The majority of Swedish systemic lupus erythematosus patients are still affected by irreversible organ impairment: factors related to damage accrual in two regional cohorts
Identifieur interne : 000799 ( Ncbi/Merge ); précédent : 000798; suivant : 000800The majority of Swedish systemic lupus erythematosus patients are still affected by irreversible organ impairment: factors related to damage accrual in two regional cohorts
Auteurs : M. Frodlund [Suède] ; S. Reid [Suède] ; J. Wetterö [Suède] ; Ö Dahlström [Suède] ; C. Sjöwall [Suède] ; D. Leonard [Suède]Source :
- Lupus [ 0961-2033 ] ; 2019.
Abstract
Although the survival of patients with systemic lupus erythematosus (SLE) has improved, irreversible organ damage remains a critical concern. We aimed to characterize damage accrual and its clinical associations and causes of death in Swedish patients.
Accumulation of damage was evaluated in 543 consecutively recruited and well-characterized cases during 1998−2017. The Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology damage index (SDI) was used to estimate damage.
Organ damage (SDI ≥ 1) was observed in 59%, and extensive damage (SDI ≥ 3) in 25% of cases. SDI ≥ 1 was significantly associated with higher age at onset, SLE duration, the number of fulfilled SLICC criteria, neurologic disorder, antiphospholipid antibody syndrome (APS), hypertension, hyperlipidemia, depression and secondary Sjögren's syndrome (SS). In addition, SDI ≥ 3 was associated with serositis, renal and haematological disorders and interstitial lung disease. A multiple regression model identified not only well-known risk factors like APS, antihypertensives and corticosteroids, but pericarditis, haemolytic anaemia, lymphopenia and myositis as being linked to SDI. Malignancy, infection and cardiovascular disease were the leading causes of death.
After a mean SLE duration of 17 years, the majority of today's Swedish SLE patients have accrued damage. We confirm previous observations and report some novel findings regarding disease phenotypes and damage accrual.
Url:
DOI: 10.1177/0961203319860198
PubMed: 31296137
PubMed Central: 6710616
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">The majority of Swedish systemic lupus erythematosus patients are
still affected by irreversible organ impairment: factors related to damage
accrual in two regional cohorts</title><author><name sortKey="Frodlund, M" sort="Frodlund, M" uniqKey="Frodlund M" first="M" last="Frodlund">M. Frodlund</name><affiliation wicri:level="1"><nlm:aff id="aff1-0961203319860198">Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping</wicri:regionArea><wicri:noRegion>Linköping</wicri:noRegion></affiliation></author><author><name sortKey="Reid, S" sort="Reid, S" uniqKey="Reid S" first="S" last="Reid">S. Reid</name><affiliation wicri:level="4"><nlm:aff id="aff2-0961203319860198">Department of Medical Sciences, Science for Life Laboratory, Rheumatology, Uppsala University, Uppsala, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Medical Sciences, Science for Life Laboratory, Rheumatology, Uppsala University, Uppsala</wicri:regionArea><orgName type="university">Université d'Uppsala</orgName><placeName><settlement type="city">Uppsala</settlement><region nuts="1">Svealand</region><region nuts="1">East Middle Sweden</region></placeName></affiliation></author><author><name sortKey="Wettero, J" sort="Wettero, J" uniqKey="Wettero J" first="J" last="Wetterö">J. Wetterö</name><affiliation wicri:level="1"><nlm:aff id="aff1-0961203319860198">Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping</wicri:regionArea><wicri:noRegion>Linköping</wicri:noRegion></affiliation></author><author><name sortKey="Dahlstrom, O" sort="Dahlstrom, O" uniqKey="Dahlstrom O" first="Ö" last="Dahlström">Ö Dahlström</name><affiliation wicri:level="1"><nlm:aff id="aff3-0961203319860198">Swedish Institute for Disability Research, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Swedish Institute for Disability Research, Department of Behavioural Sciences and Learning, Linköping University, Linköping</wicri:regionArea><wicri:noRegion>Linköping</wicri:noRegion></affiliation></author><author><name sortKey="Sjowall, C" sort="Sjowall, C" uniqKey="Sjowall