Skip to main content

Advertisement

SpringerLink
Log in

Flares in Chinese systemic lupus erythematosus patients: a 6-year follow-up study

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

This study determined the flare status of SLE patients in a single-center Chinese cohort and identified the predictors of flare in this underreported Asian population. The patients were recruited from April 2009 to February 2010 at the Peking Union Medical College Hospital (PUMCH), and then followed up regularly at our clinic until December 2015. Flare was defined as an increase in SLEDAI-2K to ≥ 4 points from the previous visit, or appearing of a new SLE manifestation or worsening of a preexisting clinical or hematological manifestation (not included in SLEDAI-2K) that results in restarting or increasing corticosteroids or immunosuppressant. Baseline and follow-up data were collected, and some of them were used as variables in survival analysis for time-to-flare outcome with Kaplan-Meier survival analysis and log-rank tests. Potential predictors with significant differences were further included in a multivariate Cox regression model for confounders adjustment and hazard ratio (HR) calculation. A total of 254 patients were finally included in our analysis. Yearly flare proportion rate was 13.0–15.7%. Renal, hematologic, and neurologic were the most frequently involved organs. Multivariate analysis confirmed onset age up to 18 years (HR 2.14, 95% CI 1.09–4.19) as a flare predictor. Organ damage at entry also showed an association trend with flare (HR = 1.693, 95% CI 0.943 ~ 3.041, p = 0.078). Chinese SLE patients showed a higher prevalence for disease flare compared with other ethnics. Future studies should be designed for figuring out the prediction role of fluctuation of anti-dsDNA antibody for disease flare.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bandeira M, Buratti S, Bartoli M, Gasparini C, Breda L, Pistorio A, Grassi S, Alpigiani MG, Barbano G, Janz-Junior LL, Martini A, Ravelli A (2006) Relationship between damage accrual, disease flares and cumulative drug therapies in juvenile-onset systemic lupus erythematosus. Lupus 15(8):515–520. https://doi.org/10.1191/0961203306lu2316oa

    Article  CAS  PubMed  Google Scholar 

  2. Conti F, Ceccarelli F, Perricone C, Leccese I, Massaro L, Pacucci VA, Truglia S, Miranda F, Spinelli FR, Alessandri C, Valesini G (2016) The chronic damage in systemic lupus erythematosus is driven by flares, glucocorticoids and antiphospholipid antibodies: results from a monocentric cohort. Lupus 25(7):719–726. https://doi.org/10.1177/0961203315627199

    Article  CAS  PubMed  Google Scholar 

  3. Ugarte-Gil MF, Acevedo-Vasquez E, Alarcon GS, Pastor-Asurza CA, Alfaro-Lozano JL, Cucho-Venegas JM, Segami MI, Wojdyla D, Soriano ER, Drenkard C, Brenol JC, de Oliveira E Silva Montandon AC, Costallat LT, Massardo L, Molina-Restrepo JF, Guibert-Toledano M, Silveira LH, Amigo MC, Barile-Fabris LA, Chacon-Diaz R, Esteva-Spinetti MH, Pons-Estel GJ, McGwin G Jr, Pons-Estel BA (2015) The number of flares patients experience impacts on damage accrual in systemic lupus erythematosus: data from a multiethnic Latin American cohort. Ann Rheum Dis 74(6):1019–1023. https://doi.org/10.1136/annrheumdis-2013-204620

    Article  CAS  PubMed  Google Scholar 

  4. Doria A, Rinaldi S, Ermani M, Salaffi F, Iaccarino L, Ghirardello A, Zampieri S, Della Libera S, Perini G, Todesco S (2004) Health-related quality of life in Italian patients with systemic lupus erythematosus. II. Role of clinical, immunological and psychological determinants. Rheumatology (Oxford) 43(12):1580–1586. https://doi.org/10.1093/rheumatology/keh392

    Article  CAS  Google Scholar 

  5. Doria A, Amoura Z, Cervera R, Khamastha MA, Schneider M, Richter J, Guillemin F, Kobelt G, Maurel F, Garofano A, Perna A, Murray M, Schmitt C, Boucot I (2014) Annual direct medical cost of active systemic lupus erythematosus in five European countries. Ann Rheum Dis 73(1):154–160. https://doi.org/10.1136/annrheumdis-2012-202443

