title: Analysis of disease activity and response to treatment in a large Spanish cohort of patients with systemic lupus erythematosus.
abstract: OBJECTIVE
  The objectives of this paper are to study the impact of disease activity in a large cohort of patients with systemic lupus erythematosus (SLE) and estimate the rate of response to therapies.
  
  
  METHODS
  We conducted a nationwide, retrospective, multicenter, cross-sectional cohort study of 3658 SLE patients. Data on demographics, disease characteristics: activity (SELENA-SLEDAI), damage, severity, hospitalizations and therapies were collected. Factors associated with refractory disease were identified by logistic regression.
  
  
  RESULTS
  A total of 3658 patients (90% female; median SLE duration (interquartile range): 10.4 years (5.3-17.1)) were included. At the time of their last evaluation, 14.7% of the patients had moderate-severe SLE (SELENA-SLEDAI score ≥6). There were 1954 (53.4%) patients who were hospitalized for activity at least once over the course of the disease. At some stage, 84.6% and 78.8% of the patients received glucocorticoids and antimalarials, respectively, and 51.3% of the patients received at least one immunosuppressant. Owing to either toxicity or ineffectiveness, cyclophosphamide was withdrawn in 21.5% of the cases, mycophenolate mofetil in 24.9%, azathioprine in 40.2% and methotrexate in 46.8%. At some stage, 7.3% of the patients received at least one biologic. A total of 898 (24.5%) patients had refractory SLE at some stage. Renal, neuropsychiatric, vasculitic, hematological and musculoskeletal involvement, a younger age at diagnosis and male gender were associated with refractory disease.
  
  
  CONCLUSIONS
  A significant percentage of patients have moderately-to-severely active SLE at some stage. Disease activity has a big impact in terms of need for treatment and cause of hospitalization. The effectiveness of the standard therapies for reducing disease activity is clearly insufficient. Some clinical features are associated with refractory SLE.
authors.affiliation: Rheumatology Department, University Hospital Complex, Instituto de Investigación Biomédica de Vigo, Spain jose.maria.pego.reigosa@sergas.es.
authors.forename: J M
authors.initials: JM
authors.lastname: Pego-Reigosa
authors.affiliation: Rheumatology Department, Doctor Negrín University Hospital of Gran Canaria, Spain.
authors.forename: Í
authors.initials: Í
authors.lastname: Rúa-Figueroa
authors.affiliation: Rheumatology Department, Gregorio Marañón University Hospital, Madrid, Spain.
authors.forename: F J
authors.initials: FJ
authors.lastname: López-Longo
authors.affiliation: Rheumatology Department, Doce de octubre University Hospital, Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Galindo-Izquierdo
authors.affiliation: Rheumatology Department, Sierrallana Hospital, Torrelavega, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Calvo-Alén
authors.affiliation: Rheumatology Department, Germans Trías I Pujol University Hospital, Badalona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Olivé-Marqués
authors.affiliation: Preventive Medicine and Epidemiology Department, University Hospital Complex, Instituto de Investigación Biomédica de Vigo, Spain.
authors.forename: V
authors.initials: V
authors.lastname: del Campo
authors.affiliation: Research Unit, Spanish Society of Rheumatology, Madrid, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: García-Yébenes
authors.affiliation: Research Unit, Spanish Society of Rheumatology, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Loza-Santamaría
authors.affiliation: Rheumatology Department, Marqués de Valdecilla University Hospital, Santander, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Blanco
authors.affiliation: Rheumatology Department, University Hospital Complex, Instituto de Investigación Biomédica de Vigo, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Melero-González
authors.affiliation: Rheumatology Department, University Hospital of Alicante, Alicante, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Vela-Casasempere
authors.affiliation: Rheumatology Department, Hospital of Torrejón, Madrid, Spain.
authors.forename: T
authors.initials: T
authors.lastname: Otón-Sánchez
authors.affiliation: Rheumatology Department, La Princesa University Hospital, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Tomero-Muriel
authors.affiliation: Rheumatology Department, Donostia Hospital, San Sebastián, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Uriarte-Isacelaya
authors.affiliation: Rheumatology Department, Hospital of Navarra, Pamplona, Spain.
authors.forename: M C
authors.initials: MC
authors.lastname: Fito-Manteca
authors.affiliation: Rheumatology Department, University Hospital Complex of A Coruña, A Coruña, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Freire-González
authors.affiliation: Rheumatology Department, Bellvitge University Hospital, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Narváez
authors.affiliation: Rheumatology Department, University Hospital Carlos Haya, Málaga, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Fernández-Nebro
authors.affiliation: Rheumatology Department, Ramón y Cajal University Hospital, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Zea-Mendoza
authors.affiliation: Rheumatology Department, Marina Baixa Hospital, Villajoyosa, and the Spanish Society of Rheumatology Systemic Autoimmune Diseases Study Group (EASSER), Spain.
authors.forename: J
authors.initials: J
authors.lastname: Rosas
authors.forename: J
authors.initials: J
authors.lastname: Carlos Rosas
mesh_terms: D000328:Adult; D000974:Antibodies, Antinuclear / Q000032:analysis; D000962:Antimalarials / Q000008:administration & dosage; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016015:Logistic Models; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012042:Registries; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology
chemical_list: D000974:Antibodies, Antinuclear; D000962:Antimalarials; D005938:Glucocorticoids; D007166:Immunosuppressive Agents
keywords: Systemic lupus erythematosus; disease activity; treatment