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Vol. 6. Issue 1.
Pages 11-15 (January - February 2010)
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Vol. 6. Issue 1.
Pages 11-15 (January - February 2010)
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Damage in Cuban patients with systemic lupus erythematosus. Relation with disease features
Daño en pacientes cubanos con lupus eritematoso sistémico. Relación con características de la enfermedad
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Miguel Estévez del Toro
Corresponding author
mestevez@infomed.sld.cu

Corresponding author.
, Araceli Chico Capote, Rafael Hechavarría, Rosa Jiménez Paneque, Elena Kokuina
Servicio de Reumatología, Hospital Hermanos Ameijeiras, Havana City, Cuba
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Article information
Abstract
Objective

To determine damage presence and predictors factors for its appearance in a cohort of Cuban patients with systemic lupus erythematosus (SLE).

Patients and methods

A retrospective cohort study included 80 patients presenting with SLE seen in Rheumatology Service of “Hermanos Ameijeiras” Clinical Surgical Hospital in Havana City, Cuba. Damage was assessed using The Systemic Lupus International Collaborating Clinics/American College of Rheumatology (ACR) Damage Index (SLIC/ACR), a tool approved for damage measurement. Damage presence was related to initial disease features to diagnose this condition, to sociodemographic elements, to treatments used, and to the disease course time. Statistical analysis had two variants: the univariate and multivariate type using Chi2 and statistical significance was established in P<.05.

Results

We found that 39 patients (48.8%) had some degree of damage. More involved domains were the musculoskeletal (18.8%), neuropsychiatric, and skin, 16.3%, pulmonary and ocular, present in 15% of cases. In the multivariate analysis, damage was associated with the use of higher than 30mg/day Prednisone doses for more of 4 weeks (OR=54.68, CI 95%=3.56–97.45, P=.001), presence of leukopenia (RO=18.73, CI 95%=2.74–62.23 m P=.004), and time course of disease (OR=1.02, CI 95%=1.00 2–1.09, P=.006).

Conclusions

Damage was practically present in half of the study patients, the most involved domain was the musculoskeletal, and use of higher than 30mg prednisone doses were the factor most associated with the presence of damage.

Keywords:
Systemic lupus erythematosus
Damage
Damage predictor
Resumen
Objetivo

Determinar la presencia de daño y factores predictores de su aparición en una cohorte de pacientes cubanos con lupus eritematoso sistémico (LES).

Pacientes y método

Se realizó un estudio de cohorte retrospectivo que incluyó a 80 pacientes con LES atendidos en el Servicio de Reumatología del Hospital Hermanos Ameijeiras en la ciudad de La Habana, Cuba. El daño fue determinado aplicando el Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index. La presencia de daño se relacionó con las características iniciales de la enfermedad al diagnóstico, con elementos sociodemográficos, con los tratamientos utilizados y con el tiempo de evolución de la enfermedad. El análisis estadístico incluyó estudios univariante y multivariado, y se utilizó el test de Chi-cuadrado (la significación estadística se fijó en p=0,05).

Resultados

Encontramos que 39 pacientes (48,8%) tenían algún grado de daño. Los dominios más afectados fueron el músculo esquelético (18,8%), el neuropsiquiátrico y la piel, ambos con un 16,3%. En el análisis multivariado el daño se asoció con la utilización de dosis de prednisona mayores de 30mg diarios por más de cuatro semanas (OR = 54,68; IC 95%: 3,56–97,45; p=0,001), presencia de leucopenia (OR = 18,73; IC 95%: 2,74–62,23; p=0,004) y el tiempo mayor de evolución de la enfermedad (OR = 1,02; IC 95%:1,002–1,09; p=0,006).

Conclusiones

El daño estuvo presente prácticamente en la mitad de los pacientes estudiados, el dominio más afectado fue el musculoesquelético y la utilización de dosis mayores a 30mg de prednisona fue el factor más asociado con la presencia de daño.

