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Liang MH, Lew ER, Fraser PA, Flower C, Hennis EH, Bae SC, Hennis A, Tikly M, Roberts WN. Choosing to End African American Health Disparities in Patients With Systemic Lupus Erythematosus. Arthritis Rheumatol 2024; 76:823-835. [PMID: 38229482 DOI: 10.1002/art.42797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/29/2023] [Accepted: 01/11/2024] [Indexed: 01/18/2024]
Abstract
Systemic lupus erythematosus (SLE) is three times more common and its manifestations are more severe in African American women compared to women of other races. It is not clear whether this is due to genetic differences or factors related to the physical or social environments, differences in health care, or a combination of these factors. Health disparities in patients with SLE between African American patients and persons of other races have been reported since the 1960s and are correlated with measures of lower socioeconomic status. Risk factors for these disparities have been demonstrated, but whether their mitigation improves outcomes for African American patients has not been tested except in self-efficacy. In 2002, the first true US population-based study of patients with SLE with death certificate records was conducted, which demonstrated a wide disparity between the number of African American women and White women dying from SLE. Five years ago, another study showed that SLE mortality rates in the United States had improved but that the African American patient mortality disparity persisted. Between 2014 and 2021, one study demonstrated racism's deleterious effects in patients with SLE. Racism may have been the unmeasured confounder, the proverbial "elephant in the room"-unnamed and unstudied. The etymology of "risk factor" has evolved from environmental risk factors to social determinants to now include structural injustice/structural racism. Racism in the United States has a centuries-long existence and is deeply ingrained in US society, making its detection and resolution difficult. However, racism being man made means Man can choose to change the it. Health disparities in patients with SLE should be addressed by viewing health care as a basic human right. We offer a conceptual framework and goals for both individual and national actions.
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Affiliation(s)
- Matthew H Liang
- Veterans Affairs Boston Healthcare System, Brigham and Women's Hospital, and Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | | | - Cindy Flower
- University of the West Indies, Cave Hill campus, Barbados
| | | | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Hanyang University Institute for Rheumatology Research, and Hanyang Institute of Bioscience and Biotechnology, Seoul, Korea
| | - Anselm Hennis
- University of the West Indies, Cave Hill campus, Barbados
| | - Mohammed Tikly
- The Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa, and Life Roseacres Hospital, Primrose, Germiston, South Africa
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Amo L, Kole HK, Scott B, Qi CF, Krymskaya L, Wang H, Miller LH, Janse CJ, Bolland S. Plasmodium curtails autoimmune nephritis via lasting bone marrow alterations, independent of hemozoin accumulation. Front Immunol 2023; 14:1192819. [PMID: 37539049 PMCID: PMC10394379 DOI: 10.3389/fimmu.2023.1192819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/30/2023] [Indexed: 08/05/2023] Open
Abstract
The host response against infection with Plasmodium commonly raises self-reactivity as a side effect, and antibody deposition in kidney has been cited as a possible cause of kidney injury during severe malaria. In contrast, animal models show that infection with the parasite confers long-term protection from lethal lupus nephritis initiated by autoantibody deposition in kidney. We have limited knowledge of the factors that make parasite infection more likely to induce kidney damage in humans, or the mechanisms underlying protection from autoimmune nephritis in animal models. Our experiments with the autoimmune-prone FcγR2B[KO] mice have shown that a prior infection with P. yoelii 17XNL protects from end-stage nephritis for a year, even when overall autoreactivity and systemic inflammation are maintained at high levels. In this report we evaluate post-infection alterations, such as hemozoin accumulation and compensatory changes in immune cells, and their potential role in the kidney-specific protective effect by Plasmodium. We ruled out the role of pigment accumulation with the use of a hemozoin-restricted P. berghei ANKA parasite, which induced a self-resolved infection that protected from autoimmune nephritis with the same mechanism as parasitic infections that accumulated normal levels of hemozoin. In contrast, adoptive transfer experiments revealed that bone marrow cells were altered by the infection and could transmit the kidney protective effect to a new host. While changes in the frequency of bone marrow cell populations after infection were variable and unique to a particular parasite strain, we detected a sustained bias in cytokine/chemokine expression that suggested lower fibrotic potential and higher Th1 bias likely affecting multiple cell populations. Sustained changes in bone marrow cell activation profile could have repercussions in immune responses long after the infection was cleared.
