Systemic lupus Erythematosus activity and Hydroxychloroquine use before and after end-stage renal disease.
Systemic lupus Erythematosus activity and Hydroxychloroquine use before and after end-stage renal disease.
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DOI：
10.1186/s12882-020-02083-2
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发表时间：
2020-10-28
期刊：
影响因子：
2.3
通讯作者：
Broder A
中科院分区：
文献类型：
--
作者：
Salgado Guerrero M;Londono Jimenez A;Dobrowolski C;Mowrey WB;Goilav B;Wang S;Broder A
终末期肾病后的SLE表现可能诊断不足和治疗不足，导致发病率和死亡率增加。ESRD后特定症状是否持续存在或向新表现的转变尚未得到广泛研究，特别是在美国的非高加索患者中。此外，尚未描述ESRD后羟氯喹（HCQ）处方模式。本研究的目的是评估狼疮活动和HCQ处方之前和之后的ESRD发展。从这项研究中获得的知识可能有助于识别SLE表现和改善ESRD后的药物管理。我们对2010年至2017年期间发生ESRD的SLE患者进行了一项回顾性队列研究。SLE相关症状，疾病活动的血清学标志物，以及药物使用收集自ESRD发展前后的医疗记录。59例患者纳入研究。25例（43%）患者在ESRD前12个月内至少有一种临床（非肾脏）SLE表现。其中，11/25例（44%）在ESRD后继续出现狼疮症状; 9例ESRD前无临床或血清学活动的患者出现活动性SLE的新症状。在ESRD后最后一次记录的访视时，42/59（71%）例患者具有一种或多种狼疮活动的临床或血清学标志物;仅17/59（29%）例患者达到临床和血清学缓解。33/59例（56%）患者在ESRD时接受了活性HCQ处方。42例ESRD后活动性SLE表现的患者中有26例（62%）接受了HCQ治疗。ESRD后继续HCQ的患者更有可能接受风湿病学家的随访（26例[87%] vs 17例[61%]，p = 0.024），记录的关节炎发生率较高（10 [32%] vs 1 [4%]，p = 0.005）、CNS表现（6 [20%] vs 1 [4%]，p = 0.055）和同时使用免疫抑制药物（22 [71%] vs 12 [43%]，p = 0.029）。狼疮活动可能在ESRD发展后持续存在。可能出现新发关节炎、狼疮相关皮疹、CNS表现、低补体和抗dsDNA抗体升高。在ESRD前后有活动性疾病证据的患者中，HCQ可能未得到充分利用。建议对SLE患者在ESRD前后进行仔细的临床和血清学监测，以发现活动性疾病的体征，并频繁进行风湿病随访。
SLE manifestations after ESRD may be underdiagnosed and undertreated, contributing to increased morbidity and mortality. Whether specific symptoms persist after ESRD or a shift towards new manifestations occurs has not been extensively studied, especially in the non-Caucasian patients in the United States. In addition, hydroxychloroquine (HCQ) prescribing patterns post-ESRD have not been described. The objective of this study was to assess lupus activity and HCQ prescribing before and after ESRD development. Knowledge gained from this study may aid in the identification of SLE manifestations and improve medication management post-ESRD. We performed a retrospective cohort study of SLE patients with incident ESRD between 2010 and 2017. SLE-related symptoms, serologic markers of disease activity, and medication use were collected from medical records before and after ESRD development. Fifty-nine patients were included in the study. Twenty-five (43%) patients had at least one clinical (non-renal) SLE manifestation documented within 12 months before ESRD. Of them, 11/25 (44%) continued to experience lupus symptoms post-ESRD; 9 patients without clinical or serological activity pre-ESRD developed new symptoms of active SLE. At the last documented visit post-ESRD, 42/59 (71%) patients had one or more clinical or serological markers of lupus activity; only 17/59 (29%) patients achieved clinical and serological remission. Thirty-three of 59 (56%) patients had an active HCQ prescription at the time of ESRD. Twenty-six of the 42 (62%) patients with active SLE manifestations post-ESRD were on HCQ. Patients who continued HCQ post-ESRD were more likely to be followed by a rheumatologist (26 [87%] vs 17 [61%], p = 0.024), had a higher frequency of documented arthritis (10 [32%] vs 1 [4%], p = 0.005), CNS manifestations (6 [20%] vs 1 [4%], p = 0.055), and concurrent immunosuppressive medication use (22 [71%] vs 12 [43%], p = 0.029). Lupus activity may persist after the development of ESRD. New onset arthritis, lupus-related rash, CNS manifestations, low complement and elevated anti-dsDNA may develop. HCQ may be underutilized in patients with evidence of active disease pre- and post ESRD. Careful clinical and serological monitoring for signs of active disease and frequent rheumatology follow up is advised in SLE patients both, pre and post-ESRD.