Palabras clave:
Lupus eritematoso sistémico
Daño
Predictor de daño
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References
[1.]
S. Bernatzky, F. Boivin, L. Joseph.
Mortality in systemic lupus erythematosus.
Arthritis Rheum, 54 (2006), pp. 2550-2557
[2.]
C.C. Mok, A. Mak, W.P. Chu, C.H. To, S.N. Wong.
Long-term survival of southern Chinese patients with systemic lupus erythematosus: A prospective study of all agegroups.
Medicine (Baltimore), 84 (2005), pp. 218-224
[3.]
A. Doria, L. Iaccarino, A. Ghirardello, S. Zampieri, S. Arienti, P. Sarzi-Puttini, et al.
Longterm prognosis and causes of death in systemic lupus erythematosus.
Am J Med, 119 (2006), pp. 700-706
[4.]
R. Cervera, M.A. Khamashta, J. Font.
Morbidity and mortality in systemic lupus erythematosus during a 10-year period: A comparison of early and late manifestation in a cohort of 1000 patients.
[5.]
D. Gladman, E. Ginzler, C. Glodsmith, P. Fortin, M. Liang, M. Urowitz, et al.
The development and initial validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index for systemic lupus erythematosus.
Arthritis Rheum, 39 (1996), pp. 363-369
[6.]
R. Goldstein, D.P. Sengar.
Comparative studies of the major histocompatibility complex in French Canadian and non-French Canadian Caucasians with systemic lupus erythematosus.
Arthritis Rheum, 36 (1993), pp. 1121-1127
[7.]
P.S. Gulko, J.D. Reveille, W.J. Koopman, S.L. Burgard, A.A. Bartolucci, G.S. Alarcon.
Anticardiolipin antibodies in systemic lupus erythematosus: Clinical correlates, HLA associations, and impact on survival.
J Rheumatol, 20 (1993), pp. 1684-1693
[8.]
E.W. Karlson, L.H. Daltroy, R.A. Lew.
The independence and stability of socioeconomic predictors of morbidity in systemic lupus erythematosus.
Arthritis Rheum, 38 (1995), pp. 267-273
[9.]
E.W. Karlson, L.H. Daltroy, R.A. Lew.
The relationship of socioeconomic status, race, and modifiable risk factors to outcomes in patients with systemic lupus erythematosus.
Arthritis Rheum, 40 (1997), pp. 47-56
[10.]
M.H. Liang, M. Rogers, M. Larson.
The psychosocial impact of systemic lupus erythematosus and rheumatoid arthritis.
Arthritis Rheum, 27 (1984), pp. 13-19
[11.]
M. Petri, S. Pérez-Gutthann, J.C. Longenecker, M. Hochberg.
Morbidity of systemic lupus erythematosus: Role of race and socioeconomic status.
Am J Med, 91 (1991), pp. 345-353
[12.]
J.D. Reveille, A. Bartolucci, G.S. Alarcón.
Prognosis in systemic lupus erythematosus. Negative impact of increasing age at onset, black race, and thrombocytopenia, as well as causes of death.
Arthritis Rheum, 33 (1990), pp. 37-48
[13.]
S. Studenski, N.B. Allen, D.S. Caldwell, J.R. Rice, R.P. Polisson.
Survival in systemic lupus erythematosus. A multivariate analysis of demographic factors.
Arthritis Rheum, 30 (1987), pp. 1326-1332
[14.]
M.K. Serdula, G.G. Rhoads.
Frequency of systemic lupus erythematosus in different ethnic groups in Hawaii.
Arthritis Rheum, 22 (1979), pp. 328-333
[15.]
S.J. Walsh, C. Algert, D.I. Gregorio, S.T. Reisine, N.F. Roth.
Divergent racial trends in mortality from systemic lupus erythematosus.
J Rheumatol, 22 (1995), pp. 1663-1668
[16.]
N. Sutcliffe, A.E. Clarke, C. Gordon, V. Farewell, D.A. Isenberg.
