Cargando…

Evolving phenotype of systemic lupus erythematosus in Caucasians: low incidence of lupus nephritis, high burden of neuropsychiatric disease and increased rates of late-onset lupus in the ‘Attikon’ cohort

OBJECTIVE: This study aimed to analyse the phenotype of systemic lupus erythematosus (SLE) at first presentation and during follow-up in a newly established SLE cohort based at ‘Attikon’ University Hospital. The hospital combines primary, secondary and tertiary care for the region of Western Attica,...

Descripción completa

Detalles Bibliográficos
Autores principales: Nikolopoulos, D, Kostopoulou, M, Pieta, A, Karageorgas, T, Tseronis, D, Chavatza, K, Flouda, S, Rapsomaniki, P, Banos, A, Kremasmenou, E, Tzavara, V, Katsimbri, P, Fanouriakis, A, Boumpas, D T
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7168806/
https://www.ncbi.nlm.nih.gov/pubmed/32106788
http://dx.doi.org/10.1177/0961203320908932
_version_ 1783523716939907072
author Nikolopoulos, D
Kostopoulou, M
Pieta, A
Karageorgas, T
Tseronis, D
Chavatza, K
Flouda, S
Rapsomaniki, P
Banos, A
Kremasmenou, E
Tzavara, V
Katsimbri, P
Fanouriakis, A
Boumpas, D T
author_facet Nikolopoulos, D
Kostopoulou, M
Pieta, A
Karageorgas, T
Tseronis, D
Chavatza, K
Flouda, S
Rapsomaniki, P
Banos, A
Kremasmenou, E
Tzavara, V
Katsimbri, P
Fanouriakis, A
Boumpas, D T
author_sort Nikolopoulos, D
collection PubMed
description OBJECTIVE: This study aimed to analyse the phenotype of systemic lupus erythematosus (SLE) at first presentation and during follow-up in a newly established SLE cohort based at ‘Attikon’ University Hospital. The hospital combines primary, secondary and tertiary care for the region of Western Attica, Greece. METHODS: This study comprised a mixed prevalent and incident cohort of 555 Caucasian patients diagnosed with SLE according to American College of Rheumatology 1997 criteria and/or the Systemic Lupus Erythematosus International Collaborating Clinics (SLICC) 2012 criteria. Demographic and clinical characteristics, patterns of severity, treatments and SLICC damage index were recorded for each patient at the time of diagnosis and at last evaluation. RESULTS: The mean age at lupus diagnosis was 38.3 years (standard deviation = 15.6 years), with a median disease duration at last follow-up of two years (interquartile range 1-11). At initial presentation, the most common ‘classification’ manifestations were arthritis (73.3%), acute cutaneous lupus (65%) and unexplained fever (25%), while among symptoms not included in any criteria set, Raynaud’s phenomenon (33%) was the most common. Kidney and neuropsychiatric involvement as presenting manifestations were present in 10.3% and 11.5% cases, respectively. Irreversible damage accrual was present in 17.8% within six months of disease diagnosis, attributed mainly to thrombotic and neuropsychiatric disease. At last evaluation, 202 (36.4%) patients had developed severe disease, of whom more than half were treated with pulse cyclophosphamide. CONCLUSION: In this cohort of Caucasian patients, lupus nephritis is not as common as in older cohorts, while neuropsychiatric disease is emerging as a major frontier in lupus prevention and care. These data may help to document changes in the natural history and treatment of SLE over time and may have implications for its early recognition and management.
format Online
Article
Text
id pubmed-7168806
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher SAGE Publications
record_format MEDLINE/PubMed
spelling pubmed-71688062020-04-28 Evolving phenotype of systemic lupus erythematosus in Caucasians: low incidence of lupus nephritis, high burden of neuropsychiatric disease and increased rates of late-onset lupus in the ‘Attikon’ cohort Nikolopoulos, D Kostopoulou, M Pieta, A Karageorgas, T Tseronis, D Chavatza, K Flouda, S Rapsomaniki, P Banos, A Kremasmenou, E Tzavara, V Katsimbri, P Fanouriakis, A Boumpas, D T Lupus Lupus around the World OBJECTIVE: This study aimed to analyse the phenotype of systemic lupus erythematosus (SLE) at first presentation and during follow-up in a newly established SLE cohort based at ‘Attikon’ University Hospital. The hospital combines primary, secondary and tertiary care for the region of Western Attica, Greece. METHODS: This study comprised a mixed prevalent and incident cohort of 555 Caucasian patients diagnosed with SLE according to American College of Rheumatology 1997 criteria and/or the Systemic Lupus Erythematosus International Collaborating Clinics (SLICC) 2012 criteria. Demographic and clinical characteristics, patterns of severity, treatments and SLICC damage index were recorded for each patient at the time of diagnosis and at last evaluation. RESULTS: The mean age at lupus diagnosis was 38.3 years (standard deviation = 15.6 years), with a median disease duration at last follow-up of two years (interquartile range 1-11). At initial presentation, the most common ‘classification’ manifestations were arthritis (73.3%), acute cutaneous lupus (65%) and unexplained fever (25%), while among symptoms not included in any criteria set, Raynaud’s phenomenon (33%) was the most common. Kidney and neuropsychiatric involvement as presenting manifestations were present in 10.3% and 11.5% cases, respectively. Irreversible damage accrual was present in 17.8% within six months of disease