C" first="C" last="Sjöwall">C. Sjöwall</name><affiliation wicri:level="1"><nlm:aff id="aff1-0961203319860198">Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping</wicri:regionArea><wicri:noRegion>Linköping</wicri:noRegion></affiliation></author><author><name sortKey="Leonard, D" sort="Leonard, D" uniqKey="Leonard D" first="D" last="Leonard">D. Leonard</name><affiliation wicri:level="4"><nlm:aff id="aff2-0961203319860198">Department of Medical Sciences, Science for Life Laboratory, Rheumatology, Uppsala University, Uppsala, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Medical Sciences, Science for Life Laboratory, Rheumatology, Uppsala University, Uppsala</wicri:regionArea><orgName type="university">Université d'Uppsala</orgName><placeName><settlement type="city">Uppsala</settlement><region nuts="1">Svealand</region><region nuts="1">East Middle Sweden</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">31296137</idno><idno type="pmc">6710616</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6710616</idno><idno type="RBID">PMC:6710616</idno><idno type="doi">10.1177/0961203319860198</idno><date when="2019">2019</date><idno type="wicri:Area/Pmc/Corpus">000691</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000691</idno><idno type="wicri:Area/Pmc/Curation">000691</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000691</idno><idno type="wicri:Area/Pmc/Checkpoint">000303</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000303</idno><idno type="wicri:Area/Ncbi/Merge">000799</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The majority of Swedish systemic lupus erythematosus patients are
still affected by irreversible organ impairment: factors related to damage
accrual in two regional cohorts</title><author><name sortKey="Frodlund, M" sort="Frodlund, M" uniqKey="Frodlund M" first="M" last="Frodlund">M. Frodlund</name><affiliation wicri:level="1"><nlm:aff id="aff1-0961203319860198">Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping</wicri:regionArea><wicri:noRegion>Linköping</wicri:noRegion></affiliation></author><author><name sortKey="Reid, S" sort="Reid, S" uniqKey="Reid S" first="S" last="Reid">S. Reid</name><affiliation wicri:level="4"><nlm:aff id="aff2-0961203319860198">Department of Medical Sciences, Science for Life Laboratory, Rheumatology, Uppsala University, Uppsala, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Medical Sciences, Science for Life Laboratory, Rheumatology, Uppsala University, Uppsala</wicri:regionArea><orgName type="university">Université d'Uppsala</orgName><placeName><settlement type="city">Uppsala</settlement><region nuts="1">Svealand</region><region nuts="1">East Middle Sweden</region></placeName></affiliation></author><author><name sortKey="Wettero, J" sort="Wettero, J" uniqKey="Wettero J" first="J" last="Wetterö">J. Wetterö</name><affiliation wicri:level="1"><nlm:aff id="aff1-0961203319860198">Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping</wicri:regionArea><wicri:noRegion>Linköping</wicri:noRegion></affiliation></author><author><name sortKey="Dahlstrom, O" sort="Dahlstrom, O" uniqKey="Dahlstrom O" first="Ö" last="Dahlström">Ö Dahlström</name><affiliation wicri:level="1"><nlm:aff id="aff3-0961203319860198">Swedish Institute for Disability Research, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Swedish Institute for Disability Research, Department of Behavioural Sciences and Learning, Linköping University, Linköping</wicri:regionArea><wicri:noRegion>Linköping</wicri:noRegion></affiliation></author><author><name sortKey="Sjowall, C" sort="Sjowall, C" uniqKey="Sjowall C" first="C" last="Sjöwall">C. Sjöwall</name><affiliation wicri:level="1"><nlm:aff id="aff1-0961203319860198">Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping</wicri:regionArea><wicri:noRegion>Linköping</wicri:noRegion></affiliation></author><author><name sortKey="Leonard, D" sort="Leonard, D" uniqKey="Leonard D" first="D" last="Leonard">D. Leonard</name><affiliation wicri:level="4"><nlm:aff id="aff2-0961203319860198">Department of Medical Sciences, Science for Life Laboratory, Rheumatology, Uppsala University, Uppsala, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Medical Sciences, Science for Life Laboratory, Rheumatology, Uppsala University, Uppsala</wicri:regionArea><orgName type="university">Université d'Uppsala</orgName><placeName><settlement type="city">Uppsala</settlement><region nuts="1">Svealand</region><region nuts="1">East Middle Sweden</region></placeName></affiliation></author></analytic><series><title level="j">Lupus</title><idno type="ISSN">0961-2033</idno><idno type="eISSN">1477-0962</idno><imprint><date when="2019">2019</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Although the survival of patients with systemic lupus erythematosus (SLE) has