The association of socioeconomic status, race, psychosocial factors and outcome in patients with systemic lupus erythematosus.
Rheumatology (Oxford), 38 (1999), pp. 1130-1137
[17.]
J. Calvo-Alén, J.D. Reveille, V. Rodríguez Valverde, G. McGwin, B.A. Baethge, A.W. Friedman, et al.
Clinical, immunogenetic and outcome features of Hispanic systemic lupus erythematosus patients of different ethnic ancestry.
Lupus, 12 (2003), pp. 377-385
[18.]
T. Stoll, B. Seifert, D.A. Isenberg.
SLICC/ACR Damage Index is valid and renal and pulmonary organ scores are predictors of severe outcome in patients with systemic lupus erythematosus.
Br J Rheumatol, 35 (1996), pp. 248-254
[19.]
P. Rahman, D.D. Gladman, M.B. Urowitz, D. Hallett, L.S. Tam.
Early damage as measured by the SLICC/ACR damage index is a predictor of mortality in systemic lupus erythematosus.
Lupus, 10 (2001), pp. 93-96
[20.]
D.D. Gladman, C.H. Goldsmith, M.B. Urowitz.
The Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index for systemic lupus international comparison.
J Rheumatol, 27 (2000), pp. 373-376
[21.]
E.M. Tan, A.S. Cohen, J.F. Fries.
The 1982 revised criteria for the classification of systemic lupus erythematosus.
Arthritis Rheum, 25 (1982), pp. 1271-1277
[22.]
G.S. Alarcón, G. McGwin, H.M. Bastian.
Systemic lupus erythematosus in the three ethnic groups: VII. Predictors of early mortality in the LUMINA cohort.
Arthritis Care Res, 45 (2001), pp. 191-202
[23.]
C.A. Pineau, S. Bernatsky, M. Abrahamowicz, C. Neville, I. Karp, A.E. Clarke.
A comparison of damage accrual across different calendar periods in systemic lupus erythematosus patients.
Lupus, 15 (2006), pp. 390-394
[24.]
Y.K. Sung, N.W. Hur, J.L. Sinskey, D. Park, S.C. Bae.
Assessment of damage in Korean patients with systemic lupus erythematosus.
J Rheumatol, 34 (2007), pp. 987-991
[25.]
C.S. Yee, H. Hussein, J. Skan, S. Bowman, D. Situnayake, C. Gordon.
Association of damage with autoantibody profile, age, race, sex, and disease duration in systemic lupus erythematosus.
Rheumatology, 42 (2003), pp. 276-279
[26.]
A. Becker–Merok, H.C. Nossent.
Damage accumulation in systemic lupus erythematosus and its relation to disease activity and mortality.
J Rheumatol, 33 (2006), pp. 1570-1577
[27.]
C. Rivest, R.A. Lew, P.M. Welsing, O. Sangha, E.A. Wright, W.N. Roberts, et al.
Association between clinical factors, socioeconomic status and organ damage in recent onset systemic lupus erythematosus.
J Rheumatol, 27 (2000), pp. 680-684
[28.]
J. Guarize, S. Appenzeller, L.T. Costallat.
Skin damage occurs early in systemic lupus erythematosus and independently of disease duration in Brazilian patients.
Rheumatol Int, 27 (2007), pp. 483-487
[29.]
A. Zonana-Nacach, A. Camargo-Coronel, P. Yáñez.
Measurement of damage in 210 Mexican patients with systemic lupus erythematosus: Relationship with disease duration.
Lupus, 7 (1988), pp. 119-123
[30.]
H.I. Brunner, E.D. Silverman, T. To, C. Bombardier, B.M. Feldman.
Risk factors for damage in chiildhood-onset systemic lupus erythematosus: cumulative disease activity and medication use predicts disease damage.
Arthritis Rheum, 46 (2002), pp. 436-444
[31.]
D.D. Gladman, M.B. Urowitz, P. Rahman, D. Ibáñez, L.S. Tan.
