DEFINITION, INCIDENCE, AND CLINICAL DESCRIPTION OF FLARE IN SYSTEMIC LUPUS-ERYTHEMATOSUS - A PROSPECTIVE COHORT STUDY
DEFINITION, INCIDENCE, AND CLINICAL DESCRIPTION OF FLARE IN SYSTEMIC LUPUS-ERYTHEMATOSUS - A PROSPECTIVE COHORT STUDY
复制标题
DOI：
10.1002/art.1780340802
复制
发表时间：
1991-08-01
影响因子：
--
通讯作者：
HOCHBERG, M
中科院分区：
文献类型：
--
作者：
PETRI, M;GENOVESE, M;HOCHBERG, M
系统性红斑狼疮 (SLE) 病程的特点是疾病活动的恶化（或发作）和缓解。作为正在进行的前瞻性队列研究的一部分，自 1987 年以来至少每季度记录 185 名 SLE 患者的 3 种疾病活动指数、医生的总体评估、狼疮活动指数和多伦多大学 SLE 疾病活动指数。我们制定了 SLE 发作的定义及其临床流行病学的描述。疾病爆发被定义为医生对疾病活动的总体评估（以 0-3 等级衡量）与上次就诊或过去 93 天内的就诊相比变化大于或等于 1.0。在 185 名患者中，98 名（53%）有大于或等于 1 次耀斑；发作总数为 146 次。随访中每患者年的发作发生率为 0.65 例。从第一次研究访视到发作的中位时间为 12 个月。耀斑通常以全身症状、肌肉骨骼受累、皮肤受累以及 C3 和 C4 水平下降为特征。在发作时，多伦多大学 SLE 疾病活动指数平均得分增加了 3.0，狼疮活动指数平均得分（经过修改以忽略医生的整体评估）增加了 0.26。总体而言，44.8% 的耀斑促使治疗方法发生变化。与没有发作的患者相比，经历发作的患者在进入研究时更符合 SLE 标准，并且在进入研究后随访时间更长。通过生存分析，没有发现进入时存在的特定临床或实验室变量可以预测首次发作的时间。这些数据表明，耀斑的量化是可能的，在患有长期系统性红斑狼疮的患者中，耀斑很常见，并且大多数耀斑涉及所谓的“次要”器官系统。
The course of systemic lupus erythematosus (SLE) is characterized by exacerbations (or flares) and remissions of disease activity. As part of an ongoing prospective cohort study, 3 disease activity indices, the physician's global assessment, the Lupus Activity Index, and the University of Toronto SLE Disease Activity Index, have been recorded, at least quarterly since 1987, on 185 SLE patients. We developed a definition of SLE flare and a description of its clinical epidemiology. Disease flare was defined as a change of greater-than-or-equal-to 1.0 in the physician's global assessment of disease activity (measured on a 0-3 scale) from the previous visit or from a visit within the last 93 days. Of the 185 patients, 98 (53%) had greater-than-or-equal-to 1 flare; the total number of flares was 146. The incidence of flare was 0.65 per patient-year of followup. The median time from the first study visit to a flare was 12 months. Flares were frequently characterized by constitutional symptoms, musculoskeletal involvement, cutaneous involvement, and decreasing levels of C3 and C4. At the time of flare, the mean University of Toronto SLE Disease Activity Index score increased by 3.0 and the mean Lupus Activity Index score (modified to omit the physician's global assessment) increased by 0.26. Overall, 44.8% of the flares prompted a change in treatment. Patients who experienced flares fulfilled more of the SLE criteria at entry and had been followed up for a longer duration after entry into the study, compared with those who did not have flares. By survival analysis, no specific clinical or laboratory variables present at entry were found to predict the time to first flare. These data show that quantification of flare is possible, flare is frequent in patients with SLE of long duration, and the majority of flares involve the so-called "minor" organ systems.