charges and reimbursements introduced by insurance type.

Results: Patients with a score of 19 or more had increased risk of hospitalization in at least the 6 months after initial outpatient visit as compared to their counterparts with scores less than 19 [p= .069]. The odds of being hospitalized for lupus among those with initial score ≥19 was 5.71 times higher than for those with score <19. Patients who scored 19 or less at initial visit had a mean hospitalization cost of $14,499, whereas those scored >19 had mean hospitalization cost of $28,725.

Conclusion: This study adds to the growing evidence that 2019 EULAR/ACR Classification Criteria score for SLE can be used as a surrogate marker to assess disease severity. The weighted 2019 EULAR/ACR Classification Criteria for SLE score offers a promising tool beyond its primary objective to find true lupus cases for research and clinical trials.

After the end of the COVID-19 public health emergency, we analysed the relationship between Systemic Lupus Erythematosous (SLE) and COVID-19 from the virologist's perspective based on recent findings. SLE and COVID-19 co-morbidity present unique challenges, as individuals with SLE may be at increased risk for severe COVID-19 illness due to immune system abnormalities and ongoing therapies. Effective management of both diseases requires careful monitoring, adherence to vaccination programs, preventive measures and approved and patient-tailored therapies. This review covers various aspects, including the clinical outcome of SLE patients infected by SARS-CoV-2, the impact of this infection on SLE onset or flare-ups and the benefits of vaccination for this population. Furthermore, this review presents the most recent recommendations on clinical management of COVID-19 in rheumatic patients, including those with SLE, discussing the currently available therapeutic options. Finally, we explore the most effective tools for SARS-CoV-2 diagnosis in autoimmune conditions and examine prognostic biomarkers in COVID-19 rheumatic patients with potential implications on their clinical oversight. By adopting a comprehensive approach, we address these complexities from the virologist's perspective, aiming to improve health care for this vulnerable population.

Background: Patients with cutaneous lupus erythematosus (CLE) can present with one or multiple different subtypes of CLE. There is limited understanding of the prevalence and associated risk factors for having multiple CLE subtype diagnoses.

Objective: This study characterized the frequency and risk factors for having multiple CLE subtypes.

Methods: This was a cross-sectional study of 319 patients with CLE enrolled in the University of Texas Southwestern Cutaneous Lupus Registry seen in outpatient dermatology clinics at the University of Texas Southwestern Medical Center and Parkland Health from January 1, 2009 to December 31, 2021. Demographic and clinical information was collected from each subject and compared using univariate and multivariable logistic regression analyses.

Results: 59 subjects (18.5%) were diagnosed with two or more CLE subtypes. Univariate analyses identified statistically significant differences in rates of systemic lupus erythematosus (SLE) diagnosis, history of positive anti-nuclear antibody, arthritis, renal disorder, and serositis in patients with multiple CLE subtype diagnoses. In the multivariable analysis, SLE diagnosis was found to be statistically significant.

Conclusions: Our study showed that almost one out of five CLE patients have multiple CLE subtypes, with SLE diagnosis being a significant risk factor. Clinicians can monitor CLE patients for developing multiple subtypes and account for systemic manifestations and laboratory abnormalities associated with SLE.

Background: Infections are a major cause of morbidity and mortality in juvenile systemic lupus erythematosus (SLE). We assessed the incidence and risk factors for major infections in juvenile SLE.

Methods: A retrospective review of 225 patients of juvenile SLE (ACR 1997 criteria) with age <18 years visiting the rheumatology clinic at a single centre between 2000 to 2020 was done from case records and the hospital electronic health records. Serious infection was defined as the need for hospitalization, or infection resulting in disability or death. Cox regression was used to determine factors associated with a serious infection and the effect of serious infection on overall survival.

Results: We reviewed 225 children (197 girls, mean age 13.89 ± 3.42 years) with a cumulative follow up of 1153.45 person-years. Eighty serious infections occurred in 63 (28% of the cohort) children at a rate of 69.35 serious infections per 1000 person-years. A second serious infection occurred in 12 children and 5 of them developed three infections.Among the cases with known etiology (78.75% of cases), bacterial infections were most common (N = 33) including S. Aureus (11), E. Coli (7), K. Pneumoniae (3), E. Fecalis (3), S. Pneumoniae (2), Acinetobacter spp. (2), Citrobacter (2), Salmonella (2) and P. Aeruginosa (1). Twenty six (32.5%) opportunistic infections occurred: Mycobacterium tuberculosis (18), Cytomegalovirus (3), disseminated Herpes zoster (4) and invasive candidiasis (1) with 15 (83.3%) of the tuberculosis cases being extrapulmonary. On multivariate analysis, fever (HR 8.51, 1.17-61.44), gastrointestinal involvement (HR 4.73, 1.13-19.94), current steroid dose (HR 1.36,1.14-1.62), average cumulative steroid dose per year (HR 1.004, 1.002-1.005) and cyclophosphamide (HR 2.22, 1.11-4.46) were associated with serious infection.Hospitalization rates were significantly higher in those with any serious infection (Rate-ratio 2.79, 1.81-3.77) as was damage accrual (SLICC damage index 1.04 vs 0.22). Serious infection-free survival at 1 year and 5 years was 84% (79.1-89.2) and 72% (65.4-79.2). There were 19 deaths with infection attributable mortality in 10 (52.6%). Serious infection predisposed to higher overall mortality with recurrent infections conferring a hazard ratio of 36.02 (8.07-160.62).