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影响因子：
27.4
作者：
Bertsias GK;Tektonidou M;Amoura Z;Aringer M;Bajema I;Berden JH;Boletis J;Cervera R;Dörner T;Doria A;Ferrario F;Floege J;Houssiau FA;Ioannidis JP;Isenberg DA;Kallenberg CG;Lightstone L;Marks SD;Martini A;Moroni G;Neumann I;Praga M;Schneider M;Starra A;Tesar V;Vasconcelos C;van Vollenhoven RF;Zakharova H;Haubitz M;Gordon C;Jayne D;Boumpas DT;European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association
通讯作者：
European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association
影响因子：
--
作者：
Petri, Michelle;Orbai, Ana-Maria;Alarcon, Graciela S.;Gordon, Caroline;Merrill, Joan T.;Fortin, Paul R.;Bruce, Ian N.;Isenberg, David;Wallace, Daniel J.;Nived, Ola;Sturfelt, Gunnar;Ramsey-Goldman, Rosalind;Bae, Sang-Cheol;Hanly, John G.;Sanchez-Guerrero, Jorge;Clarke, Ann;Aranow, Cynthia;Manzi, Susan;Urowitz, Murray;Gladman, Dafna;Kalunian, Kenneth;Costner, Melissa;Werth, Victoria P.;Zoma, Asad;Bernatsky, Sasha;Ruiz-Irastorza, Guillermo;Khamashta, Munther A.;Jacobsen, Soren;Buyon, Jill P.;Maddison, Peter;Dooley, Mary Anne;van vollenhoven, Ronald F.;Ginzler, Ellen;Stoll, Thomas;Peschken, Christine;Jorizzo, Joseph L.;Callen, Jeffrey P.;Lim, S. Sam;Fessler, Barri J.;Inanc, Murat;Kamen, Diane L.;Rahman, Anisur;Steinsson, Kristjan;Franks, Andrew G., Jr.;Sigler, Lisa;Hameed, Suhail;Fang, Hong;Ngoc Pham;Brey, Robin;Weisman, Michael H.;McGwin, Gerald, Jr.;Magder, Laurence S.
通讯作者：
Magder, Laurence S.
影响因子：
4.7
作者：
Hahn, Bevra H.;McMahon, Maureen A.;Wilkinson, Alan;Wallace, W. Dean;Daikh, David I.;Fitzgerald, John D.;Karpouzas, George A.;Merrill, Joan T.;Wallace, Daniel J.;Yazdany, Jinoos;Ramsey-Goldman, Rosalind;Singh, Karandeep;Khalighi, Mazdak;Choi, Soo-In;Gogia, Maneesh;Kafaja, Suzanne;Kamgar, Mohammad;Lau, Christine;Martin, William J.;Parikh, Sefali;Peng, Justin;Rastogi, Anjay;Chen, Weiling;Grossman, Jennifer M.
通讯作者：
Grossman, Jennifer M.
DOI：
10.3899/jrheum.110571
发表时间：
2011-11
期刊：
The Journal of rheumatology
影响因子：
--
作者：
Broder A;Khattri S;Patel R;Putterman C
通讯作者：
Putterman C
影响因子：
13.2
作者：
CHEIGH, JS;KIM, H;RUBIN, AL
通讯作者：
RUBIN, AL