Predictive factors of flares in systemic lupus erythematosus patients: data from a multiethnic Latin American cohort

M. F. Ugarte-Gil, D. Wojdyla, C. A. Pastor-Asurza, R. V. Gamboa-Cárdenas, E. M. Acevedo-Vásquez, L. J. Catoggio, M. A. García, E. Bonfá, E. I. Sato, L. Massardo, V. Pascual-Ramos, L. A. Barile, G. Reyes-Llerena, A. Iglesias-Gamarra, J. F. Molina-Restrepo, R. Chacón-Díaz, G. S. Alarcón, B. A. Pons-Estel

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Purpose: The purpose of this paper is to determine the factors predictive of flares in systemic lupus erythematosus (SLE) patients. Methods: A case-control study nested within the Grupo Latino Americano De Estudio de Lupus (GLADEL) cohort was conducted. Flare was defined as an increase ≥4 points in the SLEDAI. Cases were defined as patients with at least one flare. Controls were selected by matching cases by length of follow-up. Demographic and clinical manifestations were systematically recorded by a common protocol. Glucocorticoid use was recorded as average daily dose of prednisone and antimalarial use as percentage of time on antimalarial and categorized as never (0%), rarely (>0–25%), occasionally (>25%–50%), commonly (˃50%–75%) and frequently (˃75%). Immunosuppressive drugs were recorded as used or not used. The association between demographic, clinical manifestations, therapy and flares was examined using univariable and multivariable conditional logistic regression models. Results: A total of 465 cases and controls were included. Mean age at diagnosis among cases and controls was 27.5 vs 29.9 years, p = 0.003; gender and ethnic distributions were comparable among both groups and so was the baseline SLEDAI. Independent factors protective of flares identified by multivariable analysis were older age at diagnosis (OR = 0.929 per every five years, 95% CI 0.869–0.975; p = 0.004) and antimalarial use (frequently vs never, OR = 0.722, 95% CI 0.522–0.998; p = 0.049) whereas azathioprine use (OR = 1.820, 95% CI 1.309–2.531; p < 0.001) and SLEDAI post-baseline were predictive of them (OR = 1.034, 95% CI 1.005–1.064; p = 0.022). Conclusions: In this large, longitudinal Latin American cohort, older age at diagnosis and more frequent antimalarial use were protective whereas azathioprine use and higher disease activity were predictive of flares.

Original languageEnglish
Pages (from-to)536-544
Number of pages9
JournalLupus
Volume27
Issue number4
DOIs
StatePublished - 1 Apr 2018

Bibliographical note

Funding Information:
1Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú; 2Universidad Científica del Sur, Lima, Perú; 3Universidad Nacional de Rosario, Rosario, Argentina; 4Universidad Nacional Mayor de San Marcos, Lima, Perú; 5Sección de Reumatología, Servicio de Clínica Médica, Hospital Italiano, Instituto Universitario Escuela de Medicina Hospital Italiano and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina; 6Hospital Interzonal General de Agudos ‘‘General San Martín,’’ La Plata, Argentina; 7Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; 8Disciplina de Reumatología, Escola Paulista de Medicina, Universidade Federal da São Paulo-UNIFESP, São Paulo, Brazil; 9Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; 10Instituto Nacional de Ciencias Médicas y Nutrición ‘‘Salvador Zubirán,’’ Ciudad de Mexico, Mexico; 11Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de Mexico, Mexico; 12Centro de Investigaciones Médico Quirúrgicas-CIMEQ, Habana, Cuba; 13Universidad Nacional de Colombia, Bogotá, Colombia; 14Universidad CES, Medellin, Colombia; 15Servicio de Reumatología, Centro Nacional de Enfermedades Reumáticas, Hospital Universitario de Caracas, Caracas, Venezuela; 16Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA; and 17Hospital Provincial de Rosario, Rosario, Argentina

