系统性红斑狼疮活动度和羟氯喹在终末期肾病前后的使用。
Systemic lupus Erythematosus activity and Hydroxychloroquine use before and after end-stage renal disease.
机构信息
Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
Division of Rheumatology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
出版信息
BMC Nephrol. 2020 Oct 28;21(1):450. doi: 10.1186/s12882-020-02083-2.
BACKGROUND
SLE manifestations after ESRD may be underdiagnosed and undertreated, contributing to increased morbidity and mortality. Whether specific symptoms persist after ESRD or a shift towards new manifestations occurs has not been extensively studied, especially in the non-Caucasian patients in the United States. In addition, hydroxychloroquine (HCQ) prescribing patterns post-ESRD have not been described. The objective of this study was to assess lupus activity and HCQ prescribing before and after ESRD development. Knowledge gained from this study may aid in the identification of SLE manifestations and improve medication management post-ESRD.
METHODS
We performed a retrospective cohort study of SLE patients with incident ESRD between 2010 and 2017. SLE-related symptoms, serologic markers of disease activity, and medication use were collected from medical records before and after ESRD development.
RESULTS
Fifty-nine patients were included in the study. Twenty-five (43%) patients had at least one clinical (non-renal) SLE manifestation documented within 12 months before ESRD. Of them, 11/25 (44%) continued to experience lupus symptoms post-ESRD; 9 patients without clinical or serological activity pre-ESRD developed new symptoms of active SLE. At the last documented visit post-ESRD, 42/59 (71%) patients had one or more clinical or serological markers of lupus activity; only 17/59 (29%) patients achieved clinical and serological remission. Thirty-three of 59 (56%) patients had an active HCQ prescription at the time of ESRD. Twenty-six of the 42 (62%) patients with active SLE manifestations post-ESRD were on HCQ. Patients who continued HCQ post-ESRD were more likely to be followed by a rheumatologist (26 [87%] vs 17 [61%], p = 0.024), had a higher frequency of documented arthritis (10 [32%] vs 1 [4%], p = 0.005), CNS manifestations (6 [20%] vs 1 [4%], p = 0.055), and concurrent immunosuppressive medication use (22 [71%] vs 12 [43%], p = 0.029).
CONCLUSIONS
Lupus activity may persist after the development of ESRD. New onset arthritis, lupus-related rash, CNS manifestations, low complement and elevated anti-dsDNA may develop. HCQ may be underutilized in patients with evidence of active disease pre- and post ESRD. Careful clinical and serological monitoring for signs of active disease and frequent rheumatology follow up is advised in SLE patients both, pre and post-ESRD.
背景
ESRD 后的 SLE 表现可能诊断不足且治疗不足，这导致发病率和死亡率增加。在非高加索裔美国患者中，ESRD 后是否存在特定症状持续存在或出现新的表现尚未得到广泛研究。此外，ESRD 后羟氯喹 (HCQ) 的开具情况也尚未描述。本研究的目的是评估 ESRD 前后狼疮活动和 HCQ 开具情况。从这项研究中获得的知识可能有助于识别 SLE 表现并改善 ESRD 后的药物管理。
方法
我们对 2010 年至 2017 年间发生 ESRD 的 SLE 患者进行了回顾性队列研究。从病历中收集了 ESRD 前后的 SLE 相关症状、疾病活动的血清学标志物和药物使用情况。
结果
本研究共纳入 59 例患者。25 例（43%）患者在 ESRD 前 12 个月内至少有一次临床（非肾脏）SLE 表现记录。其中，11/25（44%）患者在 ESRD 后仍有狼疮症状；9 例在 ESRD 前无临床或血清学活动的患者出现新的活动性 SLE 症状。在 ESRD 后最后一次有记录的就诊时，42/59（71%）患者有一个或多个狼疮活动的临床或血清学标志物；仅有 17/59（29%）患者达到临床和血清学缓解。59 例患者中有 33 例（56%）在 ESRD 时开具了活性 HCQ 处方。在 ESRD 后出现活动性 SLE 表现的 42 例患者中，有 26 例（62%）服用 HCQ。继续在 ESRD 后服用 HCQ 的患者更有可能接受风湿病医生的治疗（26 [87%] vs 17 [61%]，p=0.024），关节炎（10 [32%] vs 1 [4%]，p=0.005）、CNS 表现（6 [20%] vs 1 [4%]，p=0.055）和同时使用免疫抑制药物的频率更高（22 [71%] vs 12 [43%]，p=0.029）。
结论
狼疮活动可能在 ESRD 发生后持续存在。可能会出现新的关节炎、狼疮相关皮疹、CNS 表现、补体降低和抗 dsDNA 升高。在 ESRD 前后有活动性疾病证据的患者中，HCQ 的使用可能不足。建议 SLE 患者在 ESRD 前后均进行仔细的临床和血清学监测，以发现活动性疾病的迹象，并定期进行风湿病学随访。
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