Disease activity and damage accrual during the early disease course in a multinational inception cohort of patients with systemic lupus erythematosus

• Published in: Lupus Vol. 19; no. 8; pp. 949 - 956
• Main Authors: Nossent, J., Kiss, E., Rozman, B., Pokorny, G., Vlachoyiannopoulos, P., Olesinska, M., Marchesoni, A., Mosca, M., Påi, S., Manger, K., Schneider, M., Nielsen, H., van Vollenhoven, R., Swaak, T.
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.07.2010; Sage Publications Ltd
• Subjects: Adult; Antibodies, Antinuclear - blood; Cohort Studies; Disease; Disease Progression; Europe; Female; Hospitals; Humans; Immunosuppressive Agents - therapeutic use; Internal medicine; Lupus; Lupus Erythematosus, Systemic - diagnosis; Lupus Erythematosus, Systemic - pathology; Lupus Erythematosus, Systemic - physiopathology; Lupus Erythematosus, Systemic - therapy; Male; Medical prognosis; Medicin och hälsovetenskap; Medicine; Middle Aged; Mortality; Patients; Rheumatology; Young Adult; Europe; Sweden; Netherlands; Hungary; Norway; Denmark; Poland; Italy; Slovenia; Germany; Estonia; disease activity; systemic lupus erythematosus; damage accrual; inception cohort; Europe; therapy
• ISSN: 0961-2033; 1477-0962; 1477-0962
• DOI: 10.1177/0961203310366572

An inception cohort of patients with systemic lupus erythematosus from 14 European centres was followed for up to 5 years in order to describe the current early disease course. At inclusion patients (n = 200, 89% female, mean age 35 years, 97% Caucasian, mean SLEDAI 12.2) fulfilled a mean of 6.5 ACR classification criteria. The most prevalent criteria were antinuclear Ab presence (97%) followed by anti-dsDNA Ab (74%), arthritis (69%), leukocytopenia (54%) and malar rash (53%), antiphospholipid Ab (48%) and anti-synovial membrane Ab (21.6%). Clinical signs of lupus nephritis (LN) were present in 39% with biopsy-confirmed LN seen in 25%. Frequent additional findings were hypocomplementaemia (54%), anti-SSA Ab (49%), alopecia (26%) and Raynaud’s phenomenon (31%). There were few regional differences in disease presentation and management. One and 5-year survival rates were 99% and 97% respectively. During the mean follow-up of 4.1 years 25% entered a state of early disease quiescence by global physician assessment, but the overall risk of subsequent flare was 60%. Maximum SLEDAI scores decreased over time, but 45% of patients accrued damage (SDI ≥1) for which baseline presence of proteinuria and persistent disease activity were independent predictors. The results indicate minor differences in SLE presentation and treatment within various regions of Europe and a high diagnostic reliance on anti-dsDNA Ab. Despite early reductions in disease activity and improved mortality, the risk for disease flare and damage development is, however, still substantial, especially in patients not entering an early remission.