title: Patterns of systemic lupus erythematosus expression in Europe.
abstract: OBJECTIVE
  To analyse the differences in disease expression of European SLE patients based on gender, age at diagnosis, and ethnicity.
  
  
  METHODS
  A two-year, retrospective, multicentre, observational study was carried out in five countries (France, Germany, Italy, Spain and the UK). Patients' clinical manifestations including disease activity, organ involvement, organ damage and flares were analysed.
  
  
  RESULTS
  Thirty-one centres enrolled 412 consecutive eligible patients (90.5% of women), with active disease, stratified by disease severity (half severe and half non-severe). Baseline characteristics included; mean (SD) age: 43.3 (13.6) years, SLE duration: 10.7 (8.0) years and age at disease diagnosis: 32.6 (13.0) years old. The mean (SD) SELENA-SLEDAI and SLICC/ACR scores were: 8.1 (6.7) and 0.82 (1.36), respectively. Over half of patients experienced flares (54.9%). The average number of annual flares was 1.01 (0.71) flares/year. In males compared to females, the renal system was more frequently active (53.8% vs 30.0%, p=0.002), the mean SLICC/ACR score was higher (1.15 vs 0.79, p=0.039) and the pulmonary system was more likely to be damaged (12.8% vs 3.8%, p=0.010). Furthermore, patients diagnosed at younger age displayed more renal system activity (young: 56.3% vs adult: 33.4% vs elder: 8.9%, p<0.001) and renal damage (25.0% vs 6.9% vs 2.2%, p=0.018) compared to the others. The annual number of flares (1.13 vs 1.05 vs 0.81 flares/year, p<0.0001), including the occurrence of severe flares (0.58 vs 0.51 vs 0.20, p<0.0001), was also higher in these patients. Conversely, greater organ damage was observed in patients diagnosed at an older age compared to the others. The mean SLICC/ACR score was higher (1.31 vs young: 0.88 and adult: 0.78, p<0.001) in patients diagnosed in the older age groups. The pulmonary (13.3% vs younger: 0% vs adult: 3.7%, p=0.030) and cardiovascular (17.8% vs younger: 0% vs adult: 2.9%, p<0.001) systems were more frequently damaged in these patients. Black African descents showed greater disease activity compared to Caucasian patients. They flared more often (77.1% vs 48.6%, p=0.001) and experienced a greater number of annual flares (1.57 vs 0.89 flares/year, p<0.0001), mainly more severe flares (0.89 vs 0.38/year, p<0.0001). They also were more likely to experience renal system damage.
  
  
  CONCLUSIONS
  The study showed clearly two patient subsets. The disease was the most active in Black African descents, and this phenomenon has never been described before in continental Europe. The disease was also more active in patients diagnosed at a younger or adult. Greater disease damage was observed in males and in patients diagnosed at an older age.
authors.affiliation: Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain, Carrer Villarroel, 170, 08036 Barcelona, Catalonia, Spain. Electronic address: rcervera@clinic.cat.
authors.forename: R
authors.initials: R
authors.lastname: Cervera
authors.affiliation: Division of Rheumatology, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Doria
authors.affiliation: Internal Medecine Department 2, La Pitié Salpétrière Hospital, 47-83 Bd. de l'Hôpital, 75651 Paris cedex 13, France.
authors.forename: Z
authors.initials: Z
authors.lastname: Amoura
authors.affiliation: Lupus Research Unit, The Rayne Institute Lambeth Wing, St Thomas' Hospital, London SE1 7EH, England, United Kingdom.
authors.forename: M
authors.initials: M
authors.lastname: Khamashta
authors.affiliation: Policlinic of Rheumatology, Heinrich-Heine-University, Moorenstr. 5, 40225 Düsseldorf, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Schneider
authors.affiliation: Inserm CIC-EC, University Hospital, CHU of Nancy, 54505 Nancy, France.
authors.forename: F
authors.initials: F
authors.lastname: Guillemin
authors.affiliation: Health Economics & Outcomes Research, IMS Real-World Evidence Solutions, Tour Ariane 5-7, place de la Pyramide, 92088 Paris La défense cedex, France.
authors.forename: F
authors.initials: F
authors.lastname: Maurel
authors.affiliation: Health Economics & Outcomes Research, IMS Real-World Evidence Solutions, Tour Ariane 5-7, place de la Pyramide, 92088 Paris La défense cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Garofano
authors.affiliation: Health Economics & Outcomes Research, IMS Real-World Evidence Solutions, C/Doctor Ferran 25-27, Barcelona 08034, Catalonia, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Roset
authors.affiliation: Immuno Inflammation & Infectious Diseases Global Franchise, GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, England, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Perna
authors.affiliation: Access to Medicine Centre of Excellence, GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex, TW8 9GS England, United Kingdom.
authors.forename: M
authors.initials: M
authors.lastname: Murray
authors.affiliation: Global Health Outcomes, GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, England, United Kingdom.
authors.forename: C
authors.initials: C
authors.lastname: Schmitt
authors.affiliation: Medical Department, GlaxoSmithKline, 100 route de Versailles, 78163 Marly-le-Roi Cedex, France.
authors.forename: I
authors.initials: I
authors.lastname: Boucot
mesh_terms: D001699:Biometry; D005060:Europe; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Disease; Flares; Systemic lupus erythematosus (SLE)