Accrual of organ damage over time in patients with systemic lupus erythematosus.
J Rheumatol, 30 (2003), pp. 1955-1959
[32.]
P. Maddison, V. Farewell, D. Iseberg.
The rate and pattern of organ damage in late onset systemic lupus erythematosus.
J Rheumatol, 29 (2002), pp. 913-917
[33.]
Thumboo, K.-Y. Fong, S.-P. Chan.
A prospective study of factors affecting quality of life in systemic lupus erythematosus.
J Rheumatol, 27 (2000), pp. 1414-1420
[34.]
M.V.S. Santana, C.S.H. Minami, R.M.M. Ramalho, J.C.M. Szajubok, N.C. Araujo, W.H. Chahade.
Aspectos clínicos de pacientes com lupicos com duraçao de doença maior que dez anos: Avaliaçao preliminary.
Rev Bras Reumatol, 42 (2002), pp. S87
[35.]
E.M.C. Sella, E.A. Silava, E.I. Sato.
Avaliação do índice de danos permanentes pelo Systemic Lupus International Collaborating Clinics/American Collegue of Rheumatology Damage Index for systemic lupus erythematosus 112 pacientes.
Rev Bras Reumatol, 42 (2002), pp. S89
[36.]
M. Soares, L. Reis, J.A.S. Papi, C.R.L. Cardoso.
Rate, pattern and factors related do damage in Brazilian systemic lupus erythematosus patients.
Lupus, 12 (2003), pp. 788-794
[37.]
G. Cassano, S. Roverano, S. Paira, V. Bellomio, E. Lucero, A. Berman, et al.
Accrual of organ damage over time in Argentine patients with systemic lupus erythematosus: A multi- centre study.
Clin Rheumatol, 26 (2007), pp. 2017-2022
[38.]
R. Watson.
Cutaneous lesions in systemic lupus erythematosus.
Med Clin North Am, 73 (1989), pp. 1091-1111
[39.]
M.C. Bezerra, M.C. Saraiva, E.F. Borba, C.R. Gonçalves, E. Bonfa.
Dano precoce no lupus eritematoso sistemico-associado a atividade de doença ou a terapeutica?.
Rev Bras Reumatol, 42 (2002), pp. S103
[40.]
G.M. Mody, K.B. Parag, B.C. Nathoo, D.J. Pudifin, J. Duursma, Y.K. Sedat.
High mortality with systemic lupus eythematosus in hospitalised African blacks.
Br J Rheumatol, 33 (1994), pp. 1151-1153
[41.]
O. Nived, A. Josent, A.A. Bengtsson, C. Bengtsson, G. Sturfelt.
High predictive value of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index for survival in systemic lupus erythematosus.
J Rheumatol, 29 (2002), pp. 1398-1400
[42.]
C.H. To, M. Petri.
Is antibody clustering predictive of clinical subsets and damage in systemic lupus erythematosus?.
Arthritis Rheum, 52 (2005), pp. 4003-4010
[43.]
J. Mikdashi, A. Krumholz, B. Handwerger.
Factors at diagnosis predict subsequent occurrence of seizures in systemic lupus erythematosus.
[44.]
A. Zonana Nacach, S.G. Barr, L.S. Magder, M. Petri.
Damage in systemic lupus erythematosus and its association with corticosteroids.
Arthritis Rheum, 45 (2000), pp. 1801-1808
[45.]
G.S. Alarcón, J.R. McGwin, A.A. Bartolucci, J. Roseman, J. Lisse, B.J. Fresler, et al.
Systemic lupus erythematosus in three ethnic groups. IX. Differences in damage accrual.
Arthritis Rheum, 44 (2001), pp. 2797-2806
[46.]
M. Petri.
Hydroxychloroquine prevents later damage in SLE.
Arthritis Rheum, 44 (2001), pp. S247
[47.]
Y. Molad, A. Gorshtein, A.J. Wysenbeek.
Protective effect of hydroxychloroquinein in systemic lupus erythematosus. Prospective long-term study of an Israeli cohort.
Lupus, 11 (2002), pp. 356-361
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