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

Autor:	A. Pieta, S. Flouda, Dimitrios T. Boumpas, K. Chavatza, P. Rapsomaniki, D. Tseronis, Aggelos Banos, Myrto Kostopoulou, V. Tzavara, Theofanis Karageorgas, Antonis Fanouriakis, D. Nikolopoulos, E Kremasmenou, Pelagia Katsimbri
Rok vydání:	2020
Předmět:	Adult Male 0301 basic medicine medicine.medical_specialty Lupus nephritis Late onset Comorbidity Severity of Illness Index White People Young Adult 03 medical and health sciences 0302 clinical medicine Rheumatology medicine Humans Lupus Erythematosus Systemic Lupus around the World skin and connective tissue diseases incident cohort Retrospective Studies 030203 arthritis & rheumatology Systemic lupus erythematosus Greece business.industry non-lupus criteria Incidence Incidence (epidemiology) Lupus Vasculitis Central Nervous System lupus criteria Middle Aged medicine.disease Lupus Nephritis Phenotype Dermatology Prevalent cohort 3. Good health 030104 developmental biology Cohort Female business damage Neuropsychiatric disease
Zdroj:	Lupus
ISSN:	0961-2033
DOI:	10.1177/0961203320908932
Popis:	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.
Databáze:	OpenAIRE
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