Prognosis and treatment of systemic lupus erythematosus

Current Opinion in Rheumatology

Volumn 8, Issue 5, 1996, Pages 430-437

  Gladman, Dafna D ^a  

^a TORONTO WESTERN HOSPITAL   (Canada)

Author keywords

[No Author keywords available]

Indexed keywords

BROMOCRIPTINE; PREDNISONE; STEROID;

ARTICLE; HEALTH STATUS; IMMUNOSUPPRESSIVE TREATMENT; KIDNEY FAILURE; KIDNEY TRANSPLANTATION; MORTALITY; OSTEOPOROSIS; PRIORITY JOURNAL; PROGNOSIS; PSYCHOSIS; PULMONARY HYPERTENSION; QUALITY OF LIFE; SEIZURE; SURVIVAL RATE; SYSTEMIC LUPUS ERYTHEMATOSUS;

EID: 0029807544     PISSN: 10408711     EISSN: None     Source Type: Journal    
DOI: 10.1097/00002281-199609000-00007     Document Type: Article

References (60)

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25. el-Shahawy MA, Aswad S, Mendez RG, Bangsil R, Mendez R, Massry S: Renal transplantation in systemic lupus erythematosus: a single-center experience with sixty-four cases. Am J Nephrol 1995, 15:123-128. This study outlines the outcome of 64 patients with end-stage lupus nephritis who underwent transplantation at the Mayo clinic. This study shows good kidney and patient survival overall, albeit shorter than other patients with SLE. It also demonstrates that immunosuppression with cyclosporine was better than with azathioprine alone. It is a retrospective study and does not provide information that might be helpful in comparing these patients with other lupus cohorts.
26. Lockhead KM, Pirsch JD, D'Alessandro AM, Knechtle SJ, Kalayoglu M, Sollinger HW, Beizer FO: Risk factors for renal allograft loss in patients with systemic lupus erythematosus. Kidney Int 1996, 49:512-517. This retrospective study of a transplantation database provided information on patients with lupus nephritis who underwent transplantation in comparison with nondiabetic patients with end-stage renal disease. The analysis revealed that patients with SLE fared worst in the cyclosporine era, with a higher rejection rate. Although there is information related to kidney disease, it is hard to compare this cohort with other lupus populations.
27. Abu-Shakra M, Urowitz MB, Gladman DD: Improved survival in a cohort of SLE patients compared to the general population over a 25-year period of observation. Arthritis Rheum 1994, 37(suppl 9):S216.
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29. Abu-Shakra M, Urowitz MB, Gladman DD, Gough J: Mortality studies in systemic lupus erythematosus. Results from a single centre: I. Causes of death. J Rheumatol 1995, 22:1259-1264. This paper describes the mortality in a large population of patients with SLE followed up in a single center. Major causes of mortality remain SLE activity and fection, although atherosclerotic complications are important causes in patients with long-standing disease.
30. Neumann K, Wallace DJ, Azen C, Nessim C, Fichman M, Metzger AL, Klinenberg JR: Lupus in the 1980s: III. Influence of clinical variables, biopsy and treatment on the outcome in 150 patients with lupus nephritis seen at a single center. Semin Arthritis Rheum 1995, 25:47-55. A retrospective study of patients with lupus nephritis seen at a single center. It records the types of renal disease the patients had and their treatments and outcome in terms of patient and kidney survival. Risk factors for end-stage renal disease included WHO class IV and V, black race, and nephrotic syndrome. The analysis is univariate, without consideration of multiple factors.
31. Iliopoulos AG, Tsolos GC: Immunopathogenesis and spectrum of infections in systemic lupus erythematosus. Semin Arthritis Rheum 1996, 26:318-336. In this article, the authors review the literature describing infection in SLE and identify the pertinent immunopathogenetic mechanisms that contribute to susceptibility to infection among patients with SLE.
32. McLaughlin JR, Bombardier C, Farewell VT, Gladman DD, Urowitz MB: Kidney biopsy in systemic lupus erythematosus: III. Survival analysis controlling for clinical and laboratory variables. Arthritis Rheum 1994, 37:559-567.
33. Esdaile JM, Abrahamowicz M, MacKenzie T, Hayslett JP, Kashgarian M: The time-dependence of long-term prediction in lupus nephritis. Arthritis Rheum 1994, 37:359-368.
34. Esdaile JM, Joseph L, Mackenzie T, Kashgarian M, Hayslett JP: The benefit of early treatment with immunosuppressive agents in lupus nephritis. J Rheumatol 1994, 21:2046-2051.
35. Stoll T, Seifert B, Isenberg DA: SLICC/ACR damage index Is valid, and renal and pulmonary organ scores are predictors of severe outcome In patients with systemic lupus erythematosus. Br J Rheumatol 1996, 35:248-254. Using the SLICC/ACR damage index for SLE, the authors demonstrate that the index is valid and that renal and pulmonary damage are predictive of worse outcome.
