From Childhood to Adulthood: Disease Activity Trajectories in Childhood-Onset Systemic Lupus Erythematosus
From Childhood to Adulthood: Disease Activity Trajectories in Childhood-Onset Systemic Lupus Erythematosus
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DOI：
10.1002/acr.23319
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发表时间：
2018-05-01
影响因子：
4.7
通讯作者：
Silverman, Earl D.
中科院分区：
文献类型：
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作者：
Lim, Lily Siok Hoon;Pullenayegum, Eleanor;Silverman, Earl D.
Objective.以前没有研究儿童期发病的系统性红斑狼疮（cSLE）的纵向病程。我们的目标是评估cSLE患者疾病活动轨迹的可区分差异，确定预测疾病轨迹成员资格的基线因素，并评估不同的疾病活动轨迹是否与不同的损伤发生率相关。这是一项回顾性、纵向的cSLE患者初始队列研究。患者从儿童诊断开始一直随访到成年。SLE疾病活动被建模为一个潜在的特征，联合使用系统性红斑狼疮疾病活动指数2000和泼尼松在贝叶斯生长混合模型。基线因素进行了测试的潜在类别的疾病轨迹的成员资格预测。使用混合模型测试了不同疾病活动类别的损害轨迹差异。结果。共473例患者（82%为女性），诊断时的中位年龄为14.1岁。我们研究了11，992次访视（2，666患者年）。我们确定了5类疾病活动轨迹。基线主要器官受累、美国流变学学会标准的数量和诊断时的年龄预测了不同类别的成员资格。与五年级相比，二年级亚裔学生的比例更高。1级与最大的损伤累积相关，而5级与无显著损伤累积相关，即使在10年后。cSLE患者的疾病轨迹有5种不同的潜在类型。通过基线临床和人口统计学因素预测疾病轨迹内的成员资格。不同疾病活动轨迹类别的成员资格与不同的损害轨迹相关联。
Objective. No previous study has studied the longitudinal disease course of childhood-onset systemic lupus erythematosus (cSLE). Our objectives are to assess distinguishable differences in disease activity trajectories in cSLE patients, determine baseline factors predictive of disease trajectory membership, and assess if the different disease activity trajectories are associated with different damage trajectories.Methods. This is a retrospective, longitudinal inception cohort of cSLE patients. Patients were followed from diagnosis as children, until they were adults. SLE disease activity was modeled as a latent characteristic, jointly using the Systemic Lupus Erythematosus Disease Activity Index 2000 and prednisone in a Bayesian growth mixture model. Baseline factors were tested for membership prediction of the latent classes of disease trajectories. Differences in damage trajectories by disease activity classes were tested using a mixed model.Results. A total of 473 patients (82% females), with median age at diagnosis of 14.1 years, were studied. We studied 11,992 visits (2,666 patient-years). We identified 5 classes of disease activity trajectories. Baseline major organ involvement, number of American College of Rheumatology criteria, and age at diagnosis predicted memberships into different classes. A higher proportion of Asians was in class 2 compared to class 5. Class 1 was associated with the most accrual of damage, while class 5 was associated with no significant damage accrual, even after 10 years.Conclusion. There are 5 distinct latent classes of disease trajectory in patients with cSLE. Membership within disease trajectories is predicted by baseline clinical and demographic factors. Membership in different disease activity trajectory classes is associated with different damage trajectories.