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Complement levels and risk of organ involvement in patients with systemic lupus erythematosus

OBJECTIVE: Complement plays a major role in SLE. Complement participation has been linked to disease activity and damage. Our objective was to estimate the association of complement behaviour with clinical manifestations, visceral injury and mortality in patients with SLE. METHODS: Complement determ...

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Autores principales: Gandino, Ignacio Javier, Scolnik, Marina, Bertiller, Emmanuel, Scaglioni, Valeria, Catoggio, Luis Jose, Soriano, Enrique Roberto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2017
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5729297/
https://www.ncbi.nlm.nih.gov/pubmed/29259790
http://dx.doi.org/10.1136/lupus-2017-000209
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author Gandino, Ignacio Javier
Scolnik, Marina
Bertiller, Emmanuel
Scaglioni, Valeria
Catoggio, Luis Jose
Soriano, Enrique Roberto
author_facet Gandino, Ignacio Javier
Scolnik, Marina
Bertiller, Emmanuel
Scaglioni, Valeria
Catoggio, Luis Jose
Soriano, Enrique Roberto
author_sort Gandino, Ignacio Javier
collection PubMed
description OBJECTIVE: Complement plays a major role in SLE. Complement participation has been linked to disease activity and damage. Our objective was to estimate the association of complement behaviour with clinical manifestations, visceral injury and mortality in patients with SLE. METHODS: Complement determinations (C3 and C4 levels) were analysed in patients with SLE (fulfilling American College of Rheumatology (ACR) or Systemic Lupus International Collaborating Clinics (SLICC)criteria) seen at a university hospital between 2000 and 2013. Patients were grouped in those with permanent C3 and/or C4 low values (low complement group), those with C3 and C4 constant normal values (normal complement group) and those with fluctuant values (periods of normal and periods of low values: fluctuant group). Clinical characteristics and mortality were analysed and compared between groups. RESULTS: 270 patients with SLE were included (242 females, 89.6%), mean age at diagnosis was 34.2 years (SD 15.8). 75 patients had fluctuant levels of complement, 79 patients had persistent low complement levels and 116 had normal complement levels. Lupus glomerulonephritis was more frequent in patients with fluctuant levels (75%, 56% and 49%, respectively, p=0002). The normal complement group had less frequency of haematological involvement and anti-double stranded DNA (dsDNA) antibodies. At the end of the follow-up, 53% of the patients had damage (SLICC/ACR ≥1). In a Cox proportional hazard model age at diagnosis, neurological impairment, thrombocytopaenia and corticosteroids were associated with more damage, while hydroxychloroquine was a protective factor. There were no differences between complements groups on accumulated damage. Ten-year survival rate was 93%, 93.5% and 92% for the normal complement group, the persistently low group and the fluctuant group, respectively. CONCLUSIONS: Patients with constant normal complement had lower prevalence of haematological involvement and anti-dsDNA, while patients with fluctuant complement had higher renal impairment. Neither the persistent low complement nor the fluctuant complement groups had increased mortality and/or visceral damage.
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spelling pubmed-57292972017-12-19 Complement levels and risk of organ involvement in patients with systemic lupus erythematosus Gandino, Ignacio Javier Scolnik, Marina Bertiller, Emmanuel Scaglioni, Valeria Catoggio, Luis Jose Soriano, Enrique Roberto Lupus Sci Med Epidemiology and Outcomes OBJECTIVE: Complement plays a major role in SLE. Complement participation has been linked to disease activity and damage. Our objective was to estimate the association of complement behaviour with clinical manifestations, visceral injury and mortality in patients with SLE. METHODS: Complement determinations (C3 and C4 levels) were analysed in patients with SLE (fulfilling American College of Rheumatology (ACR) or Systemic Lupus International Collaborating Clinics (SLICC)criteria) seen at a university hospital between 2000 and 2013. Patients were grouped in those with permanent C3 and/or C4 low values (low complement group), those with C3 and C4 constant normal values (normal complement group) and those with fluctuant values (periods of normal and periods of low values: fluctuant group). Clinical characteristics and mortality were analysed and compared between groups. RESULTS: 270 patients with SLE were included (242 females, 89.6%), mean age at diagnosis was 34.2 years (SD 15.8). 75 patients had fluctuant levels of complement, 79 patients had persistent low complement levels and 116 had normal complement levels. Lupus glomerulonephritis was more frequent in patients with fluctuant levels (75%, 56% and 49%, respectively, p=0002). The normal complement group had less frequency of haematological involvement and anti-double stranded DNA (dsDNA) antibodies. At the end of the follow-up, 53% of the patients had damage (SLICC/ACR ≥1). In a Cox proportional hazard model age at diagnosis, neurological impairment, thrombocytopaenia and corticosteroids were associated with more damage, while hydroxychloroquine was a protective factor. There were no differences between complements groups on accumulated damage. Ten-year survival rate was 93%, 93.5% and 92% for the normal complement group, the persistently low group and the fluctuant group, respectively. CONCLUSIONS: Patients with constant normal complement had lower prevalence of haematological involvement and anti-dsDNA, while patients with fluctuant complement had higher renal impairment. Neither the persistent low complement nor the fluctuant complement groups had increased mortality and/or visceral damage. BMJ Publishing Group 2017-06-25 /pmc/articles/PMC5729297/ /pubmed/29259790 http://dx.doi.org/10.1136/lupus-2017-000209 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Epidemiology and Outcomes
Gandino, Ignacio Javier
Scolnik, Marina
Bertiller, Emmanuel
Scaglioni, Valeria
Catoggio, Luis Jose
Soriano, Enrique Roberto
Complement levels and risk of organ involvement in patients with systemic lupus erythematosus
title Complement levels and risk of organ involvement in patients with systemic lupus erythematosus
title_full Complement levels and risk of organ involvement in patients with systemic lupus erythematosus
title_fullStr Complement levels and risk of organ involvement in patients with systemic lupus erythematosus
title_full_unstemmed Complement levels and risk of organ involvement in patients with systemic lupus erythematosus
title_short Complement levels and risk of organ involvement in patients with systemic lupus erythematosus
title_sort complement levels and risk of organ involvement in patients with systemic lupus erythematosus
topic Epidemiology and Outcomes
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5729297/
https://www.ncbi.nlm.nih.gov/pubmed/29259790
http://dx.doi.org/10.1136/lupus-2017-000209
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