36. Hay EM: Systemic lupus erythematosus. Baillieres Clin Rheumatol 1995, 9:437-470. This article reviews the development of the criteria for the classification of SLE and their pitfalls. It then summarizes the available indices for the assessment of disease activity in SLE and discusses the measurements of damage and quality of life in this disease.
37. Goulet JR, Mackenzie T, Levinton C, Hayslett JP, Ciampi A, Esdaile JM: The longterm prognosis of lupus nephritis: the impact of disease activity. J Rheumatol 1993, 20:59-65.
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39. Drenkard C, Villa AR, Alarcon-Segovia D, Perez-Vazquez ME: Influence of the antiphospholipid syndrome in the survival of patients with systemic lupus erythematosus. J Rheumatol 1994, 21:1067-1072.
40. Karlson EW, Daltroy LH, Lew RA, Wright EA, Partridge AJ, Roberts WN, Stern SH, Stratton KV, Wacholtz MC, Grosflam JM, Liang M: The independence and stability of socioeconomic predictors of morbidity in systemic lupus erythematosus. Arthritis Rheum 1995, 38:267-273. In this multicenter study, the authors studied the relationship between socioeconomic factors and disease activity at diagnosis in five centers. Patients with higher education and insurance had lower disease activity at diagnosis.
41. Raymond AA, Zariah AA, Samad SA, Chin CN, Kong NCT: Brain calcification in patients with cerebral lupus. Lupus 1996, 5:123-138. A small study of 27 patients with SLE, half of whom demonstrated CT scan abnormalities. Eight patients had calcifications. Although it is a small study, it highlights that there are cerebral abnormalities in patients with SLE that are not related to active inflammation.
42. Urowitz MB, Gladman DD, Slonim D, Glanz B, Gough J, Pauzner R, Heslegrave R, Darby P, MacKinnon A: Neurocognitive dysfunction in patients with inactive systemic lupus erythematosus. Arthritis Rheum 1995, 38(suppl 9):S302. This study demonstrated that 43% of patients with inactive SLE had neurocognitive dysfunction compared with 19% of healthy controls. This neurocognitive dysfunction was not related to active disease and thus may reflect consequences of previous disease and its treatment.
43. . Winslow TM, Ossipov MA, Fazio GP, Simonson JS, Redberg RF, Schiller NB: Five-year follow-up study of the prevalence and progression of pulmonary hypertension in systemic lupus erythematosus. Am Heart J 1995, 129:510-515. This study of echocardiography in patients with SLE identified a 14% prevalence of pulmonary hypertension, which increased to 43% after a 5-year follow-up. Although this is an important observation, the study lacks the detail on the patient population that is required to compare these patients with other cohorts or to deduce the relationship of pulmonary hypertension to previous clinical disease in these patients.
44. Formiga F, Moga I, Nolla JM, Pac M, Mitjavila F, Roig-Escofet D: Loss of bone mineral density in pramenopausal women with systemic lupus erythematosus. Ann Rheum Dis 1995, 54:274-276. This is a study of 74 premenopausal women with SLE, all of whom had been treated with steroids. Dual energy x-ray absorptiometry scanning revealed decreased bone density in comparison with 50 healthy controls and reference values. Unfortunately, we are not given enough information about the patients' disease, eg, whether they have had arthritis and what their level of disability has been.
45. Mahood J, Bogoch E, Gladman DD, MacDonald J, Urowitz MB, Goldsmith CH: Osteonecrosis of the hip in SLE: observer and patient variation on six methods of assessing femoral head involvement J Orthop Rheumatol 1995, 8:37-42. This study demonstrates the reliability of radiographic assessment of the femoral head in patients with SLE.
46. Gladman D, Ginzler E, Goldsmith C, Fortin P, Liang M, Urowitz M, Bacon P, Bombardieri S, Hanly J, Hay E, et al.: The development and Initial validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage Index for systemic lupus erythematosus. Arthritis Rheum 1996, 39:363-369. This article describes the development of the SLICC/ACR damage index for SLE by SLICC and the ACR. The index describes damage occurring in patients with SLE since the onset of disease and includes morbidity related to the inflammatory process, complications of drug therapy, and intercurrent illness without attribution.
47. Gladman D, Goldsmith C, Urowitz M, Bacon P, Fortin P, Ginzler E, Gordon C, Hanly J, Hay E, Isenberg D, et al.: The SLICC/ACR Damage Index for SLE: international comparison. Arthritis Rheum 1995, 38(suppl 9):S174. In this study, the authors compared populations from eight centers in North America and Europe and found that the SLICC/ACR index increased over time and was predictive of mortality.
