Abstract
A Danish multicentre study was undertaken of the manifestations, infections, thrombotic events, survival and predictive factors of survival in 513 Danish patients with systemic lupus erythematosus (SLE) according to the 1982 classification criteria of the American College of Rheumatology. The mean duration of follow-up was 8.2 years from diagnosis and 12.8 years from first symptom. This paper describes the most common clinical and laboratory manifestations and their relationship to sex and age at the time of onset and diagnosis. Cluster analysis revealed three clinically defined clusters at the time of disease onset. Cluster 1 (57% of patients) consisted of relatively elderly patients without nephropathy or malar rash, but with a high prevalence of discoid lesions. Cluster 2 (18%) consisted of patients with nephropathy, a third of whom also developed serositis and lymphopenia. The patients of the third cluster (25%) all had malar rash and half were photosensitive. Follow-up showed that the patients of cluster 2 developed azotaemia, large proteinuria, arterial hypertension and myositis significantly more often than did the rest of the patients, but the mortality was not increased. The risk of developing renal end-stage disease was highest in men with early-onset disease.
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Tan EM, Cohen AS, Fries JF. The 1982 revised criteria for the classification of systemic lupus erythematosus (SLE). Arthritis Rheum 1982;25:1271–7.
Halberg P, Alsbjørn B, Balsløv JT, et al. Systemic lupus erythematosus: follow-up study of 148 patients. I: Classification, clinical and laboratory findings, course and outcome. Clin Rheumatol 1987;6:13–21.
Abu-Shakra M, Urowitz MB, Gladman DD, Gough J. Mortality studies in systemic lupus erythematosus. Results from a single center. I. Causes of death. J Rheumatol 1995;22:1259–64.
Antolin J, Amerigo MJ, Cantabrana A, Roces A, Jiminez P. Systemic lupus erythematosus: clinical manifestations and immunological parameters in 194 patients. Subgroup of classification. Clin Rheumatol 1995;14:678–85.
Ward MM, Studenski S. Age-associated clinical manifestations of systemic lupus erythematosus: a multivariate regression analysis. J Rheumatol 1990;17:476–81.
Voss A, Green A, Junker P. Systemic lupus erythematosus in Denmark: clinical and epidemiological characterization of a county-based cohort. Scand J Rheumatol 1998;27:98–105.
Humbel RL. Detection of antinuclear antibodies by immunofluorescence. In: van Venroij, Maini RN, editors. Manual of biological markers of disease — A2. Dordrecht: Kluwer Academic. 1993:1–16.
Dean AG, Dean JA, Coulombier D, et al. Epi Info, Version 6: a word processing, database, and statistics program for epidemiology on microcomputers. Atlanta, Georgia, USA: Centers for Disease Control and Prevention, 1994.
SYSSTAT 5.04 for Windows. Evanston, Illinois: SYSSTAT Inc., 1994.
Reveille JD, Bartolucci A, Alarcón GS. Prognosis in systemic lupus erythematosus. Negative impact of increasing age at onset, black race, and thrombocytopenia, as well as causes of death. Arthritis Rheum 1990;33:37–48.
Ward MM, Studenski S. Systemic lupus erythematosus in men: a multivariate analysis of gender differences in clinical manifestations. J Rheumatol 1990;17:220–4.
Bokemeyer B, Thiele KG. Cluster analysis of 109 patients with systemic lupus erythematosus. Klin Wochenschr 1985;63:79–83.
Sedzimirska M, Jacak A, Laba C, Klimczak A, Lange A. Variants of SLE—a statistical approach for discrimination of a group of SLE cases into different subgroups sharing symptomatology. A pilot study. Arch Immunol Ther Exp (Warsz) 1991;39:397–404.
Clarke AE, Bloch DA, Danoff DS, Esdaile JM. Decreasing costs and improving outcomes in systemic lupus erythematosus: using regression trees to develop health policy. J Rheumatol 1994; 21:2246–53.
Jacobsen S, Petersen J, Ullman S, et al. A multicentre study of 513 Danish patients with systemic lupus erythematosus. II: Mortality and clinical factors of prognostic value. Clin Rheumatol 1998;17:478–84
Hay E, Croft P. Predicting outcome in current clinic attenders: a biased view. Ann Rheum Dis 1994;53:357–8.
Cervera R, Khamasthta MA, Font J, et al. Systemic lupus erythematosus: clinical and immunological patterns of disease expression in a cohort of 1000 patients. Medicine 1993;72:113–24.
Vitali C, Bencivelli W, Isenberg DA, et al. Disease activity in systemic lupus erythematosus: report of the Consensus Study Group of the European Workshop for Rheumatology Research. I. A descriptive analysis of 704 European lupus patients. Clin Exp Rheumatol 1992;10:527–39.
Jonsson H, Nived O, Sturfelt G. Outcome in systemic lupus erythematosus: a prospective study of patients from a defined population. Medicine 1989;68:141–50.
Ginzler EM, Felson DT, Anthony JM, Anderson JJ. Hypertension increases the risk of renal deterioration in systemic lupus erythematosus. J Rheumatol 1993;20:1694–700.
Swaak AJG, Nossent JC, Bronsweld W, et al. Systemic lupus erythematosus. I. Outcome and survival: Dutch experience with 110 patients studied prospectively. Ann Rheum Dis 1989;48:447–54.
Ward MM, Polisson RP. A meta-analysis of the clinical manifestations of older-onset systemic lupus erythematosus. Arthritis Rheum 1989;32:1226–32.
Hashimoto H, Tsuda H, Hirano T, Takasaki Y, Matsumoto T, Hirose S. Differences in clinical and immunological findings of systemic lupus erythematosus related to age. J Rheumatol 1987;14:497–501.
Miller MH, Urowitz MB, Gladman DD, Killinger DW. Systemic lupus erythematosus in males. Medicine (Baltimore) 1983; 62:327–34.
Blum A, Rubinow A, Galun E. Predominance of renal involvement in male patients with systemic lupus erythematosus. Clin Exp Rheumatol 1991;9:206–7.
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Jacobsen, S., Petersen, J., Ullman, S. et al. A multicentre study of 513 Danish patients with systemic lupus erythematosus. I. Disease manifestations and analyses of clinical subsets. Clin Rheumatol 17, 468–477 (1998). https://doi.org/10.1007/BF01451282
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DOI: https://doi.org/10.1007/BF01451282