improved, irreversible organ damage remains a critical concern. We aimed to
characterize damage accrual and its clinical associations and causes of
death in Swedish patients.</p></sec><sec id="sec2a-0961203319860198" sec-type="methods"><title>Methods</title><p>Accumulation of damage was evaluated in 543 consecutively recruited and
well-characterized cases during 1998−2017. The Systemic Lupus International
Collaborating Clinics (SLICC)/American College of Rheumatology damage index
(SDI) was used to estimate damage.</p></sec><sec id="sec3a-0961203319860198" sec-type="results"><title>Results</title><p>Organ damage (SDI ≥ 1) was observed in 59%, and extensive damage (SDI ≥ 3) in
25% of cases. SDI ≥ 1 was significantly associated with higher age at onset,
SLE duration, the number of fulfilled SLICC criteria, neurologic disorder,
antiphospholipid antibody syndrome (APS), hypertension, hyperlipidemia,
depression and secondary Sjögren's syndrome (SS). In addition, SDI ≥ 3 was
associated with serositis, renal and haematological disorders and
interstitial lung disease. A multiple regression model identified not only
well-known risk factors like APS, antihypertensives and corticosteroids, but
pericarditis, haemolytic anaemia, lymphopenia and myositis as being linked
to SDI. Malignancy, infection and cardiovascular disease were the leading
causes of death.</p></sec><sec id="sec4a-0961203319860198" sec-type="conclusions"><title>Conclusions</title><p>After a mean SLE duration of 17 years, the majority of today's Swedish SLE
patients have accrued damage. We confirm previous observations and report
some novel findings regarding disease phenotypes and damage accrual.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Bruce, In" uniqKey="Bruce I">IN Bruce</name></author><author><name sortKey="O Keeffe, Ag" uniqKey="O Keeffe A">AG O'Keeffe</name></author><author><name sortKey="Farewell, V" uniqKey="Farewell V">V Farewell</name></author><author><name sortKey="Hanly, Jg" uniqKey="Hanly J">JG Hanly</name></author><author><name sortKey="Manzi, S" uniqKey="Manzi S">S Manzi</name></author><author><name sortKey="Su, L" uniqKey="Su L">L Su</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bengtsson, Aa" uniqKey="Bengtsson A">AA Bengtsson</name></author><author><name sortKey="Ronnblom, L" uniqKey="Ronnblom L">L Ronnblom</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rahman, P" uniqKey="Rahman P">P Rahman</name></author><author><name sortKey="Gladman, Dd" 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article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Lupus</journal-id><journal-id journal-id-type="iso-abbrev">Lupus</journal-id><journal-id journal-id-type="publisher-id">LUP</journal-id><journal-id journal-id-type="hwp">splup</journal-id><journal-title-group><journal-title>Lupus</journal-title></journal-title-group><issn pub-type="ppub">0961-2033</issn><issn pub-type="epub">1477-0962</issn><publisher><publisher-name>SAGE Publications</publisher-name><publisher-loc>Sage UK: London, England</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">31296137</article-id><article-id pub-id-type="pmc">6710616</article-id><article-id pub-id-type="doi">10.1177/0961203319860198</article-id><article-id pub-id-type="publisher-id">10.1177_0961203319860198</article-id><article-categories><subj-group subj-group-type="heading"><subject>Lupus around the World</subject></subj-group></article-categories><title-group><article-title>The majority of Swedish systemic lupus erythematosus patients are
still affected by irreversible organ impairment: factors related to damage
