Aljohani Roaa, Gladman Dafna D, Su Jiandong, Urowitz Murray B
University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, 399 Bathurst Street, 1E-410B, Toronto, ON, M5T 2S8, Canada.
Department of Medicine, Taibah University, Medina, Kingdom of Saudi Arabia.
Clin Rheumatol. 2017 Aug;36(8):1773-1778. doi: 10.1007/s10067-017-3713-7. Epub 2017 Jun 6.
To compare management and outcomes of SLE patients treated in community clinics (Cc) with those treated in specialty clinic (Sc) within 10 years after SLE diagnosis. A single-center, matched cohort study design was used. We identified 54 SLE patients who were referred to a Sc from Cc within 5 years of SLE diagnosis, and 101 inception SLE patients who followed in a Sc. Patients in Cc were matched 1:2 based on gender, decade of SLE diagnosis, and age at diagnosis within 3 years with Sc patients. Disease characteristics, damage accumulation, death, cardiovascular (CVS) risk factors, and events were compared at 5 and 10 years of disease. Regression analyses taking into account the paired data were conducted. At 5 years of disease, patients referred from Cc had less cumulative ACR criteria, but more active disease. They were on higher doses of glucocorticoids (GCS) but less antimalarial treatment. At 10 years of disease and follow-up entirely in Sc, Sc patients had less disease activity. They had lower cumulative GCS doses. They had less hypertension and osteoporosis but more hypercholesterolemia than Cc patients. No statistically significant difference in damage accrual, CVS events, and death were detected. Regression analysis confirmed an association between being inception Sc patients and less active disease at 10 years. Lupus patients should be under the care of a lupus specialist early in their disease course for better control of their disease activity and to minimize use of GCS.
比较系统性红斑狼疮（SLE）患者在诊断后10年内于社区诊所（Cc）和专科诊所（Sc）接受治疗的管理情况及治疗结果。采用单中心配对队列研究设计。我们确定了54例在SLE诊断后5年内从Cc转诊至Sc的SLE患者，以及101例在Sc就诊的初发SLE患者。根据性别、SLE诊断年代以及诊断时年龄在3年内的情况，将Cc的患者与Sc的患者按1:2进行配对。在疾病的5年和10年时比较疾病特征、损伤累积、死亡、心血管（CVS）危险因素及事件。进行了考虑配对数据的回归分析。在疾病5年时，从Cc转诊的患者达到美国风湿病学会（ACR）标准的累积情况较少，但疾病活动度更高。他们使用的糖皮质激素（GCS）剂量更高，但抗疟治疗较少。在疾病10年时以及完全在Sc进行随访时，Sc的患者疾病活动度较低。他们的GCS累积剂量较低。与Cc的患者相比，他们患高血压和骨质疏松症的较少，但高胆固醇血症较多。在损伤累积、CVS事件和死亡方面未检测到统计学上的显著差异。回归分析证实初发Sc患者与10年时疾病活动度较低之间存在关联。狼疮患者在疾病病程早期应由狼疮专科医生进行治疗，以更好地控制疾病活动度并尽量减少GCS的使用。
