32 research outputs found
HLA class II DNA typing in a large series of European patients with systemic lupus erythematosus: correlations with clinical and autoantibody subsets
We conducted this study to determine the HLA class II allele associations in a large cohort of patients of homogeneous ethnic derivation with systemic lupus erythematosus (SLE). The large sample size allowed us to stratify patients according to their clinical and serologic characteristics. We studied 577 European Caucasian patients with SLE. Antinuclear antibodies (Hep-2 cells), anti-dsDNA antibodies (Crithidia luciliae), and antibodies to extractable nuclear antigens Ro (SS-A), La (SS-B), U1-RNP, Sm, Jo1, SCL70, and PCNA, were detected in all patients. Molecular typing of HLA-DRB1, DRB3, DQA1, and DQB1 loci was performed by the polymerase chain reaction-sequence specific oligonucleotide probes (PCR-SSOP) method. We found a significantly increased frequency of DRB1*03, DRB1*15, DRB1*16, DQA1*0102, DQB1*0502, DQB1*0602, DQB1*0201, DQB1*0303, and DQB1*0304 in lupus patients as compared with healthy controls. In addition, DRB1*03 was associated with anti-Ro, anti-La, pleuritis, and involvement of lung, kidney, and central nervous system. DRB1*15 and DQB1*0602 were associated with anti-dsDNA antibodies; DQB1*0201 with anti-Ro and anti-La, leukopenia, digital skin vasculitis, and pleuritis; and DQB1*0502 was associated with anti-Ro, renal involvement, discoid lupus, and livedo reticularis. In conclusion, our study shows some new HLA clinical and serologic associations in SLE and further confirms that the role of MHC genes is mainly to predispose to particular serologic and clinical manifestations of this disease
Incomplete lupus erythematosus: results of a multicentre study under the supervision of the EULAR Standing Committee on International Clinical Studies Including Therapeutic Trials (ESCISIT)
OBJECTIVE: Patients characterized with antinuclear antibodies (ANA) and
disease symptoms related to one organ system can be described as having
incomplete systemic lupus erythematosus (SLE). The aim of this multicentre
study was to describe the outcome of these so-called incomplete SLE
patients. Two aspects of the outcome were studied: (i) the disease course,
defined by the presence or absence of clinical symptoms; and (ii) the
number of patients that eventually developed full SLE. METHODS: Outcome
parameters were the ACR criteria, the SLE disease Activity Index (SLEDAI),
the European Consensus Lupus Activity Measure (ECLAM) and the requirement
for treatment. In 10 European rheumatology centres, patients who had been
evaluated in the last 3 months of 1994 and had been diagnosed as having
incomplete SLE on clinical grounds for at least 1 yr were included in the
study. All 122 patients who were included in the study were evaluated
annually during 3 yr of follow-up. RESULTS: Our results are confined to a
patient cohort defined by disease duration of at least 1 yr, being under
clinical care at the different centres in Europe. These patients showed
disease activity that was related mostly to symptoms of the skin and the
musculoskeletal system, and leucocytopenia. During the follow-up, low
doses of prednisolone were still being prescribed in 43% of the patients.
On recruitment to the study, 22 of the 122 incomplete SLE patients already
fulfilled the ACR criteria for the diagnosis of SLE. In the 3 yr of
follow-up only three patients developed SLE. CONCLUSIONS: A high
proportion of patients in our cohort defined on clinical grounds as having
incomplete SLE eventually showed disease activity defined by the SLEDAI as
well as ECLAM. However, only three cases developed to SLE during the
follow-up. This suggests that incomplete SLE forms a subgroup of SLE that
has a good prognosis
Systemic lupus erythematosus. Disease outcome in patients with a disease duration of at least 10 years: second evaluation
Data related to the disease course of patients with systemic lupus erythematosus (SLE) with special attention to the persistence of disease activity in the long term are scarce. At this moment reliable figures are only known about the survival rate as a measure of outcome. The aim of this multicenter study was to describe the outcome of SLE patients with a disease duration of greater than 10 y. Outcome parameters were two disease activity-scoring systems (SLEDAI and ECLAM), the end organ damage (SLICC/ACR damage index) and treatment. Our results are derived from 187 SLE patients followed at 10 different centres in Europe over a period of 1 y. Serious clinical signs or exacerbations, defined by the occurrence or detoriation of already existing symptoms of renal and cerebral nervous systems were observed in 2-11% of the patients, seizures and psychosis in 3%, proteinuria in 11% and an increase in serum creatinine in 5% of the patients. No change took place in the overall damage index. Yet, the disease course in most patients was characterized by periods of tiredness (42-60%), arthritis (20-25%), skin involvement such as malar rash (32-40%), migraine (15-20%), anaemia (15%) and leucopenia (17-19%). Summarizing these results it is shown that patients, still under care after such a long time of having this disease, do have a disease that is far from extinguished
Morbidity and mortality in systemic lupus erythematosus during a 10-year period - A comparison of early and late manifestations in a cohort of 1,000 patients