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Affiliation(s)
- Laura Amo
- Laboratory of Immunogenetics, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, United States
| | - Hemanta K. Kole
- Laboratory of Immunogenetics, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, United States
| | - Bethany Scott
- Laboratory of Immunogenetics, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, United States
| | - Chen-Feng Qi
- Laboratory of Immunogenetics, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, United States
| | - Ludmila Krymskaya
- Laboratory of Immunogenetics, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, United States
| | - Hongsheng Wang
- Laboratory of Immunogenetics, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, United States
| | - Louis H. Miller
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, United States
| | - Chris J. Janse
- Leiden Malaria Research Group, Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Silvia Bolland
- Laboratory of Immunogenetics, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, United States
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Suzon B, Louis-Sidney F, Aglaé C, Henry K, Bagoée C, Wolff S, Moinet F, Emal-Aglaé V, Polomat K, DeBandt M, Deligny C, Couturier A. Good Long-Term Prognosis of Lupus Nephritis in the High-Income Afro-Caribbean Population of Martinique with Free Access to Healthcare. J Clin Med 2022; 11:jcm11164860. [PMID: 36013099 PMCID: PMC9410092 DOI: 10.3390/jcm11164860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022] Open
Abstract
Lupus nephritis (LN) has been described as having worse survival and renal outcomes in African-descent patients than Caucasians. We aimed to provide long-term population-based data in an Afro-descendant cohort of LN with high income and easy and free access to specialized healthcare. Study design: We performed a retrospective population-based analysis using data from 2002–2015 of 1140 renal biopsies at the University Hospital of Martinique (French West Indies). All systemic lupus erythematosus patients with a diagnosis of LN followed for at least 12 months in Martinique or who died during this period were included. Results: A total of 89 patients were included, of whom 68 (76.4%) had proliferative (class III or IV), 17 (19.1%) had membranous (class V), and 4 (4.5%) had class I or II lupus nephritis according to the ISN/RPS classification. At a mean follow-up of 118.3 months, 51.7% of patients were still in remission. The rates of end-stage renal disease were 13.5%, 19.1%, and 21.3% at 10, 15, and 20 years of follow-up, respectively, and mortality rates were 4.5%, 5.6%, and 7.9% at 10, 15, and 20 years of follow-up, respectively. Conclusions: The good survival of our Afro-descendant LN patients, similar to that observed in Caucasians, shades the burden of ethnicity but rather emphasizes and reinforces the importance of optimizing all modifiable factors associated with poor outcome, especially socioeconomics.
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Affiliation(s)
- Benoit Suzon
- Department of Internal Medicine, Martinique University Hospital, CEDEX CS, 90632 Fort-de-France, Martinique, France
- Correspondence:
| | - Fabienne Louis-Sidney
- Department of Rheumatology, Martinique University Hospital, CEDEX CS, 90632 Fort-de-France, Martinique, France
| | - Cédric Aglaé
- Department of Nephrology, Martinique University Hospital, CEDEX CS, 90632 Fort-de-France, Martinique, France
| | - Kim Henry
- Department of Internal Medicine, Martinique University Hospital, CEDEX CS, 90632 Fort-de-France, Martinique, France
| | - Cécile Bagoée
- Department of Internal Medicine, Martinique University Hospital, CEDEX CS, 90632 Fort-de-France, Martinique, France
| | - Sophie Wolff
- Department of Internal Medicine, Martinique University Hospital, CEDEX CS, 90632 Fort-de-France, Martinique, France
| | - Florence Moinet
- Department of Internal Medicine, Martinique University Hospital, CEDEX CS, 90632 Fort-de-France, Martinique, France
| | - Violaine Emal-Aglaé
- Department of Nephrology, Martinique University Hospital, CEDEX CS, 90632 Fort-de-France, Martinique, France
| | - Katlyne Polomat
- Department of Internal Medicine, Martinique University Hospital, CEDEX CS, 90632 Fort-de-France, Martinique, France
| | - Michel DeBandt
- Department of Rheumatology, Martinique University Hospital, CEDEX CS, 90632 Fort-de-France, Martinique, France
| | - Christophe Deligny
- Department of Internal Medicine, Martinique University Hospital, CEDEX CS, 90632 Fort-de-France, Martinique, France
| | - Aymeric Couturier
- Department of Internal Medicine, Martinique University Hospital, CEDEX CS, 90632 Fort-de-France, Martinique, France
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Long-Term Outcome in Systemic Lupus Erythematosus; Knowledge from Population-Based Cohorts. J Clin Med 2021; 10:jcm10194306. [PMID: 34640322 PMCID: PMC8509465 DOI: 10.3390/jcm10194306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Accurate knowledge of outcomes in Systemic Lupus Erythematosus (SLE) is crucial to understanding the true burden of the disease. The main objective of this systematic review was to gather all population-based studies on mortality, end-stage renal disease (ESRD) and cancer in SLE. Method: We performed a systematic literature search in two electronic databases (MEDLINE and Embase) to identify all population-based articles on SLE and survival, mortality, ESRD and cancer. The SLE diagnosis had to be verified. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). Results: We included 40/1041 articles on mortality (27), ESRD (11) and cancer (3), of which six were defined as inception studies. In the total SLE cohort, the standardized mortality ratio ranged from 1.9 to 4.6. Cardiovascular disease was the most frequent cause of death in studies with follow-up times over 15 years. SLE progressed to ESRD in 5–11% of all SLE patients. There are no data supporting increased cancer incidence from population-based inception cohorts. Conclusion: There is a need for more population-based studies on outcomes of SLE, especially inception studies, with the use of control groups and follow-up times over 15 years.