accrual in two regional cohorts</article-title></title-group><contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">https://orcid.org/0000-0001-7522-5069</contrib-id><name><surname>Frodlund</surname><given-names>M</given-names></name><xref ref-type="aff" rid="aff1-0961203319860198">1</xref><xref ref-type="corresp" rid="corresp1-0961203319860198"></xref></contrib><contrib contrib-type="author"><name><surname>Reid</surname><given-names>S</given-names></name><xref ref-type="aff" rid="aff2-0961203319860198">2</xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">https://orcid.org/0000-0002-6916-5490</contrib-id><name><surname>Wetterö</surname><given-names>J</given-names></name><xref ref-type="aff" rid="aff1-0961203319860198">1</xref></contrib><contrib contrib-type="author"><name><surname>Dahlström</surname><given-names>Ö</given-names></name><xref ref-type="aff" rid="aff3-0961203319860198">3</xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">https://orcid.org/0000-0003-0900-2048</contrib-id><name><surname>Sjöwall</surname><given-names>C</given-names></name><xref ref-type="aff" rid="aff1-0961203319860198">1</xref></contrib><contrib contrib-type="author"><name><surname>Leonard</surname><given-names>D</given-names></name><xref ref-type="aff" rid="aff2-0961203319860198">2</xref></contrib></contrib-group><aff id="aff1-0961203319860198"><label>1</label>Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden</aff><aff id="aff2-0961203319860198"><label>2</label>Department of Medical Sciences, Science for Life Laboratory, Rheumatology, Uppsala University, Uppsala, Sweden</aff><aff id="aff3-0961203319860198"><label>3</label>Swedish Institute for Disability Research, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden</aff><author-notes><corresp id="corresp1-0961203319860198">M Frodlund, Rheumatology Unit, University
Hospital, SE–581 85 Linköping, Sweden. Email:
<email>martina.frodlund@regionostergotland.se</email></corresp></author-notes><pub-date pub-type="epub"><day>11</day><month>7</month><year>2019</year></pub-date><pub-date pub-type="ppub"><month>9</month><year>2019</year></pub-date><volume>28</volume><issue>10</issue><fpage>1261</fpage><lpage>1272</lpage><history><date date-type="received"><day>14</day><month>3</month><year>2019</year></date><date date-type="accepted"><day>5</day><month>6</month><year>2019</year></date></history><permissions><copyright-statement>© The Author(s) 2019</copyright-statement><copyright-year>2019</copyright-year><copyright-holder content-type="sage">SAGE Publications</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/"><license-p>This article is distributed under the terms of the Creative Commons
Attribution-NonCommercial 4.0 License (<ext-link ext-link-type="uri" xlink:href="http://www.creativecommons.org/licenses/by-nc/4.0/">http://www.creativecommons.org/licenses/by-nc/4.0/</ext-link>) which
permits non-commercial use, reproduction and distribution of the work
without further permission provided the original work is attributed as
specified on the SAGE and Open Access pages (<ext-link ext-link-type="uri" xlink:href="https://us.sagepub.com/en-us/nam/open-access-at-sage">https://us.sagepub.com/en-us/nam/open-access-at-sage</ext-link>).</license-p></license></permissions><abstract><sec><title>Background</title><p>Although the survival of patients with systemic lupus erythematosus (SLE) has
improved, irreversible organ damage remains a critical concern. We aimed to
characterize damage accrual and its clinical associations and causes of
death in Swedish patients.</p></sec><sec id="sec2a-0961203319860198" sec-type="methods"><title>Methods</title><p>Accumulation of damage was evaluated in 543 consecutively recruited and
well-characterized cases during 1998−2017. The Systemic Lupus International
Collaborating Clinics (SLICC)/American College of Rheumatology damage index
(SDI) was used to estimate damage.</p></sec><sec id="sec3a-0961203319860198" sec-type="results"><title>Results</title><p>Organ damage (SDI ≥ 1) was observed in 59%, and extensive damage (SDI ≥ 3) in
25% of cases. SDI ≥ 1 was significantly associated with higher age at onset,
SLE duration, the number of fulfilled SLICC criteria, neurologic disorder,
antiphospholipid antibody syndrome (APS), hypertension, hyperlipidemia,
depression and secondary Sjögren's syndrome (SS). In addition, SDI ≥ 3 was