Conclusion: Serious infections are a major cause of mortality and damage in SLE. Constitutional symptoms, gastrointestinal involvement, current and cumulative steroid dose and cyclophosphamide predict serious infections. TB prophylaxis in patients with SLE should be considered in endemic areas, especially when using high-dose steroid therapy.

Objective: Cognitive impairment (CI) in systemic lupus erythematosus (SLE) is quite common and is an important prognostic factor due to its severity. The aim of our study was to determine the proportion and type of CI in SLE and to identify associated risk factors.

Methods: We performed a cross-sectional study (January - March 2022). Participants included SLE patients and controls (No-SLE). SLE patients were subdivided into those with and those without CI to identify associated risk factors. CI was defined based on the results of eight specific tests assessing various cognitive functions, with MMSE used for overall cognitive assessment. Impairment was indicated by abnormalities in at least five of these eight functions.

Results: Our study included 60 lupus and 40 non-lupus participants. The median disease duration of patients in the SLE group was 72 months (interquartile range: 24 - 150 months). The proportion of cognitive impairment in SLE was 31.7%. The comparative study of cognitive functions between the two groups of participants with and without SLE concluded that executive functions and verbal fluency were more impaired in the lupus group compared to the non-lupus group. It also concluded that there were no statistically significant differences in attention and concentration, episodic memory, working memory, calculation, visuospatial and visuoconstructive activity, or judgement. In the multivariate analysis, patients with SLE have a significantly higher risk of CI (Adjusted OR 3.76, 95% CI: 1.217 - 11.621) compared to non-SLE individuals. Each additional year of age increases the risk by 4.4% (Adjusted OR 1.044, 95% CI: 1.008 - 1.082). For factors associated with CI in SLE, the multivariate analysis concluded that the duration of corticosteroid therapy, by months, had an adjusted OR equal to 1.009 (CI (95%): 1.000-1.018), and the duration of education, by years, had an adjusted OR equal to 0.857 (CI (95%): 0.736-0.999).

Conclusion: Screening for CI in lupus patients is important, especially for those with factors associated with these disorders such as prolonged duration of corticosteroid therapy and shortened schooling.

Background: Lupus cystitis, a severe complication of systemic lupus erythematosus (SLE), presents considerable treatment challenges.

Purpose: This case report describes the use of telitacicept in treating severe SLE with lupus cystitis.

Research design: A single patient with lupus cystitis.

Study sample: A patient with symptoms including frequent urination, urgency, and acute urinary retention.

Data collection and analysis: Initial treatments included corticosteroid pulse therapy, immunoglobulin, and cyclophosphamide, which improved laboratory indicators but failed to alleviate symptoms of urinary retention. The patient was then treated with telitacicept.

Results: Significant alleviation of urinary retention was observed shortly after incorporating telitacicept into the treatment regimen. The patient's condition remained stable with no relapse during the subsequent 10 months of follow-up.

Conclusions: This case highlights the therapeutic potential of telitacicept for SLE patients who are unresponsive to conventional therapies, particularly those with severe manifestations such as lupus cystitis.

Introduction: Systemic lupus erythematosus (SLE) causes widespread inflammation and damage in affected organs. Severity is determined by the type of organ systems affected and the extent of involvement. SLE occurs in childhood or adulthood and disease severity varies according to age of onset. We compared disease features and changes in disease severity over time between childhood-onset (cSLE) and adult-onset SLE (aSLE).

Methods: Patients 0-64 years old, newly diagnosed with SLE during 2014-2020 were identified using the MarketScan® database. A validated algorithm was used to assess disease severity. Improving severity versus baseline was defined as a transition from a higher (severe) to a lower (mild/moderate) disease state during each evaluation period. Group comparisons were made using the Pearson chi-square test for categorical and t test for continuous measures.

Results: A total of 10,912 patients were included. Most (89.9%) were female with a mean age of 14.2 versus 44.6 years for cSLE and aSLE groups, respectively. Patients with cSLE were more likely to have severe disease at diagnosis (38.3% vs 10.7%; p < .0001) versus aSLE. The largest reduction in SLE severity occurred during 6 to <12 months post-index with cSLE experiencing the greatest improvement (36.7% vs 19.9%; p < .0001) compared with aSLE. However, despite improvements observed over time in cSLE, this group was still more likely to have severe disease at 0 to <6 months (26.4% vs 10.5%) and 6 to <12 months (14.4% vs 8.6%) post-index compared with aSLE patients (p < .01, all). For aSLE, the proportions of patients experiencing either an improvement or deterioration in symptoms was similar during 0 to <6 months and 6 to <12 months. However, during 12 to <24 months, nearly twice as many patients in this group experienced a deterioration in symptoms (30.1%) compared to improvement (15.6%).

Conclusions: Children with SLE present with greater symptom severity compared with adults. Although children were more likely to experience improvements following treatment, they had more active disease over time than aSLE patients. Disease severity remained stable for aSLE patients until the second year of follow-up, when more patients experienced a deterioration rather than improvement in symptoms.