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Khedr EM, Gamal RM, Rashad SM, Yacoub M, Ahmed GK. Impact of depression on quality of life in systemic lupus erythematosus patients. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00343-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
Abstract
Background
Depression is common in systemic lupus erythematosus (SLE) and is an unmeasured risk factor, yet its symptoms can be neglected in standard disease evaluations. The purpose of this study was to assess the frequency and the impact of depression on quality of life in SLE patients. We recruited 32 patients with SLE and 15 healthy control volunteers in the study. The following investigations were undertaken in each patient: clinical and rheumatologic assessment, SLE Disease Activity Index-2k (SLEDAI-2k), Beck Depression Inventory (BDI), Short-Form Health Survey (SF-36) questionnaire, and routine laboratory tests.
Results
There was a high percentage of depression (46.9%) in the SLE patients. Regarding quality of life (SF-36), there were significant affection of the physical and mental composite summary domains (PCS and MCS) scores in lupus patients compared with controls (P < 0.000 for both) with the same significant in depressed compared with non-depressed patients. SF-36 subscales (physical function, limit emotional, emotional wellbeing, and social function) were significantly affected in depressed lupus patients compared with non-depressed patients. There was a significant negative correlation between the score of MCS domain of SF-36 with BDI (P < 0.000) while positive correlation between SLEDAI score with depression score. In contrast, there were no significant correlations between MCS or PCS with age, duration of illness, or SLEDAI-2K.
Conclusions
Depression is common in SLE patients and had a negative impact on quality of life particularly on MCS domain and positive correlation with disease severity score.
Trial registration
This study was registered on clinical trial with registration number: NCT03165682 https://clinicaltrials.gov/ct2/show/NCT03165682 on 24 May 2017.
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Flower C. Assessment of SLE activity for acute clinical decision-making: use of a colour-coded threat-level approach for the non-rheumatologist. Lupus Sci Med 2021; 8:8/1/e000484. [PMID: 33579800 PMCID: PMC7883849 DOI: 10.1136/lupus-2021-000484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/27/2021] [Indexed: 11/03/2022]
Abstract
Systemic lupus erythematosus (SLE) activity indices are widely applied in academic centres and for research protocols but are often not part of usual care in busy under-resourced clinical settings especially where non-rheumatologists are involved in SLE management. We developed a simplified activity index based on the established knowledge and experience of SLE in our hospital and further applied a treatment guideline to assist in acute clinical decision-making. The index is colour-coded for easy reference and categorizes clinical complications in order of the severity of the threat they pose to the patient. An index such as this can be modified to have wider application and relevance in other countries with reduced access to specialist care.
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Affiliation(s)
- Cindy Flower
- Faculty of Medicine, University of the West Indies, Cave Hill Campus, Barbados
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Kedves M, Kósa F, Kunovszki P, Takács P, Szabó MZ, Karyekar C, Lofland JH, Nagy G. Large-scale mortality gap between SLE and control population is associated with increased infection-related mortality in lupus. Rheumatology (Oxford) 2021; 59:3443-3451. [PMID: 32357240 PMCID: PMC7590419 DOI: 10.1093/rheumatology/keaa188] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 03/19/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The aim of the present study was to analyse the incidence, prevalence, mortality and cause of death data of adult SLE patients and matched controls in a full-populational, nationwide, retrospective study. METHODS This non-interventional study was based on database research of the National Health Insurance Fund of Hungary. A total of 7888 patients were included in the analyses, within which two subgroups of incident patients were created: the 'All incident SLE patients' group consisted of all incident SLE patients (4503 patients), while the 'Treated SLE patients' group contained those who received relevant therapy in the first 6 months after diagnosis (2582 patients). RESULTS The median age of the SLE population was found to be 46.5 years (women 85%). The incidence rate was 4.86 and 2.78 per 100 000 inhabitants in the 'All incident SLE patients' and 'Treated SLE patients' groups, respectively. The standardized mortality ratio was 1.63 and 2.09 in the 'All incident SLE patients' and 'Treated SLE patients' groups, respectively. Overall survival was significantly lower (P < 0.001) in both groups than in the general population, with hazard ratio = 2.17 in the 'All incident SLE patients' group and hazard ratio = 2.75 in the 'Treated SLE patients' group. There was no significant difference between SLE and control deaths regarding cerebrovascular conditions as the cause of death. Generally, cancer-related deaths were less common, while haematological cancer and infection-related deaths were more common in SLE patients. CONCLUSION Infections, especially sepsis, had the largest positive effect on top of the extra mortality of SLE. This highlights that SLE patients are at increased risk of infection-related death.
