Division of Rheumatology, Department of Medicine, National University Hospital of Singapore, Level 10, NUHS Tower Block, 1E Kent Ridge Road, 119228, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Division of Rheumatology, Department of Medicine, National University Hospital of Singapore, Level 10, NUHS Tower Block, 1E Kent Ridge Road, 119228, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Semin Arthritis Rheum. 2019 Aug;49(1):91-97. doi: 10.1016/j.semarthrit.2019.01.001. Epub 2019 Jan 5.
Data on flares in Asian patients with systemic lupus erythematosus (SLE) are scarce. Here, we aim to identify the baseline predictors of flares in a cohort of Southeast Asian patients with SLE.
Consecutive adult patients with prevalent SLE according to the 1997 ACR or 2012 SLICC criteria were enrolled and followed three-monthly. Clinical and laboratory data were collected at every visit using a standardised protocol. Flares were defined using the SELENA-SLEDAI Flare Index (SFI). Baseline predictors of flare in patients with stable disease (SLE Disease Activity Index-2K (SLEDAI-2K) of ≤ 4) were determined using Cox proportional hazards.
Of the 210 patients recruited, 148 (70.5%) were Chinese. The median (IQR) SLEDAI-2K at entry was 2 (0-4) and the median (IQR) disease duration was 10 (4.4-16.4) years. At baseline, 152 (72.4%) patients had stable disease. After a median (IQR) follow-up of 31.5 (24.1-36.3) months, 109 (51.9%) flared. Stable patients who flared tended to be in the lowest tertile of age (HR 3.08, 95% CI 1.72-5.48, p < 0.01), had thrombocytopenia (HR 5.01, 95% CI 1.32-18.99, p = 0.02), hypocomplementemia (HR 3.35, 95% CI 1.54-7.30, p < 0.01) and had the highest baseline prednisolone doses (HR 2.39, 95% CI 1.28-4.46, p = 0.01). Conversely, patients in the lowest tertile of disease duration tended not to flare (HR 0.41, 95% CI 0.21-0.80, p = 0.01).
Flares are common in Asian SLE patients with initial stable disease. Close monitoring is needed for patients who are younger, with longer disease duration, thrombocytopenia, hypocomplementemia, or who required a higher baseline prednisolone dose.
亚洲系统性红斑狼疮（SLE）患者的疾病发作数据较为匮乏。本研究旨在确定东南亚 SLE 患者队列中疾病发作的基线预测因素。
根据 1997 年 ACR 或 2012 年 SLICC 标准，连续纳入初诊的成年 SLE 患者，并进行每 3 个月一次的随访。每次就诊时均采用标准化方案采集临床和实验室数据。采用 SELENA-SLEDAI 疾病活动指数（SFI）定义疾病发作。使用 Cox 比例风险模型确定疾病活动指数-2K（SLEDAI-2K）评分≤4 分的稳定期患者（SLEDAI-2K）发作的基线预测因素。
在纳入的 210 例患者中，有 148 例（70.5%）为中国人。入组时 SLEDAI-2K 的中位数（IQR）为 2（0-4），疾病病程的中位数（IQR）为 10（4.4-16.4）年。基线时，152 例（72.4%）患者病情稳定。中位（IQR）随访 31.5（24.1-36.3）个月后，109 例（51.9%）患者出现疾病发作。病情稳定但出现疾病发作的患者往往年龄处于最低三分位数（HR 3.08，95%CI 1.72-5.48，p<0.01），伴有血小板减少症（HR 5.01，95%CI 1.32-18.99，p=0.02）、低补体血症（HR 3.35，95%CI 1.54-7.30，p<0.01）和最高基线泼尼松剂量（HR 2.39，95%CI 1.28-4.46，p=0.01）。相反，疾病病程处于最低三分位数的患者不太可能出现疾病发作（HR 0.41，95%CI 0.21-0.80，p=0.01）。
亚洲 SLE 患者在初诊时疾病稳定，但疾病发作较为常见。对于年龄较小、疾病病程较长、伴有血小板减少症、低补体血症或需要较高基线泼尼松剂量的患者，需要密切监测。
