Davidson, Julie

Kan, Hong

McHugh, Neil

Molta, Charles

Nightingale, Alison

English

OPUS

The incidence and presentation of systemic lupus erythematosus (SLE) in UK primary care using the UK Clinical Practice Research Datalink (CPRD)

        Citation for published version:Nightingale, A, Davidson, J, Molta, C, Kan, H & McHugh, N 2014, 'The incidence and presentation of systemiclupus erythematosus (SLE) in UK primary care using the UK Clinical Practice Research Datalink (CPRD)',Annals of the Rheumatic Diseases, vol. 73, no. Suppl 2, pp. 325.Publication date:2014Document VersionEarly version, also known as pre-printLink to publicationUniversity of BathAlternative formatsIf you require this document in an alternative format, please contact:openaccess@bath.ac.ukGeneral rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright ownersand it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.Take down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Download date: 03. Nov. 2022EULAR abstracts DEADLINE for submission:  31 Jan 2014 Submit for GSK review:    Topics: Topic 17 SLE, Sjögren's and APS - clinical aspects (other than treatment)  Topic 32 Epidemiology, health services and outcome research  Both under topic 32?  Abstract information: https://b-com.mci-group.com/AbstractSubmission/EULAR2014.aspx Abstract info:  For standardisation, the acceptable length of the abstract is not more than 3600 characters and 50 lines, author's details and headers included. This also includes non-visible characters such as spaces and punctuation.   The abstract should be structured into the following sections:  a. A title which clearly indicates the nature of the investigation  b. Background  c. Objectives  d. Methods  e. Results  f. Conclusions  g. References   One graph/image can be included with the following criteria:  Image width: min. 50 pixels - max. 750 pixels  Image height: min. 50 pixels - max. 750 pixels Image quality: min. 96 dpi - max. 300 dpi Image file size: min. 35 KB - max. 1000 KB  Allowed file type: gif, jpg  Please note that insertion of graphs and images may significantly reduce the number of remaining allowed characters.     EULAR 2014 ABSTRACT 1 DRAFT FINAL Characters with spaces (limit is 3,600) WORD COUNT 3562 ; 45 lines.  Title: The Incidence and Presentation of Systemic Lupus Erythematosus (SLE) in UK Primary Care using the UK Clinical Practice Research Datalink (CPRD) Authors:  Alison L Nightingale1, Julie E Davidson2, Charles T. Molta3, Hong J. Kan4 Neil J McHugh1,5 Affiliations:  1. Department of Pharmacy and Pharmacology, University of Bath, UK 2. Worldwide Epidemiology, GlaxoSmithKline R&D, Stockley Park, UK 3. U.S. Health Outcomes, GlaxoSmithKline, Research Triangle Park, NC 27709, USA. 4. U.S. Medical Affairs, GlaxoSmithKline, Philadelphia, PA, USA 5. Royal National Hospital for Rheumatic Diseases, Bath, UK Background: The onset of SLE is often described as varied and insidious yet few studies have described the pattern of the onset of symptoms using primary care data. We used the CPRD to investigate the way in which SLE presents in UK primary care. Objectives: To calculate the incidence of SLE in the CPRD population between 1/1/00 and 31/12/12; to describe the presentation of symptoms of SLE and to determine the time from the accumulation of up to five SLE symptoms to SLE diagnosis.  Methods: We identified incident cases of SLE using a previously described identification algorithm1. Kaplan-Meier failure curves were constructed looking back from SLE diagnosis to the recording of symptoms related to SLE (i.e. using the presence of symptoms as the failure). The equality of the failure curves were compared for age group (< 30, 30-49 and ≥ 50 yrs) at diagnosis using the Log Rank test.  Results: There were 1426 incident cases (170 males, 1256 females) giving age-standardised incidence rates of 0.7/100,000/yr in males (CI950.7,0.8) and 5.4/100,000/yr (CI955.3,5.5) in females. Peak incidence rates were in women aged 30-59 years. The failure curves indicated a gradual onset of symptoms and the median time from first symptom to diagnosis was 5.9yrs (IQR 3.0,9.9). In those aged  <30, 30-49 and 50+ at diagnosis the median times from first symptom to diagnosis were 3.3yrs (IQR 2.7,3.9), 4.6yrs (IQR 4.2,5.1) and 6.4yrs (IQR 5.8,6.8); from second symptom to diagnosis1.9yrs (IQR 1.3,2.4), 3.3yrs(2.9,3.6) and 4.2yrs(IQR 3.7,4.7) respectively and from third symptom to diagnosis 1.2yrs (IQR 0.6,1.7), 2.2yrs (IQR 1.9,2.5) and 2.8yrs (IQR 2.4,3.2) respectively. Younger patients were more likely to have constitutional (p<0.001), neurological (p<0.001) and musculoskeletal (p = 0.02) symptoms whereas older patients had more cardiorespiratory symptoms and vasculitis (p< 0.001) prior to diagnosis. There was a significant difference between the failure curves for the time from the accumulation of one, two and three symptoms of SLE to diagnosis by age group (p<0.001).  Musculoskeletal symptoms were the most frequent first symptom in patients aged <30 and 50+ at diagnosis whereas neurological symptoms were most the most common first symptom in those aged 30-49.  Conclusions: The presentation of symptoms of SLE is varied and insidious with a long delay from first symptom to SLE diagnosis. Those diagnosed after the age of 50 had a significantly longer time from the presentation of their symptoms to diagnosis (6.4yrs) than those aged <30 (3.3yrs). The longer delay to diagnosis in older patients may be due to a combination of low diagnostic suspicion and a more insidious pattern of onset.  Sponsor: GlaxoSmithKline; WEUKBRE6479 Reference:    1. Nightingale AL, Farmer RD, de Vries CS. Incidence of clinically diagnosed systemic lupus erythematosus 1992-1998 using the UK General Practice Research Database. Pharmacoepidemiol Drug Saf. Sep 2006;15(9):656-661. 

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The incidence and presentation of systemic lupus erythematosus (SLE) in UK primary care using the UK Clinical Practice Research Datalink (CPRD)

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