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Affiliation(s)
- Melinda Kedves
- Department of Rheumatology, Hospital of Bács-Kiskun County, Kecskemét
| | - Fruzsina Kósa
- Janssen Global Commercial Strategy Organization, Budapest
| | | | - Péter Takács
- Janssen Global Commercial Strategy Organization, Budapest
| | | | - Chetan Karyekar
- Janssen R&D Services, Janssen Global Commercial Organization, Horsham, PA, USA
| | - Jennifer H Lofland
- Janssen R&D Services, Janssen Global Commercial Organization, Horsham, PA, USA
| | - György Nagy
- Department of Rheumatology, 3rd Department of Internal Medicine, Semmelweis University, Budapest.,Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest.,Department of Rheumatology, Buda Hospital of the Hospitaller Order of Saint John of God, Budapest, Hungary
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The Impact of Protein Acetylation/Deacetylation on Systemic Lupus Erythematosus. Int J Mol Sci 2018; 19:ijms19124007. [PMID: 30545086 PMCID: PMC6321219 DOI: 10.3390/ijms19124007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/30/2018] [Accepted: 12/10/2018] [Indexed: 02/08/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease in which the body’s immune system mistakenly attacks healthy cells. Although the exact cause of SLE has not been identified, it is clear that both genetics and environmental factors trigger the disease. Identical twins have a 24% chance of getting lupus disease if the other one is affected. Internal factors such as female gender and sex hormones, the major histocompatibility complex (MHC) locus and other genetic polymorphisms have been shown to affect SLE, as well as external, environmental influences such as sunlight exposure, smoking, vitamin D deficiency, and certain infections. Several studies have reported and proposed multiple associations between the alteration of the epigenome and the pathogenesis of autoimmune disease. Epigenetic factors contributing to SLE include microRNAs, DNA methylation status, and the acetylation/deacetylation of histone proteins. Additionally, the acetylation of non-histone proteins can also influence cellular function. A better understanding of non-genomic factors that regulate SLE will provide insight into the mechanisms that initiate and facilitate disease and also contribute to the development of novel therapeutics that can specifically target pathogenic molecular pathways.
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Zollars ES, Hyer M, Wolf B, Chapin R. Measuring lupus arthritis activity using contrasted high-field MRI. Associations with clinical measures of disease activity and novel patterns of disease. Lupus Sci Med 2018; 5:e000264. [PMID: 30094039 PMCID: PMC6069922 DOI: 10.1136/lupus-2018-000264] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/12/2018] [Accepted: 06/13/2018] [Indexed: 11/03/2022]
Abstract
Objective Arthritis in SLE is poorly described, and there is no objective measure for quantification of arthritis. In this pilot study, we aim to assess the utility of the Rheumatoid Arthritis MRI Scoring System (RAMRIS) for the quantification of lupus arthritis. Methods Patients were eligible for entry into the study if they were evaluated at the Medical University of South Carolina Lupus Center and determined by their treating rheumatologist to have active hand arthritis due to SLE. Standard of care lupus activity measures were collected, along with a detailed physical exam. MRIs were obtained using standard musculoskeletal sequences with gadolinium contrast. Semiquantitative scoring of the images used the Outcome Measures in Rheumatology Clinical Trials RAMRIS system. Results RAMRIS demonstrates large amounts of synovitis, tenosynovitis, bone marrow oedema and erosive disease in only a minority of patients. Some patients were not scored as having any synovitis or tenosynovitis. We describe potential features of lupus arthritis that are not captured in the RAMRIS scores and may be contributing to symptoms. Conclusion Lupus arthritis is an entity separate from rheumatoid arthritis and requires the development of new quantitative methods to describe and quantitate it. MRI findings suggest the inadequacy of a typical lupus musculoskeletal measure including swollen/tender joint counts to assess the level of disease activity.
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Affiliation(s)
- Eric S Zollars
- Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Madison Hyer
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Bethany Wolf
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Russell Chapin
- Division of Musculoskeletal Radiology, Medical University of South Carolina, Charleston, South Carolina, USA
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Xie X, Yang H, Nie A, Chen H, Li J. Predictors of medication nonadherence in patients with systemic lupus erythematosus in Sichuan: a cross-sectional study. Patient Prefer Adherence 2018; 12:1505-1511. [PMID: 30197502 PMCID: PMC6112788 DOI: 10.2147/ppa.s169776] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The aim of this study was to determine the prevalence and predictors of medication nonadherence among patients with systemic lupus erythematosus (SLE) in Sichuan. PATIENTS AND METHODS A cross-sectional investigation was performed. Participants were recruited by consecutive sampling from the Rheumatic Clinic of a university hospital between June and September 2016. Patients' self-reported medication adherence was assessed by the eight-item Morisky Medication Adherence Scale. Additional surveys included patients' demographics, and clinical and treatment characteristics. Logistic regression analysis was used to identify the predictors of medication nonadherence. RESULTS A total of 140 patients were included in analysis. The percentage of patients classified as nonadherent to medication was 75%. Low education, rural residency, childlessness, limited comprehension of medication instructions, side effects experienced, dissatisfaction with treatment and better physical health were associated with an increased risk of nonadherence. CONCLUSION This study demonstrated a high prevalence of medication nonadherence among SLE patients in Sichuan, and factors associated with the nonadherence are multifaceted. Interventions for these factors, such as appropriate adjustment of the service resources for patients with rheumatic disease in rural communities and improved communication between the health care providers and the patients, may contribute to improve the medication adherence of this cohort.