diagnosis, attributed mainly to thrombotic and neuropsychiatric disease. At last evaluation, 202 (36.4%) patients had developed severe disease, of whom more than half were treated with pulse cyclophosphamide. CONCLUSION: In this cohort of Caucasian patients, lupus nephritis is not as common as in older cohorts, while neuropsychiatric disease is emerging as a major frontier in lupus prevention and care. These data may help to document changes in the natural history and treatment of SLE over time and may have implications for its early recognition and management. SAGE Publications 2020-02-27 2020-04 /pmc/articles/PMC7168806/ /pubmed/32106788 http://dx.doi.org/10.1177/0961203320908932 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) 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 (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Lupus around the World
Nikolopoulos, D
Kostopoulou, M
Pieta, A
Karageorgas, T
Tseronis, D
Chavatza, K
Flouda, S
Rapsomaniki, P
Banos, A
Kremasmenou, E
Tzavara, V
Katsimbri, P
Fanouriakis, A
Boumpas, D T
Evolving phenotype of systemic lupus erythematosus in Caucasians: low incidence of lupus nephritis, high burden of neuropsychiatric disease and increased rates of late-onset lupus in the ‘Attikon’ cohort
title Evolving phenotype of systemic lupus erythematosus in Caucasians: low incidence of lupus nephritis, high burden of neuropsychiatric disease and increased rates of late-onset lupus in the ‘Attikon’ cohort
title_full Evolving phenotype of systemic lupus erythematosus in Caucasians: low incidence of lupus nephritis, high burden of neuropsychiatric disease and increased rates of late-onset lupus in the ‘Attikon’ cohort
title_fullStr Evolving phenotype of systemic lupus erythematosus in Caucasians: low incidence of lupus nephritis, high burden of neuropsychiatric disease and increased rates of late-onset lupus in the ‘Attikon’ cohort
title_full_unstemmed Evolving phenotype of systemic lupus erythematosus in Caucasians: low incidence of lupus nephritis, high burden of neuropsychiatric disease and increased rates of late-onset lupus in the ‘Attikon’ cohort
title_short Evolving phenotype of systemic lupus erythematosus in Caucasians: low incidence of lupus nephritis, high burden of neuropsychiatric disease and increased rates of late-onset lupus in the ‘Attikon’ cohort
title_sort evolving phenotype of systemic lupus erythematosus in caucasians: low incidence of lupus nephritis, high burden of neuropsychiatric disease and increased rates of late-onset lupus in the ‘attikon’ cohort
topic Lupus around the World
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7168806/
https://www.ncbi.nlm.nih.gov/pubmed/32106788
http://dx.doi.org/10.1177/0961203320908932
work_keys_str_mv AT nikolopoulosd evolvingphenotypeofsystemiclupuserythematosusincaucasianslowincidenceoflupusnephritishighburdenofneuropsychiatricdiseaseandincreasedratesoflateonsetlupusintheattikoncohort
AT kostopouloum evolvingphenotypeofsystemiclupuserythematosusincaucasianslowincidenceoflupusnephritishighburdenofneuropsychiatricdiseaseandincreasedratesoflateonsetlupusintheattikoncohort
AT pietaa evolvingphenotypeofsystemiclupuserythematosusincaucasianslowincidenceoflupusnephritishighburdenofneuropsychiatricdiseaseandincreasedratesoflateonsetlupusintheattikoncohort
AT karageorgast evolvingphenotypeofsystemiclupuserythematosusincaucasianslowincidenceoflupusnephritishighburdenofneuropsychiatricdiseaseandincreasedratesoflateonsetlupusintheattikoncohort
AT tseronisd evolvingphenotypeofsystemiclupuserythematosusincaucasianslowincidenceoflupusnephritishighburdenofneuropsychiatricdiseaseandincreasedratesoflateonsetlupusintheattikoncohort
AT chavatzak evolvingphenotypeofsystemiclupuserythematosusincaucasianslowincidenceoflupusnephritishighburdenofneuropsychiatricdiseaseandincreasedratesoflateonsetlupusintheattikoncohort
AT floudas evolvingphenotypeofsystemiclupuserythematosusincaucasianslowincidenceoflupusnephritishighburdenofneuropsychiatricdiseaseandincreasedratesoflateonsetlupusintheattikoncohort
AT rapsomanikip evolvingphenotypeofsystemiclupuserythematosusincaucasianslowincidenceoflupusnephritishighburdenofneuropsychiatricdiseaseandincreasedratesoflateonsetlupusintheattikoncohort
AT banosa evolvingphenotypeofsystemiclupuserythematosusincaucasianslowincidenceoflupusnephritishighburdenofneuropsychiatricdiseaseandincreasedratesoflateonsetlupusintheattikoncohort
AT kremasmenoue evolvingphenotypeofsystemiclupuserythematosusincaucasianslowincidenceoflupusnephritishighburdenofneuropsychiatricdiseaseandincreasedratesoflateonsetlupusintheattikoncohort
AT tzavarav evolvingphenotypeofsystemiclupuserythematosusincaucasianslowincidenceoflupusnephritishighburdenofneuropsychiatricdiseaseandincreasedratesoflateonsetlupusintheattikoncohort
AT katsimbrip evolvingphenotypeofsystemiclupuserythematosusincaucasianslowincidenceoflupusnephritishighburdenofneuropsychiatricdiseaseandincreasedratesoflateonsetlupusintheattikoncohort
AT fanouriakisa evolvingphenotypeofsystemiclupuserythematosusincaucasianslowincidenceoflupusnephritishighburdenofneuropsychiatricdiseaseandincreasedratesoflateonsetlupusintheattikoncohort
AT boumpasdt evolvingphenotypeofsystemiclupuserythematosusincaucasianslowincidenceoflupusnephritishighburdenofneuropsychiatricdiseaseandincreasedratesoflateonsetlupusintheattikoncohort