Funding Information:
ARGENTINA: Enrique R. Soriano, María Flavia Ceballos Recalde and Edson Velozo (Sección de Reumatología, Servicio de Clínica Médica; Hospital Italiano and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina); Jorge A. Manni, Sebastián Grimaudo and Judith Sarano (Instituto de Investigaciones Médicas ‘‘Alfredo Lanari,’’ Buenos Aires); Emilce Schneeberger, María S. Arriola and Graciela Gómez (Instituto de Rehabilitación Psicofísica, Buenos Aires); Ana Inés Marcos and Juan Carlos Marcosa (Hospital Interzonal General de Agudos ‘‘General San Martín,’’ La Plata); Hugo R. Scherbarth, Jorge A. López and Estela L. Motta (Hospital Interzonal General de Agudos ‘‘Dr. Oscar Alende,’’ Mar del Plata); Cristina Drenkard, Susana Gamron, Laura Onetti and Sandra Buliubasich (Hospital Nacional de Clínicas, Córdoba); Verónica Saurit, Francisco Caeiro and Alejandro Alvarellos (Servicio de Reumatología, Hospital Privado, Centro Medico de Córdoba, Córdoba); Silvana Gentiletti, Norberto Quagliatto, Alberto A. Gentiletti and Daniel Machadoa (Hospital Provincial de Rosario, Rosario); Marcelo Abdala and Simón Palatnika (Hospital Provincial del Centenario, Universidad Nacional de Rosario, Rosario); Guillermo A. Berbotto and Carlos A. Battagliottia (Hospital Escuela ‘‘Eva Perón,’’ Granadero Baigorria). BRAZIL: Eduardo F. Borba (Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo); Alexandre Wagner S. Souza (Disciplina de Reumatología, Escola Paulista de Medicina, Universidade Federal da São Paulo-UNIFESP, São Paulo); Lilian T. Lavras Costallat, Manoel Barros Bertolo and Ibsen Bellini Coimbra (Faculdade de Ciências Médicas, Universidade Estadual de Campinas); João C. Tavares Brenol, Ricardo Xavier and Tamara Mucenic (Hospital das Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul); Fernando de Souza Cavalcanti, Ângela Luzia Branco Duarte and Cláudia Diniz Lopes Marques (Centro de Ciências da Saúde, Universidade Federal de Pernambuco); Nilzio Antonio da Silva, Ana Carolina de O. e Silva and Tatiana Ferracine Pacheco (Faculdade de Medicina, Universidade Federal de Goiás, Goiânia). COLOMBIA: José Fernando Molina-Restrepo, Javier Molina-López, Gloria Vásquez, Luis A. Ramirez and Oscar Uribe (Universidad de Antioquia, Hospital Universitario ‘‘San Vicente de Paul,’’ Medellín); Antonio Iglesias-Rodríguez (Universidad del Bosque, Bogotá), Eduardo Egea-Bermejo (Universidad del Norte, Barranquilla); Renato A. Guzmán-Moreno and José F. Restrepo-Suárez (Clínica Saludcoop 104 Jorge Piñeros Corpas and Hospital San Juan de Dios, Universidad Nacional de Colombia, Bogotá). CUBA: Marlene Guibert-Toledano and Alfredo Hernández-Martínez (Centro de Investigaciones Médico Quirúrgicas-CIMEQ, Habana). CHILE: Sergio Jacobelli (Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago); Oscar Neira and Leonardo R. Guzmán (Hospital del Salvador, Facultad de Medicina, Universidad de Chile, Santiago). GUATEMALA: Abraham García-Kutzbach, Claudia Castellanos and Erwin Cajas (Hospital Universitario Esperanza, Ciudad de Guatemala). MEXICO: Mario H. Cardiel (Centro de Investigación Clínica de Morelia SC, Morelia, Michoacan); Donato Alarcón-Segoviaa and Antonio R. Villa (Instituto Nacional de Ciencias Médicas y Nutrición ‘‘Salvador Zubirán,’’ Ciudad de Mexico); Mary Carmen Amigo (Reumatología, Centro Medico ABC, Ciudad de Mexico); Luis H. Silveira (Instituto Nacional de Cardiología ‘‘Ignacio Chávez,’’ Ciudad de Mexico); Ignacio García De La Torre, Gerardo Orozco-Barocio and Magali L. Estrada-Contreras (Hospital General de Occidente de la Secretaría de Salud, Guadalajara, Jalisco); María Josefina Sauza del Pozo, Laura E. Aranda Baca and Adelfia Urenda Quezada (Instituto Mexicano de Seguro Social, Hospital de Especialidades N° 25, Monterrey, Nuevo León); Guillermo F. Huerta-Yáñez (Hospital de Especialidades Miguel Hidalgo, Aguascalientes). PERÚ: José Luis Alfaro-Lozano, Jorge M. Cucho-Venegas (Hospital Nacional ‘‘Guillermo Almenara Irigoyen,’’ EsSalud, Lima); María Inés Segami, Cecilia P. Chung and Magaly Alva-Linares (Hospital Nacional ‘‘Edgardo Rebagliatti Martins,’’ EsSalud, Lima). VENEZUELA: Isaac Abadi and Neriza Rangel (Servicio de Reumatología, Centro Nacional de Enfermedades Reumáticas, Hospital Universitario de Caracas, Caracas); María H. Esteva-Spinetti and Jorge Vivas (Hospital Central de San Cristóbal, San Cristóbal). aDeceased.

Publisher Copyright:
© 2017, © The Author(s) 2017.

Keywords

  • Systemic lupus erythematosus
  • antimalarials
  • flares
  • risk factors

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