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Affiliation(s)
- Xia Xie
- West China School of Nursing and Department of Nursing, West China Hospital, Sichuan University, Chengdu, China,
| | - Hui Yang
- West China School of Nursing and Department of Nursing, West China Hospital, Sichuan University, Chengdu, China,
| | - Anliu Nie
- West China School of Nursing and Department of Nursing, West China Hospital, Sichuan University, Chengdu, China,
| | - Hong Chen
- West China School of Nursing and Department of Nursing, West China Hospital, Sichuan University, Chengdu, China,
| | - Jiping Li
- West China School of Nursing and Department of Nursing, West China Hospital, Sichuan University, Chengdu, China,
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Samanta M, Nandi M, Mondal R, Hazra A, Sarkar S, Sabui T, Kundu CK, Biswas A. Childhood lupus nephritis: 12 years of experience from a developing country's perspective. Eur J Rheumatol 2017; 4:178-183. [PMID: 29163999 DOI: 10.5152/eurjrheum.2017.16117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 04/12/2017] [Indexed: 12/18/2022] Open
Abstract
Objective To assess the long-term outcome of lupus nephritis in children with systemic lupus erythematosus followed up over 12 years at a tertiary care teaching hospital in Eastern India. Material and Methods This is a retrospective observational study of the clinicopathological presentation, management, and outcome in 46 children with lupus nephritis over a period of 12 years at a tertiary teaching hospital in Eastern India. Mortality was compared between different lupus classes and therapy groups with Kaplan-Meier analysis and log-rank test. Results The incidence of lupus nephritis was 58.97% [95% confidence interval (CI) 48.06%-59.89%] with the mean age at presentation being 10.2±2.43 years (range 5.5-14.5) years. Majority belonged to class IV (30.43%), followed by class II (26.91%), class III (23.91), and class V (8.70%). Outcome analysis of children with lupus nephritis over 12 years revealed that 24 (52.17%) achieved complete remission of disease activity, 5 attained partial remission, 4 continued to have active disease, 5 developed end-stage renal disease (ESRD), and 8 died. Overall mortality thus observed was 17.39% with septicemia in the background of ESRD being the commonest cause. No significant difference in mortality was observed between different lupus nephritis classes or therapy arm groups. Conclusion The study throws light on various aspects of lupus nephritis and their long-term outcome patterns in children from developing countries such as India.
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Affiliation(s)
- Moumita Samanta
- Department of Pediatrics, NRS Medical College, Kolkata, India
| | - Madhumita Nandi
- Department of Pediatrics, NRS Medical College, Kolkata, India
| | - Rakesh Mondal
- Department of Pediatrics, Medical College and Hospital, Kolkata, India
| | - Avijit Hazra
- Department of Pharmacology, IPGME&R SSKM Hospital, Kolkata, India
| | - Sumatra Sarkar
- Department of Pediatrics, IPGME&R SSKM Hospital, Kolkata, India
| | - Tapas Sabui
- Department of Pediatrics, RGKAR Medical College, Kolkata, India
| | | | - Arnab Biswas
- Department of Pediatrics, NRS Medical College, Kolkata, India
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Zaman GS. Introduction and Physiology of Lupus. Lupus 2017. [DOI: 10.5772/intechopen.68635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Pronostic à long terme de la néphropathie lupique dans la population afrocaribéenne de Martinique ayant un accès gratuit aux soins médicaux. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jarukitsopa S, Hoganson DD, Crowson CS, Sokumbi O, Davis MD, Michet CJ, Matteson EL, Maradit Kremers H, Chowdhary VR. Epidemiology of systemic lupus erythematosus and cutaneous lupus erythematosus in a predominantly white population in the United States. Arthritis Care Res (Hoboken) 2015; 67:817-28. [PMID: 25369985 DOI: 10.1002/acr.22502] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/08/2014] [Accepted: 10/21/2014] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Epidemiologic studies comparing the incidence and prevalence of systemic lupus erythematosus (SLE) and isolated cutaneous lupus erythematosus (CLE) are few. Olmsted County, Minnesota provides a unique setting for such a study