Contribution of the disease and its therapy on the SLICC/ACR-DI in early systemic lupus erythematosus
Contribution of the disease and its therapy on the SLICC/ACR-DI in early systemic lupus erythematosus
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DOI：
10.1590/s0482-50042004000200004
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发表时间：
2004-04-01
影响因子：
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通讯作者：
Bonfá, Eloisa
中科院分区：
文献类型：
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作者：
Bezerra, Mailze Campos;Silva Júnior, Francisco Saraiva da;Bonfá, Eloisa
未贴标：关于系统性红斑狼疮（SLE）患者病程的大部分信息仅限于疾病发作后的前五年。目的：描述SLE患者早期损害的转归，并鉴别疾病本身或治疗的影响是其损害的主要原因。在所有患者中，系统性狼疮国际合作诊所/美国流变学学院损伤指数（SLICC/ACR-DI）在诊断时进行评分，并在接下来的三年中每年进行评分。在每次访视时评估临床表现以及治疗。SLICC/ACR-DI评分为每个器官系统和器官系统内的损害的患病率进行了评估，以及其可能的主要原因（疾病或治疗）。大多数患者（94%）表现为皮肤和关节受累，40%为肾脏，28%为肺部，18%为神经系统表现。研究结束时，52例（63.4%）患者的SLICC评分无损伤。其余30例患者中，16例评分为1分，14例评分= 2分。总共发生了36起损害，其中23起归因于疾病，13起归因于治疗（64%比36%; p < 0.05）。最常见的损伤系统是关节和神经系统（27.7%），其次是肾系统（13.8%）。所有神经系统受累的患者尽管进行了积极的治疗，但由于疾病本身而导致早期损伤，而在10例关节损伤患者中，70%（7例）与类固醇治疗（骨坏死）相关。相比之下，13.8%的患者观察到过早的肾损伤，所有患者均为无反应的重度肾炎。其他不良反应的治疗包括1心绞痛，2白内障，1糖尿病和2过早menopauses.CONCLUSIONS：这项研究表明，早期损害仍然是一个主要问题，在SLE，加强了新的战略，以尽量减少损伤，特别是神经系统的表现。此外，使用类固醇保留剂减少皮质类固醇治疗引起的发病率似乎也很重要。
UNLABELLED: The majority of the information available about the disease course of patients with systemic lupus erythematosus (SLE) is restricted to the first five years after disease onset. However, data about early damage were rarely reported.OBJECTIVE: to describe the early damage outcome of SLE patients in early disease and to discriminate the influence of disease itself or its therapy as the main cause of their damage.METHODS: we retrospectively studied 82 patients with SLE, diagnosed during the period from 1998 to 1999 in our institution. In all patients the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR-DI) was scored at the diagnosis and annually for the next three years. Clinical manifestations were evaluated at each visit as well as the therapy. The SLICC/ACR-DI scores for each organ system and the prevalence of damage within organ systems were assessed, as well as its possible main cause (disease or therapy).RESULTS: the mean age at entry was 31.6 years with female predominance of 94%. The majority of the patients (94%) presented cutaneous and articular involvement, 40% renal, 28% pulmonary, and 18% neurological manifestations. At the end of the study, 52 (63.4%) patients had no damage to score with SLICC. From the remaining 30 patients, 16 had a score of 1 and 14 had a score = 2. In total, 36 damages occurred, 23 of them attributed to the disease and 13 to the therapy (64% vs. 36%; p < 0.05). The most frequently injured systems were the articular and the neurological (27.7%) ones, followed by the renal (13.8%) system. All patients with neurological involvement have early damage due to the disease itself in spite of the aggressive therapeutic whereas from 10 patients with articular damage, 70% (7) were associated with steroid therapy (osteonecrosis). In contrast, premature renal injury was observed in 13.8%, all of them with unresponsive severe nephritis. Other adverse effect of therapy included 1 angina, 2 cataracts, 1 diabetes and 2 premature menopauses.CONCLUSIONS: this study suggests that early damage is still a major problem in SLE that reinforces the need for new strategies in order to minimize injury, particularly for neurological manifestations. Moreover, it also seems important to reduce morbidity induced by corticosteroid therapy with the use of steroid-sparing agents.