Identification of clinical predictors of flare in systemic lupus erythematosus patients: a 24-month prospective cohort study.
OBJECTIVE
SLE has a relapsing-remitting course with disease activity flares over time. This study aims to identify clinical predictors of SLE flares.


METHODS
This prospective cohort study over 24 months included all SLE patients on follow-up at one academic lupus clinic. Flare was defined as an increase in SLEDAI-2K score ≥4 points. Baseline clinical and demographic parameters were compared using survival analysis for time-to-flare outcome with univariate log-rank tests. Variables with significant differences were further evaluated as predictors with multivariate Cox regression models adjusting for potential confounding or contributing factors and hazard ratio (HR) calculation.


RESULTS
A total of 202 SLE patients were included. Over the follow-up period, 1083 visits were documented and 16.8% of patients presented with flares. In multivariate analysis, the following parameters emerged as flare predictors: SLE diagnosis up to 25 years of age (HR = 2.14, P = 0.03), lupus nephritis previous to baseline visit (HR = 4.78, P < 0.0001) and immunosuppressor treatment for severe SLE (HR = 3.22, P < 0.001). Baseline disease activity, disease duration and treatment with prednisone or HCQ were not predictive factors.


CONCLUSIONS
Patients with an SLE diagnosis before age 25 years, lupus nephritis or immunosuppressor treatment for severe SLE present greater HRs for flares, suggesting the need for tighter clinical monitoring. Current immunosuppressive strategies seem to be inefficient in providing flare prevention.
Serviço de Reumatologia, Hospitais da Universidade de Coimbra, Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal. lupus@huc.min-saude.pt.
Luís
L
Inês
Cátia
C
Duarte
Rosário Santos
RS
Silva
Ana Sofia
AS
Teixeira
Fernando Pereira
FP
Fonseca
José António P
JA
da Silva
D000328:Adult; D001706:Biopsy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents
cohort study; outcomes research; prognosis; prospective study; systemic lupus erythematosus