owing to resources of the Rochester Epidemiology Project. We sought to describe and compare the incidence and prevalence of SLE and CLE from 1993-2005. METHODS SLE cases were identified from review of medical records and fulfilled the 1982 American College of Rheumatology classification criteria. CLE cases included patients with classic discoid lupus erythematosus, subacute CLE, lupus panniculitis, and bullous lupus erythematosus. Age- and sex-adjusted incidence and prevalence were standardized to the 2000 US white population. RESULTS The age- and sex-adjusted incidence of SLE (2.9 per 100,000; 95% confidence interval [95% CI] 2.0-3.7) was similar to that of CLE (4.2 per 100,000; 95% CI 3.1-5.2, P = 0.10). However, the incidence of CLE was 3 times higher than SLE in men (2.4 versus 0.8 per 100,000; P = 0.009). The age- and sex-adjusted prevalence of CLE on January 1, 2006 was higher than that of SLE (70.4 versus 30.5 per 100,000; P < 0.001). The prevalences of CLE and SLE in women were similar, but the prevalence of CLE was higher in men than in women (56.9 versus 1.6 per 100,000; P < 0.001). The incidence of CLE rose steadily with age and peaked at 60-69 years. CONCLUSION The incidences of CLE and SLE are similar, but CLE is more common than SLE in men and in older adults. These findings may reflect differences in genetic or environmental etiology of CLE.
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Affiliation(s)
| | | | | | | | - Mark D Davis
- Mayo Clinic College of Medicine, Rochester, Minnesota
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Wang Z, Wang Y, Zhu R, Tian X, Xu D, Wang Q, Wu C, Zhang S, Zhao J, Zhao Y, Li M, Zeng X. Long-term survival and death causes of systemic lupus erythematosus in China: a systemic review of observational studies. Medicine (Baltimore) 2015; 94:e794. [PMID: 25929930 PMCID: PMC4603034 DOI: 10.1097/md.0000000000000794] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 03/21/2015] [Accepted: 03/29/2015] [Indexed: 02/07/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with an increased risk of death compared to general population. Although previous studies showed improvement in survival of SLE, the long-term prognosis has not been elaborated in China.This study aims to integrate the observational studies estimating current long-term survival of Chinese SLE patients and analyze the death-cause situation of SLE in China.The study is a systemic review of English and non-English articles using MEDLINE, EMBASE, CNKI, WANFANG, and SINOMED databases. Additional studies were found by consultation with clinical experts, browse of references in selected papers, and search of related textbooks. Our major search terms were SLE, follow-up, prognosis, survival, mortality, and China.We included cohort studies for survival analysis, and both cohort studies and case series for death-cause analysis in China.The extraction of the articles were done by 2 authors independently using predesigned charts, including characteristics of study, clinical data, analyzing data, and study quality indicators.All pooled analyses were conducted both for random-effects model and fixed-effects model. Funnel plots and Egger regression tests were applied to check potential publication bias. Heterogeneity was tested by sensitivity analysis. We identified 5 studies for survival analysis comprising 4469 Chinese patients with SLE (380 observed deaths). Thirty-six studies were suitable for death-cause analysis with 2179 observed deaths (derived from more than 20,000 Chinese patients with SLE). The overall pooled survival rates for SLE in China were 94% for 5-year survival rate and 89% for 10-year survival rate after disease onset from the year 1995 to 2013, which were similar with previous publications in Asia-Pacific area. The proportions of different causes of death showed infection (33.2%), renal involvement (18.7%), lupus encephalopathy (13.8%), and cardiovascular disease (11.5%) as the top 4 causes.The overall survival rates for Chinese patients with SLE resembled previous publications in Asia-Pacific area. But the death causes of SLE in China were of some differences indicating relatively higher proportion of infection and lupus encephalopathy and lower cardiovascular disease. Ethnicity and more aggressive treatment might have contributed to the difference in death composition.