    Article  PubMed  Google Scholar 

  6. Doria A, Iaccarino L, La Montagna G, Mathieu A, Piga M, Galeazzi M, Iuliano A, Maurel FB, Garofano AM, Perna AG, Porcasi RE (2015) Clinical profile and direct medical cost of care of adults presenting with systemic lupus erythematosus in Italy. Clin Exp Rheumatol 33(3):375–384

    PubMed  Google Scholar 

  7. Lee J, Dhillon N, Pope J (2013) All-cause hospitalizations in systemic lupus erythematosus from a large Canadian referral centre. Rheumatology (Oxford) 52(5):905–909. https://doi.org/10.1093/rheumatology/kes391

    Article  Google Scholar 

  8. Conti F, Ceccarelli F, Perricone C, Miranda F, Truglia S, Massaro L, Pacucci VA, Conti V, Bartosiewicz I, Spinelli FR, Alessandri C, Valesini G (2012) Flare, persistently active disease, and serologically active clinically quiescent disease in systemic lupus erythematosus: a 2-year follow-up study. PLoS One 7(9):e45934. https://doi.org/10.1371/journal.pone.0045934

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Floris A, Piga M, Cauli A, Mathieu A (2016) Predictors of flares in systemic lupus erythematosus: preventive therapeutic intervention based on serial anti-dsDNA antibodies assessment. Analysis of a monocentric cohort and literature review. Autoimmun Rev 15(7):656–663. https://doi.org/10.1016/j.autrev.2016.02.019

    Article  CAS  PubMed  Google Scholar 

  10. Ines L, Duarte C, Silva RS, Teixeira AS, Fonseca FP, da Silva JA (2014) Identification of clinical predictors of flare in systemic lupus erythematosus patients: a 24-month prospective cohort study. Rheumatology (Oxford) 53(1):85–89. https://doi.org/10.1093/rheumatology/ket322

    Article  Google Scholar 

  11. Laustrup H, Voss A, Green A, Junker P (2010) SLE disease patterns in a Danish population-based lupus cohort: an 8-year prospective study. Lupus 19(3):239–246. https://doi.org/10.1177/0961203309351033

    Article  CAS  PubMed  Google Scholar 

  12. Nikpour M, Urowitz MB, Ibanez D, Gladman DD (2009) Frequency and determinants of flare and persistently active disease in systemic lupus erythematosus. Arthritis Rheum 61(9):1152–1158. https://doi.org/10.1002/art.24741

    Article  PubMed  Google Scholar 

  13. Steiman AJ, Gladman DD, Ibanez D, Urowitz MB (2012) Outcomes in patients with systemic lupus erythematosus with and without a prolonged serologically active clinically quiescent period. Arthritis Care Res 64(4):511–518. https://doi.org/10.1002/acr.21568

    Article  Google Scholar 

  14. Conti F, Ceccarelli F, Perricone C, Massaro L, Spinelli FR, Valesini G (2010) Low incidence of flare and persistent active disease in a cohort of Italian patients with systemic lupus erythematosus: comment on the article by Nikpour et al. Arthritis Care Res 62(6):899–900; author reply 900. https://doi.org/10.1002/acr.20145

    Article  Google Scholar 

  15. Li M, Zhang W, Leng X, Li Z, Ye Z, Li C, Li X, Zhu P, Wang Z, Zheng Y, Li X, Zhang M, Zhang F, Zhao Y, Zeng X (2013) Chinese SLE treatment and research group (CSTAR) registry: I. Major clinical characteristics of Chinese patients with systemic lupus erythematosus. Lupus 22(11):1192–1199. https://doi.org/10.1177/0961203313499086

    Article  CAS  PubMed  Google Scholar 

  16. Cervera R, Doria A, Amoura Z, Khamashta M, Schneider M, Guillemin F, Maurel F, Garofano A, Roset M, Perna A, Murray M, Schmitt C, Boucot I (2014) Patterns of systemic lupus erythematosus expression in Europe. Autoimmun Rev 13(6):621–629. https://doi.org/10.1016/j.autrev.2013.11.007

    Article  CAS  PubMed  Google Scholar 

  17. Mirzayan MJ, Schmidt RE, Witte T (2000) Prognostic parameters for flare in systemic lupus erythematosus. Rheumatology (Oxford) 39(12):1316–1319