In the present study, we assessed the frequency and characteristics of the main causes of morbidity and mortality in systemic lupus erythematosus (SLE) during a 10-year period and compared the frequency of early manifestations with those that appeared later in the evolution of the disease. In 1990, we started a multicenter study of 1,000 patients from 7 European countries. All had medical histories documented and underwent medical interview and routine general physical examination when entered in the study, and all were followed prospectively by the same physicians during the ensuing 10 years (1990-2000).A total of 481 (48.1%) patients presented 1 or more episodes of arthritis at any time during the 10 years, 311 (31.1%) patients had malar rash, 279 (27.9%) active nephropathy, 194 (19.4%) neurologic involvement, 166 (16.6%) fever, 163 (16.3%) Raynaud phenomenon, 160 (16.0%) serositis (pleuritis and/or pericarditis), 134 (13.4%) thrombocytopenia, and 92 (9.2%) thrombosis. When the prevalences of the clinical manifestations during the initial 5 years of follow-up (1990-1995) were compared with those during the ensuing 5 years (1995-2000), most manifestations were found to be more frequent during the initial 5 years. Of the 1,000 patients, 360 (36%) presented infections, 169 (16.9%) hypertension, 121 (12.1%) osteoporosis, and 81 (8.1%) cytopenia due to immunosuppressive agents. Twenty-three (2.3%) patients developed malignancies; the most frequent primary localizations were the uterus and the breast.Sixty-eight (6.8%) patients died, and the most frequent causes of death were similarly divided between active SLE (26.5%), thromboses (26.5%), and infections (25%). A survival probability of 92% at 10 years was found. A lower survival probability was detected in those patients who presented at the beginning of the study with nephropathy (88% versus 94% in patients without nephropathy, p = 0.045). When the causes of death during the initial 5 years of follow-up (1990-1995) were compared with those during the ensuing 5 years (1995-2000), active SLE and infections (28.9% each) appeared to be the most common causes during the initial 5 years, while thromboses (26.1%) became the most common cause of death during the last 5 years.In conclusion, most of the SLE inflammatory manifestations appear to be less common after a long-term evolution of the disease, probably reflecting the effect of therapy as well as the progressive remission of the disease in many patients. Meanwhile, a more prominent role of thrombotic events is becoming evident, affecting both morbidity and mortality in SLE
Clinical features and prognosis of patients with idiopathic inflammatory myopathies and anti-Jo-1 antibodies
Inhibition of radiographic progression with combination etanercept and methotrexate in patients with moderately active rheumatoid arthritis previously treated with monotherapy
OBJECTIVE: To determine the effect of changing from etanercept or methotrexate
monotherapy to etanercept plus methotrexate combination therapy on radiographic
progression in rheumatoid arthritis (RA) patients. METHODS: Patients enrolled in
this 1-year open-label study previously completed a 3-year blinded study in which
they received methotrexate or etanercept monotherapy or the combination of both.
All patients received the combination of etanercept 25 mg subcutaneously twice
weekly plus oral methotrexate up to 20 mg/week. The primary radiographic endpoint
was a change in modified total Sharp score (TSS), as assessed by blinded readers.
RESULTS: At baseline, patients previously receiving methotrexate monotherapy
(etanercept-added, n = 52) or etanercept monotherapy (methotrexate-added, n = 68)
had moderate disease activity levels (mean disease activity score (DAS) of 2.6
and 2.5, respectively), whereas patients previously receiving combination therapy
(n = 90) had a low disease activity level (mean DAS of 2.0). The addition of
etanercept to methotrexate monotherapy resulted in a significant reduction in
radiographic progression (p<0.05). Mean TSS changes in the previous year versus
the current year were +1.79 versus +0.25 for the etanercept-added group (p<0.05);
+0.51 versus -0.18 for the methotrexate-added group (NS) and +0.42 versus +0.24
for the combination group (NS). CONCLUSION: In these RA patients with on average
moderate disease activity despite previous methotrexate monotherapy, combination
treatment with etanercept and methotrexate inhibited radiographic progression and
improved radiographic outcomes. These data, in conjunction with the previously
published clinical data, support the use of combination therapy in RA patients
with moderate disease activity
Incomplete lupus erythematosus: results of a multicentre study under the supervision of the EULAR Standing Committee on International Clinical Studies including Therapeutic Trials (ESCISIT)
Objective. Patients characterized with antinuclear antibodies (ANA) and
disease symptoms related to one organ system can be described as having
incomplete systemic lupus erythematosus (SLE). Thr aim of this
multicentre study was to describe the outcome of these so-called
incomplete SLE patients. Two aspects of the outcome were studied: (i)
the disease course, defined by the presence or absence of clinical
symptoms: and (ii) the number of patients that eventually developed full
SLE.
Methods. Outcome parameters were the ACR criteria, the SLE: disease
Activity Index (SLEDAI), the European Consensus Lupus Activity Measure
(ECLAM) and the requirement for treatment. In 10 European rheumatology
centres, patients who had been evaluated in the last 3 months of 1994
and had been diagnosed as having incomplete SLE on clinical grounds for
at least yr were included in the study. All 122, patients who were
included in the study were evaluated annually during 3 yr of follow-up.
Results. Our results are confined to a patient cohort defined by disease
duration of at least yr, being under clinical care at the different
centres in Europe. These patients showed disease activity that was
related mostly to symptoms of the skin and the musculoskeletal system,
and leucocytopenia. During the follow-up, low doses of prednisolone were
still being prescribed in 43%, of the patients. On recruitment to the
study, 22 of the 112 incomplete SLE patients already fulfilled the ACR
criteria for the diagnosis of SLE. Tn the 3 yr of follow-up only three
patients developed SLE.
Conclusions, A high proportion of patients in our cohort defined on
clinical grounds as having incomplete SLE eventually showed disease
activity defined by the SLEDAI as well as ECLAM. However, only three
cases developed to SLE during the follow-up. This suggests that
incomplete SLE forms a subgroup of SLE that has a good prognosis