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Affiliation(s)
- Ziqian Wang
- From the Department of Rheumatology (ZW, RZ, XT, DX, QW, CW, SZ, JZ, YZ, ML, XZ), Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, ; and Department of Epidemiology and Bio-statistics (YW), Institute of Basic Medical Sciences, China Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Mavragani CP, Fragoulis GE, Somarakis G, Drosos A, Tzioufas AG, Moutsopoulos HM. Clinical and laboratory predictors of distinct histopathogical features of lupus nephritis. Medicine (Baltimore) 2015; 94:e829. [PMID: 26020385 PMCID: PMC4616414 DOI: 10.1097/md.0000000000000829] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The authors aimed to explore whether distinct clinical, serological, and urinalysis findings are associated with specific histological classes of lupus nephritis. Clinical and laboratory features were recorded at the time of clinical diagnosis from 297 consecutive patients with biopsy-confirmed lupus nephritis. Univariate and logistic regression analyses were performed and a risk score was developed to estimate the risk for developing different classes of lupus nephritis. Variables independently associated with class II included absence of malar rash, negative anti-dsDNA, and ≤5 urine leucocytes/high power field (hpf); with III/IV: age at nephritis diagnosis ≤32 years old, presence of musculoskeletal features, new-onset hypertension, positive anti-dsDNA, >5 urine leucocytes/hpf, creatinine >1.2 mg/dL, cellular casts >1/hpf, and absence of nephrotic range proteinuria; with V: age at nephritis diagnosis >32 years, malar rash, absence of musculoskeletal complaints or serum C3 hypocomplementemia, nephrotic range proteinuria, and ≤9 urine erythrocytes/hpf. A risk predictive score of specific histological classes was calculated for each patient. Associations between 2, 3 or more risk factors with specific histological classes were also revealed [Odds ratios (95% confidence interval) (≥2 risk factors) was 6.7 (2.8-17.4) for class II nephritis, 15.6 (5.1-47.8), and 8.2 (3.6-19.0) for classes III/IV and for class V, respectively (≥3 risk factors)]. The identification of independent factors associated with specific classes of lupus nephritis can provide guidance in selecting specific therapeutic modalities, particularly in cases in which renal biopsy is contraindicated.
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Affiliation(s)
- Clio P Mavragani
- From the Department of Physiology (CPM); Department of Pathophysiology, School of Medicine, University of Athens, Athens (GEF, AGT, HMM); and Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece (GS, AD)
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Nasonov E, Soloviev S, Davidson JE, Lila A, Togizbayev G, Ivanova R, Baimukhamedov C, Omarbekova Z, Iaremenko O, Gnylorybov A, Shevchuk S, Vasylyev A, Pereira MHS. Standard medical care of patients with systemic lupus erythematosus (SLE) in large specialised centres: data from the Russian Federation, Ukraine and Republic of Kazakhstan (ESSENCE). Lupus Sci Med 2015; 2:e000060. [PMID: 25717382 PMCID: PMC4336862 DOI: 10.1136/lupus-2014-000060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 12/18/2014] [Accepted: 01/26/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe disease characteristics and treatment regimens for adult patients with systemic lupus erythematosus (SLE) with autoantibody positive disease in three countries (the Russian Federation, Ukraine and Republic of Kazakhstan). METHODS The Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q wave Coronary Events (ESSENCE) study was a 1-year, retrospective, multicentre, observational study. Data included patients' characteristics, disease activity and severity, and healthcare resource use in 2010. RESULTS Twelve centres enrolled 436 eligible patients: 232 in Russia, 110 in Kazakhstan and 94 in Ukraine. Mean age ranged from 36 to 42 years and median SLE duration from 3 to 6.8 years. According to study definitions, 69.2% of patients in Russia, 72.7% in Kazakhstan and 55.4% in Ukraine had severe disease at diagnosis. SLE activity (Nasonova classification, 1972) decreased from diagnosis to the last visit in 2010 in all countries. At the last visit, mean (SD) Safety of Estrogens in Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus Disease Activity Index score was 13.8 (10.5) in Russia, 19.4 (16.9) in Kazakhstan and 7.2 (6.8) in Ukraine, and Systemic Lupus International Collaborative Clinics/American College of Rheumatology damage index was 2.0 (2.2), 3.3 (3.2) and 2.2 (2.0), respectively. Treatment regimens included predominantly glucocorticoids (96.7-99.1%), immunosuppressants or cytotoxic drugs, for example, azathioprine and cyclophosphamide (20.7-53.2%), and antimalarial drugs (18.3-40.8%). CONCLUSIONS The study provides reliable insight into the SLE clinical profiles in the referenced countries. Patients were 4-10 years younger in the study and had 3-7 years shorter SLE duration than in Western European countries and both SLE activity and severity were higher with higher rate of hospitalisations, but decreased during treatment. Local and international scales demonstrated correlation in SLE activity and organ damage evaluation. There were differences in clinical characteristics and healthcare features across the countries.
