title: Disease flare patterns and predictors of systemic lupus erythematosus in a monocentric cohort of 423 Japanese patients during a long-term follow-up: The JUDE study.
abstract: OBJECTIVE
  To clarify the clinical features of systemic lupus erythematosus (SLE) patients, factors associated with flares, and changes over time.
  
  
  METHODS
  Patients having SLE with a visiting history were entered into the Juntendo University Database of Erythematosus. We included 423 cases in the long-term follow-up analysis, and 383 cases were followed for 10 years after the initiation of any therapeutic intervention (comparative analysis: 1973-1982, 82 cases; 1983-1992, 141, and 1993-2002, 160). We assessed changes in the patients' background characteristics, disease symptoms, flare rates, etc.
  
  
  RESULTS
  Among the 423 cases, the mean follow-up period was 25.9 years, and mean number of flares was 0.51. Of those, 31.9% had ≥1 flares. Thrombocytopenia at onset contributed to the flares. For disease symptoms at onset, a recent trend in increasing thrombocytopenia was observed. The combination rate of immunosuppressive agents for diseases other than lupus nephritis was slightly increased, and there was no improvement until the first flare or in the flare rate.
  
  
  CONCLUSIONS
  Thrombocytopenia at onset is predictive factor for flares. Since SLE is a diverse disease with varying symptoms at recurrence, the treatment guidelines should be improved for thrombocytopenia from a long-term perspective.
authors.affiliation: a Department of Internal Medicine and Rheumatology , Juntendo University School of Medicine , Tokyo , Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Minowa
authors.affiliation: a Department of Internal Medicine and Rheumatology , Juntendo University School of Medicine , Tokyo , Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Amano
authors.affiliation: a Department of Internal Medicine and Rheumatology , Juntendo University School of Medicine , Tokyo , Japan.
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Ando
authors.affiliation: a Department of Internal Medicine and Rheumatology , Juntendo University School of Medicine , Tokyo , Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: a Department of Internal Medicine and Rheumatology , Juntendo University School of Medicine , Tokyo , Japan.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Ogasawara
authors.affiliation: a Department of Internal Medicine and Rheumatology , Juntendo University School of Medicine , Tokyo , Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Kawano
authors.affiliation: a Department of Internal Medicine and Rheumatology , Juntendo University School of Medicine , Tokyo , Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kaneko
authors.affiliation: a Department of Internal Medicine and Rheumatology , Juntendo University School of Medicine , Tokyo , Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Morimoto
authors.affiliation: a Department of Internal Medicine and Rheumatology , Juntendo University School of Medicine , Tokyo , Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Yamaji
authors.affiliation: a Department of Internal Medicine and Rheumatology , Juntendo University School of Medicine , Tokyo , Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Tamura
authors.affiliation: a Department of Internal Medicine and Rheumatology , Juntendo University School of Medicine , Tokyo , Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Tokano
authors.affiliation: a Department of Internal Medicine and Rheumatology , Juntendo University School of Medicine , Tokyo , Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hashimoto
authors.affiliation: a Department of Internal Medicine and Rheumatology , Juntendo University School of Medicine , Tokyo , Japan.
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Takasaki
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D002648:Child; 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; D008875:Middle Aged; D012008:Recurrence; D012720:Severity of Illness Index; D063189:Symptom Assessment; D013921:Thrombocytopenia / Q000175:diagnosis* / Q000188:drug therapy; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents
keywords: Clinical features; Cohort; Lupus nephritis; Systemic lupus erythematosus; Thrombocytopenia