48. Gladman D, Urowitz M, Goldsmith C, Fortin P, Ginzler E, Gordon C, Hanly J, Isenberg D, Kalunian K, Nived O, et al.: Assessment of the reliability of SLICC/ACR Damage Index for SLE. Arthritis Rheum 1996, in press. Members of SLICC demonstrated that they assess patients in the same way, both in terms of disease activity, using SLEDAI, and by calculating accumulated damage, using the SLICC/ACR damage index.
49. Gladman D, Urowitz M, Ong A, Gough J: A comparison of five health status instruments in patients with systemic lupus erythematosus (SLE). Lupus 1996, 5:190-195. The MOS SF-20 was found to correlate with health status assessed by the Health Assessment Questionnnaire, a depression scale, a fatigue scale, and two disability measures.
50. Stoll R, Gordon C, Stelfert B, Richardson K, Bacon PA, Malik J, Isenberg DA: Consistency and validity of patient administered assessment of quality of life by the MOS SF-36; Its association with disease activity and damage in patients with systemic lupus erythematosus and a comparison with the MOS SF-20. J Rheumatol 1996, in press. In a study comparing SF-20 and SF-36 in 150 patients, both instruments were easy to complete. Correlation of scores between SF-36 and SF-20 was good in general. There appeared to be some correlation between disease activity measured by the British Isles Lupus Activity Group instrument and domains of the SF-36.
51. Gladman D, Urowitz M, Ong A, Gough J, MacKinnon A: Lack of correlation among the 3 outcomes describing SLE: disease activity, damage and quality of life. Clin Exp Rheumatol 1996, 14:305-308. This article demonstrates a lack of correlation between disease activity measured by SLEDAI, accumulated damage measured by SLICC, and health status measured by the MOS SF-20, suggesting that all three are necessary to describe patients with SLE.
52. . Gladman D, Urowitz M, Fortin P, Isenberg D, Petri M, Goldsmith C, Gordon C, et al.: Workshop report: Systemic Lupus International Collaborating Clinics (SLICC) Conference on Assessment of Lupus Flare and Quality of Life Measures in SLE. J Rheumatol 1996, 23:1953-1955. A report of the workshop definition of lupus flare and quality of life measures is presented.
53. Urowitz M, Gladman D, Gough J, MacKinnon A: Fibromyalgia is a major contributor to quality of life in lupus. Arthritis Rheum 1995, 38(suppl 9):S247. As shown in a previous study for the SF-20, the SF-36 domains did not correlate with either disease activity measured by SLEDAI or damage measured by the SLICC/ACR damage index. However, a strong correlation was identified between fibromyalgia and all domains of the SF-36.
54. Bootsma H, Spronk P, Derksen R, de Boer G, Wolters-Dicke H, Hermans J, Limburg P, Gmeling-Meyling F, Kater L, Kallenberg C: Prevention of relapse in systemic lupus erythematosus. Lancet 1995, 345:1595-1599. A unique study of the uae of increased prednisone to control elevation of anti-double-stranded DNA antibodies and thus prevent relapses of SLE. The main difficulty of the study is the definition of relapse.
55. Walz-Leblanc B, Gladman DD, Urowitz MB, Goodman PJ: Serologically active clinically quiescent SLE. J Rheumatol 1994, 21:2239-2241.
56. Esdaile JM, Abrahamowicz M, Joseph L, MacKenzie T, Li Y, Danoff D: Laboratory tests as predictors of disease exacerbations in systemic lupus erythematosus. Arthritis Rheum 1996, 39:370-378. The authors studied whether changes in laboratory tests were predictive for clinical flares in SLE and concluded that the laboratory tests were not predictive. However, they did note some statistically significant P values, which they discarded because of multiple testing and which may not be necessary because they were testing features that had been shown previously. Moreover, their definition of flare may be too strict.
57. McMurray RW, Weidensaul D, Allen SH, Walker SE: Efficacy of bromocriptine in an open label therapeutic trial for systemic lupus erythematosus. J Rheumatol 1995, 22:2084-2091.
58. Cervera H, Jara LJ, Pizarro S, Enkerlin HI, Fernandez M, Medicna F, Fraga A, Miranda JM: Danazol for systemic lupus erythematosus with refractory autoimmune thrombocytopenia or Even's syndrome. J Rheumatol 1995, 22:1867-1871.
59. Schroeder JO, Zeuner RA, Euler HH, Loffler H: High dose intravenous gammaglobulins in systemic lupus erythematosus: clinical and serological results of a pilot study. J Rheumatol 1996, 23:71-75. In an uncontrolled study of 12 patients with SUE, the authors showed an improvement in SLEDAI and reduction of anti-double-stranded DNA antibodies.
60. Bermas BL, Hill JA: Effects of immunosuppressive drugs during pregnancy. Arthritis Rheum 1995, 38:1722-1732. An excellent review of immunosuppressive drugs used during pregnancy, which is relevant to physicians looking after patients with SLE.