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Affiliation(s)
- E Nasonov
- Institute of Rheumatology at Russian Academy of Medical Science , Moscow , Russian Federation
| | - S Soloviev
- Institute of Rheumatology at Russian Academy of Medical Science , Moscow , Russian Federation
| | - J E Davidson
- Worldwide Epidemiology, GlaxoSmithKline R&D, Stockley Park , London , UK
| | - A Lila
- North-Western Medical University named after I.I. Mechnikov , St Petersburg , Russian Federation
| | - G Togizbayev
- Kazakh Medical University of Continuing Education , Almaty , Kazakhstan
| | - R Ivanova
- Internal Medicine Department, Semey State Medical University , Semey , Kazakhstan
| | - Ch Baimukhamedov
- Kazakh Medical University of Continuing Education , Almaty , Kazakhstan
| | - Zh Omarbekova
- Kazakh Medical University of Continuing Education , Almaty , Kazakhstan
| | - O Iaremenko
- National Medical University named after O.O. Bogomolets , Kyiv , Ukraine
| | - A Gnylorybov
- Institute of Urgent and Recovery Surgery named after V.K. Gusak, National Academy of Medical Sciences of Ukraine , Donetsk , Ukraine
| | - S Shevchuk
- Scientific Research institute of Rehabilitation of Disabled, Vinnytsia National Medical University named after Pirogov , Vinnitsa , Ukraine
| | - A Vasylyev
- Commonwealth of Independent States Medical Department, GlaxoSmithKline , London , UK
| | - M H S Pereira
- Commonwealth of Independent States Medical Department, GlaxoSmithKline , London , UK
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Lim SS, Bayakly AR, Helmick CG, Gordon C, Easley K, Drenkard C. The incidence and prevalence of systemic lupus erythematosus, 2002-2004: The Georgia Lupus Registry. Arthritis Rheumatol 2014; 66:357-68. [PMID: 24504808 PMCID: PMC4617771 DOI: 10.1002/art.38239] [Citation(s) in RCA: 240] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 10/15/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The Georgia Lupus Registry is a population-based registry designed to improve our ability to estimate the incidence and prevalence of systemic lupus erythematosus (SLE) in a large population. METHODS Potential cases of SLE were identified from multiple sources during the years 2002 through 2004. Cases were defined according to the American College of Rheumatology (ACR) criteria for SLE or a combined definition. Age-standardized rates were determined and stratified by race and sex. With capture-recapture analyses, we estimated the under-ascertainment of cases. RESULTS Using the ACR case definition, the overall crude and age-adjusted incidence rate was 5.6 per 100,000, with capture-recapture and combined definition rates being slightly higher. The age-adjusted incidence rate in women was >5 times higher than that for men (9.2 versus 1.8). Black women had an incidence rate nearly 3 times higher than that in white women, with a significantly higher rate in the group ages 30-59 years. The overall crude and age-adjusted prevalence rates were 74.4 and 73 per 100,000, respectively. The age-adjusted prevalence rate in women was nearly 9 times higher than that for men (127.6 versus 14.7). Black women had very high rates (196.2). A striking difference was seen in the proportion of prevalent cases with end-stage renal disease, with 7-fold greater involvement among black patients. CONCLUSION With the more complete case-finding methods we used, the incidence and prevalence rates of SLE are among the highest reported in the US. The results continue to underscore striking sex, age, and racial disparities between black patients and white patients with SLE.
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Affiliation(s)
- S. Sam Lim
- Emory University, Department of Medicine, Division of Rheumatology, Atlanta, GA
| | | | | | | | - Kirk Easley
- Emory University, Rollins School of Public Health, Department of Biostatistics and Bioinformatics, Atlanta, GA
| | - Cristina Drenkard
- Emory University, Department of Medicine, Division of Rheumatology, Atlanta, GA
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Comparison of the systemic lupus erythematosus activity questionnaire and the systemic lupus erythematosus disease activity index in a black barbadian population. Int J Rheumatol 2013; 2013:875369. [PMID: 24282416 PMCID: PMC3824559 DOI: 10.1155/2013/875369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 09/10/2013] [Indexed: 11/17/2022] Open
Abstract
In Barbados, use of the Systemic Lupus Erythematosus (SLE) Disease Activity Index (SLEDAI) is limited by the unavailability of serologic markers. The SLE Activity Questionnaire (SLAQ) excludes laboratory measurements and is therefore more accessible. Here, we investigate the agreement between the SLAQ, the SLEDAI, and the physician global assessment (PGA). A pilot of 32 participants completed the SLAQ and SLEDAI. The tools were compared (1) in their original format, (2) limited to common indices, and (3) limited to the same patient recall period. We compared the proportions of persons reporting disease activity and the concordance between calculated activity scores for SLAQ versus SLEDAI and for SLAQ versus PGA. Seventy-eight percent versus 59% of participants reported disease activity with the original SLEDAI versus SLAQ, respectively. The relationship was reversed to 22% versus 59% when the matched item tools were compared. Concordance was 0.62 (95% CI 0.42–0.81) between the original scores, 0.70 (0.57–0.83) when restricted by matched items, and 0.72 (0.59–0.84) when further restricted by recall period. Concordance between the SLAQ and PGA was 0.56 (0.32–0.80). Reversal of the disease activity percentage in the matched items comparison highlights the inadequacy of tools that exclude laboratory measurements and suggests that the subjective nature of SLAQ may contribute to over-reporting. Further work is needed to produce a robust disease activity tool apt for resource-constrained environments.
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