    Article  CAS  Google Scholar 

  18. Petri M, Genovese M, Engle E, Hochberg M (1991) Definition, incidence, and clinical description of flare in systemic lupus erythematosus. A prospective cohort study. Arthritis Rheum 34(8):937–944

    Article  CAS  PubMed  Google Scholar 

  19. Petri M, Singh S, Tesfasyone H, Malik A (2009) Prevalence of flare and influence of demographic and serologic factors on flare risk in systemic lupus erythematosus: a prospective study. J Rheumatol 36(11):2476–2480. https://doi.org/10.3899/jrheum.090019

    Article  PubMed  Google Scholar 

  20. van den Berg L, Nossent H, Rekvig O (2006) Prior anti-dsDNA antibody status does not predict later disease manifestations in systemic lupus erythematosus. Clin Rheumatol 25(3):347–352. https://doi.org/10.1007/s10067-005-0047-7

    Article  PubMed  Google Scholar 

  21. Ibanez D, Gladman DD, Urowitz MB (2005) Adjusted mean Systemic Lupus Erythematosus Disease Activity Index-2K is a predictor of outcome in SLE. J Rheumatol 32(5):824–827

    PubMed  Google Scholar 

  22. Wu CY, Li CF, Wu QJ, Xu JH, Jiang LD, Gong L, Wu FQ, Gu JR, Zhao JL, Li MT, Zhao Y, Zeng XF (2017) Chinese systemic lupus erythematosus treatment and research group registry IX: clinical features and survival of childhood-onset systemic lupus erythematosus in China. Chin Med J 130(11):1276–1282. https://doi.org/10.4103/0366-6999.206346

    Article  PubMed  PubMed Central  Google Scholar 

  23. Brunner HI, Gladman DD, Ibanez D, Urowitz MD, Silverman ED (2008) Difference in disease features between childhood-onset and adult-onset systemic lupus erythematosus. Arthritis Rheum 58(2):556–562. https://doi.org/10.1002/art.23204

    Article  PubMed  Google Scholar 

  24. Hoffman IE, Lauwerys BR, De Keyser F, Huizinga TW, Isenberg D, Cebecauer L, Dehoorne J, Joos R, Hendrickx G, Houssiau F, Elewaut D (2009) Juvenile-onset systemic lupus erythematosus: different clinical and serological pattern than adult-onset systemic lupus erythematosus. Ann Rheum Dis 68(3):412–415. https://doi.org/10.1136/ard.2008.094813

    Article  CAS  PubMed  Google Scholar 

  25. Livingston B, Bonner A, Pope J (2011) Differences in clinical manifestations between childhood-onset lupus and adult-onset lupus: a meta-analysis. Lupus 20(13):1345–1355. https://doi.org/10.1177/0961203311416694

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This study was supported by the Chinese National Key Technology R&D Program, Ministry of Science and Technology (2017YFC0907601, 2017YFC0907602, 2017YFC0907603 2008BAI59B02), the Chinese National High Technology Research and Development Program, Ministry of Science and Technology (2012AA02A513).

Author information

Author notes

  1. Liying Peng, Ziqian Wang, and Mengtao Li contributed equally to this study.

Authors and Affiliations

  1. Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Beijing, 100730, China

    Liying Peng, Ziqian Wang, Mengtao Li, Dong Xu, Qian Wang, Shangzhu Zhang, Jiuliang Zhao, Xinping Tian & Xiaofeng Zeng

  2. Department of Epidemiology and Bio-statistics (YW), Institute of Basic Medical Science, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100005, China

    Yanhong Wang

Authors
  1. Liying Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ziqian Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mengtao Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yanhong Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dong Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Qian Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shangzhu Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jiuliang Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Xinping Tian
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Xiaofeng Zeng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Mengtao Li or Xiaofeng Zeng.

Ethics declarations

This study was approved by the Ethics Committee of PUMCH, Chinese Academy of Medical Sciences (Approval number, S-197), and an informed consent form was obtained from all participants at the inclusion of new participants.

Disclosures

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Peng, L., Wang, Z., Li, M. et al. Flares in Chinese systemic lupus erythematosus patients: a 6-year follow-up study. Clin Rheumatol 36, 2727–2732 (2017). https://doi.org/10.1007/s10067-017-3842-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-017-3842-z

Keywords

Search

Navigation