associated with serositis, renal and haematological disorders and
interstitial lung disease. A multiple regression model identified not only
well-known risk factors like APS, antihypertensives and corticosteroids, but
pericarditis, haemolytic anaemia, lymphopenia and myositis as being linked
to SDI. Malignancy, infection and cardiovascular disease were the leading
causes of death.</p></sec><sec id="sec4a-0961203319860198" sec-type="conclusions"><title>Conclusions</title><p>After a mean SLE duration of 17 years, the majority of today's Swedish SLE
patients have accrued damage. We confirm previous observations and report
some novel findings regarding disease phenotypes and damage accrual.</p></sec></abstract><kwd-group><kwd>Damage accrual</kwd><kwd>immunosuppressants</kwd><kwd>mortality</kwd><kwd>SLE phenotypes</kwd><kwd>Sweden</kwd><kwd>systemic lupus erythematosus</kwd></kwd-group><funding-group><award-group id="award1-0961203319860198"><funding-source id="funding1-0961203319860198"><institution-wrap><institution>The Ingegerd Johansson donation</institution><institution-id institution-id-type="FundRef"></institution-id></institution-wrap></funding-source></award-group><award-group id="award2-0961203319860198"><funding-source id="funding2-0961203319860198"><institution-wrap><institution>The County Council of Östergötland</institution><institution-id institution-id-type="FundRef"></institution-id></institution-wrap></funding-source></award-group><award-group id="award3-0961203319860198"><funding-source id="funding3-0961203319860198"><institution-wrap><institution>The Swedish Society of Medicine </institution><institution-id institution-id-type="FundRef"></institution-id></institution-wrap></funding-source></award-group><award-group id="award4-0961203319860198"><funding-source id="funding4-0961203319860198"><institution-wrap><institution>The King Gustaf V's 80-year anniversary
foundation</institution><institution-id institution-id-type="FundRef"></institution-id></institution-wrap></funding-source></award-group><award-group id="award5-0961203319860198"><funding-source id="funding5-0961203319860198"><institution-wrap><institution>The Selander foundation</institution><institution-id institution-id-type="FundRef"></institution-id></institution-wrap></funding-source></award-group><award-group id="award6-0961203319860198"><funding-source id="funding6-0961203319860198"><institution-wrap><institution>The County Council of Uppsala</institution><institution-id institution-id-type="FundRef"></institution-id></institution-wrap></funding-source></award-group><award-group id="award7-0961203319860198"><funding-source id="funding7-0961203319860198"><institution-wrap><institution>The King Gustaf V and Queen Victoria's Freemasons
foundation</institution><institution-id institution-id-type="FundRef"></institution-id></institution-wrap></funding-source></award-group><award-group id="award8-0961203319860198"><funding-source id="funding8-0961203319860198"><institution-wrap><institution>The Swedish Rheumatism Association</institution><institution-id institution-id-type="FundRef"></institution-id></institution-wrap></funding-source></award-group></funding-group></article-meta></front></pmc><affiliations><list><country><li>Suède</li></country><region><li>East Middle Sweden</li><li>Svealand</li></region><settlement><li>Uppsala</li></settlement><orgName><li>Université d'Uppsala</li></orgName></list><tree><country name="Suède"><noRegion><name sortKey="Frodlund, M" sort="Frodlund, M" uniqKey="Frodlund M" first="M" last="Frodlund">M. Frodlund</name></noRegion><name sortKey="Dahlstrom, O" sort="Dahlstrom, O" uniqKey="Dahlstrom O" first="Ö" last="Dahlström">Ö Dahlström</name><name sortKey="Leonard, D" sort="Leonard, D" uniqKey="Leonard D" first="D" last="Leonard">D. Leonard</name><name sortKey="Reid, S" sort="Reid, S" uniqKey="Reid S" first="S" last="Reid">S. Reid</name><name sortKey="Sjowall, C" sort="Sjowall, C" uniqKey="Sjowall C" first="C" last="Sjöwall">C. Sjöwall</name><name sortKey="Wettero, J" sort="Wettero, J" uniqKey="Wettero J" first="J" last="Wetterö">J. Wetterö</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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