Development of SLE among "potential SLE" patients seen in consultation: Long-term follow-up

M. Al Daabil, E. M. Massarotti, A. Fine, H. Tsao, P. Ho, P. H. Schur, B. L. Bermas, Karen H. Costenbader

Research output: Contribution to journalArticle

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Abstract

Methods We identified patients first seen at the Brigham and Women's Hospital Lupus Center between 1 January 1992 and 31 December 2012 and thought to have potential SLE by a board-certified rheumatologist. All had 1-3 SLE ACR criteria at initial visit and > 2 follow-up visits ≥ 3 months apart. We reviewed medical records through 15 May 2013 for: SLE signs and symptoms, autoimmune serologies, prescriptions and diagnoses by board-certified rheumatologists. Bivariable analyses and multivariable logistic regression models were used to identify independent predictors of developing SLE.

Objective To identify factors associated with development of systemic lupus erythematosus (SLE) among patients evaluated at a tertiary care Lupus Center for potential SLE.

Results Two hundred and sixty four patients met inclusion criteria. At initial visit, mean age was 39.2 (SD 12.4) years, 94% were female and 67% white. Mean number of SLE ACR criteria was 2.7 (SD 1.0) and 88% were antinuclear antibody (ANA) positive at initial consultation. Mean follow-up time was 6.3 (SD 4.3) years and 67% were prescribed hydroxychloroquine in follow-up. At most recent visit, 56 (21%) had been diagnosed with SLE; 47 (18%) were thought not to have SLE and 161 (61%) were still considered to have potential SLE. In multivariable regression models, oral ulcers (OR 2.40, 95% CI 1.03-5.58), anti-dsDNA (OR 2.59, 95% CI 1.25-5.35) and baseline proteinuria or cellular casts (OR 16.20, 95% CI 1.63-161.02) were independent predictors of developing SLE. The most common other final diagnoses included fibromyalgia, Sjögren's syndrome, mixed connective tissue disease and cutaneous lupus.

Conclusion Among patients with potential SLE at initial consultation, 21% were diagnosed with definite SLE within 6.3 years. Oral ulcers, anti-dsDNA and proteinuria or cellular casts were independent predictors of developing definite SLE. A better means of accurately identifying those who will develop SLE among those presenting with potential disease is necessary.

Original languageEnglish (US)
Pages (from-to)1508-1513
Number of pages6
JournalInternational Journal of Clinical Practice
Volume68
Issue number12
DOIs
StatePublished - Jan 1 2014

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Systemic Lupus Erythematosus
Referral and Consultation
Oral Ulcer
Proteinuria
Logistic Models
Mixed Connective Tissue Disease
Hydroxychloroquine
Fibromyalgia
Antinuclear Antibodies
Serology
Tertiary Care Centers
Signs and Symptoms
Medical Records
Prescriptions

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Al Daabil, M., Massarotti, E. M., Fine, A., Tsao, H., Ho, P., Schur, P. H., ... Costenbader, K. H. (2014). Development of SLE among "potential SLE" patients seen in consultation: Long-term follow-up. International Journal of Clinical Practice, 68(12), 1508-1513. https://doi.org/10.1111/ijcp.12466

Development of SLE among "potential SLE" patients seen in consultation : Long-term follow-up. / