Al Daabil M, Massarotti E M, Fine A, Tsao H, Ho P, Schur P H, Bermas B L, Costenbader K H
Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA.
Int J Clin Pract. 2014 Dec;68(12):1508-13. doi: 10.1111/ijcp.12466. Epub 2014 May 23.
To identify factors associated with development of systemic lupus erythematosus (SLE) among patients evaluated at a tertiary care Lupus Center for potential SLE.
We identified patients first seen at the Brigham and Women's Hospital Lupus Center between 1 January 1992 and 31 December 2012 and thought to have potential SLE by a board-certified rheumatologist. All had 1-3 SLE ACR criteria at initial visit and > 2 follow-up visits ≥ 3 months apart. We reviewed medical records through 15 May 2013 for: SLE signs and symptoms, autoimmune serologies, prescriptions and diagnoses by board-certified rheumatologists. Bivariable analyses and multivariable logistic regression models were used to identify independent predictors of developing SLE.
Two hundred and sixty four patients met inclusion criteria. At initial visit, mean age was 39.2 (SD 12.4) years, 94% were female and 67% white. Mean number of SLE ACR criteria was 2.7 (SD 1.0) and 88% were antinuclear antibody (ANA) positive at initial consultation. Mean follow-up time was 6.3 (SD 4.3) years and 67% were prescribed hydroxychloroquine in follow-up. At most recent visit, 56 (21%) had been diagnosed with SLE; 47 (18%) were thought not to have SLE and 161 (61%) were still considered to have potential SLE. In multivariable regression models, oral ulcers (OR 2.40, 95% CI 1.03-5.58), anti-dsDNA (OR 2.59, 95% CI 1.25-5.35) and baseline proteinuria or cellular casts (OR 16.20, 95% CI 1.63-161.02) were independent predictors of developing SLE. The most common other final diagnoses included fibromyalgia, Sjögren's syndrome, mixed connective tissue disease and cutaneous lupus.
Among patients with potential SLE at initial consultation, 21% were diagnosed with definite SLE within 6.3 years. Oral ulcers, anti-dsDNA and proteinuria or cellular casts were independent predictors of developing definite SLE. A better means of accurately identifying those who will develop SLE among those presenting with potential disease is necessary.
确定在一家三级医疗狼疮中心接受潜在系统性红斑狼疮（SLE）评估的患者中，与SLE发生相关的因素。
我们确定了1992年1月1日至2012年12月31日期间首次在布莱根妇女医院狼疮中心就诊、并被一名获得委员会认证的风湿病学家认为患有潜在SLE的患者。所有患者在初次就诊时均有1 - 3项SLE美国风湿病学会（ACR）标准，且有>2次随访，随访间隔≥3个月。我们查阅了截至2013年5月15日的病历，内容包括：SLE的体征和症状、自身免疫血清学、处方以及获得委员会认证的风湿病学家的诊断。采用双变量分析和多变量逻辑回归模型来确定发生SLE的独立预测因素。
264名患者符合纳入标准。初次就诊时，平均年龄为39.2（标准差12.4）岁，94%为女性，67%为白人。SLE ACR标准的平均数量为2.7（标准差1.0），初次会诊时88%的患者抗核抗体（ANA）呈阳性。平均随访时间为6.3（标准差4.3）年，随访期间67%的患者服用了羟氯喹。在最近一次就诊时，56名（21%）患者被诊断为SLE；47名（18%）患者被认为没有SLE，161名（61%）患者仍被认为患有潜在SLE。在多变量回归模型中，口腔溃疡（比值比[OR]2.40，95%置信区间[CI]1.03 - 5.58）、抗双链DNA（OR 2.59，95% CI 1.25 - 5.35）以及基线蛋白尿或细胞管型（OR 16.20，95% CI 1.63 - 161.02）是发生SLE的独立预测因素。最常见的其他最终诊断包括纤维肌痛、干燥综合征、混合性结缔组织病和皮肤型狼疮。
在初次会诊时有潜在SLE的患者中，21%在6.3年内被诊断为明确的SLE。口腔溃疡、抗双链DNA以及蛋白尿或细胞管型是发生明确SLE的独立预测因素。需要一种更好的方法来准确识别那些患有潜在疾病且将会发展为SLE的患者。
