Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 06273, Korea.
Sci Rep. 2023 Feb 21;13(1):3068. doi: 10.1038/s41598-023-29772-w.
To estimate the risk of systemic lupus erythematosus (SLE) flares based on the autoantibody positivity at the time of SLE diagnosis. This retrospective cohort study included 228 patients with newly diagnosed SLE. Clinical characteristics including autoantibody positivity at the time of diagnosis of SLE were reviewed. Flares were defined as a new British Isles Lupus Assessment Group (BILAG) A score or BILAG B score for at least one organ system. Multivariable Cox regression analyses were performed to estimate the risk of flares according to autoantibody positivity. Anti-dsDNA, anti-Sm, anti-U1RNP, anti-Ro, and anti-La antibodies (Abs) were positive in 50.0%, 30.7%, 42.5%, 54.8%, and 22.4% of the patients, respectively. The incidence rate of flares was 28.2/100 person-years. Multivariable Cox regression analysis, adjusted for potential confounders, revealed that anti-dsDNA Ab positivity (adjusted hazard ratio [HR]: 1.46, p = 0.037) and anti-Sm Ab positivity (adjusted HR: 1.81, p = 0.004) at the time of diagnosis of SLE were associated with higher risk of flares. To better delineate the flare risk, patients were categorized as double-negative, single-positive, double-positive for anti-dsDNA and anti-Sm Abs. Compared with double-negativity, double-positivity (adjusted HR: 3.34, p < 0.001) was associated with higher risk of flares, while anti-dsDNA Ab single-positivity (adjusted HR: 1.11, p = 0.620) or anti-Sm Ab single-positivity (adjusted HR: 1.32, p = 0.270) was not associated with higher risk of flares. Patients who are double-positive for anti-dsDNA and anti-Sm Abs at the time of the diagnosis of SLE are at higher risk of flares and may benefit from stringent monitoring and early preventive treatment.
基于系统性红斑狼疮（SLE）诊断时的自身抗体阳性来估计 SLE 发作的风险。这项回顾性队列研究纳入了 228 例新诊断的 SLE 患者。回顾了包括 SLE 诊断时自身抗体阳性在内的临床特征。发作定义为新的不列颠群岛狼疮评估组（BILAG）A 评分或至少一个器官系统的 BILAG B 评分。采用多变量 Cox 回归分析根据自身抗体阳性来估计发作的风险。抗 dsDNA、抗 Sm、抗 U1RNP、抗 Ro 和抗 La 抗体（Abs）在患者中的阳性率分别为 50.0%、30.7%、42.5%、54.8%和 22.4%。发作的发生率为 28.2/100 人年。多变量 Cox 回归分析，调整了潜在混杂因素后，发现 SLE 诊断时抗 dsDNA Ab 阳性（调整后的危险比[HR]：1.46，p=0.037）和抗 Sm Ab 阳性（调整后的 HR：1.81，p=0.004）与发作风险增加相关。为了更好地区分发作风险，将患者分为抗 dsDNA 和抗 Sm Abs 双阴性、单阳性、双阳性。与双阴性相比，双阳性（调整后的 HR：3.34，p<0.001）与更高的发作风险相关，而抗 dsDNA Ab 单阳性（调整后的 HR：1.11，p=0.620）或抗 Sm Ab 单阳性（调整后的 HR：1.32，p=0.270）与更高的发作风险无关。SLE 诊断时抗 dsDNA 和抗 Sm Abs 双阳性的患者发作风险更高，可能受益于严格监测和早期预防治疗。
