Servicio de Reumatología, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú. Universidad Científica del Sur, Lima, Perú
Servicio de Reumatología, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú. Universidad Nacional Mayor de San Marcos, Lima, Perú
Ann Rheum Dis. 2015 Jun;74(6):1019-23. doi: 10.1136/annrheumdis-2013-204620. Epub 2014 Feb 13.
To determine the association between the number of flares systemic lupus erythematosus (SLE) patients experience and damage accrual, independently of other known risk factors.
SLE patients (34 centres, nine Latin American countries) with a recent diagnosis (≤2 years) and ≥3 evaluations were studied. Disease activity was ascertained with the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and damage with the SLICC/ACR Damage Index (SDI). Flare was defined as an increase ≥4 points in the SLEDAI between two study visits. An ambidirectional case- crossover design was used to determine the association between the number of flares and damage accrual.
901 patients were eligible for the study; 500 of them (55.5%) experienced at least one flare, being the mean number of flares 0.9 (SD: 1.0). 574 intervals from 251 patients were included in the case-crossover design since they have case and control intervals, whereas, the remaining patients did not. Their mean age at diagnosis was 27.9 years (SD: 11.1), 213 (84.9%) were women. The mean baseline SDI and SLEDAI were 1.3 (1.3) and 13.6 (8.1), respectively. Other features were comparable to those of the entire sample. After adjusting for possible confounding variables, the number of flares, regardless of their severity, was associated with damage accrual (SDI) OR 2.05, 95% CI 1.43 to 2.94, p<0.001 (OR 2.62, 95% CI 1.31 to 5.24, p=0.006 for severe and OR 1.91, 95% CI 1.28 to 2.83, p=0.001 for mild-moderate).
The number of flares patients experience, regardless of their severity, increases the risk of damage accrual, independently of other known risk factors.
确定红斑狼疮（SLE）患者经历的发作次数与累积损伤之间的关联，而不考虑其他已知的危险因素。
研究了最近诊断（≤2 年）且有≥3 次评估的 34 个中心的 9 个拉丁美洲国家的 SLE 患者。通过系统性红斑狼疮疾病活动指数（SLEDAI）确定疾病活动度，通过 SLICC/ACR 损伤指数（SDI）确定损伤程度。发作定义为两次研究就诊之间 SLEDAI 增加≥4 分。采用双向病例交叉设计来确定发作次数与损伤累积之间的关联。
901 名患者符合研究条件；其中 500 名（55.5%）患者经历了至少一次发作，平均发作次数为 0.9（标准差[SD]：1.0）。由于有病例和对照间隔，251 名患者中有 574 个间隔被纳入病例交叉设计，而其余患者则没有。他们的平均诊断年龄为 27.9 岁（SD：11.1），213 名（84.9%）为女性。基线 SDI 和 SLEDAI 的平均值分别为 1.3（1.3）和 13.6（8.1）。其他特征与整个样本相似。在调整可能的混杂变量后，无论严重程度如何，发作次数都与损伤累积（SDI）相关（OR 2.05，95%CI 1.43 至 2.94，p<0.001；OR 2.62，95%CI 1.31 至 5.24，p=0.006 用于严重和 OR 1.91，95%CI 1.28 至 2.83，p=0.001 用于轻度至中度）。
患者经历的发作次数，无论严重程度如何，都会增加损伤累积的风险，而不考虑其他已知的危险因素。
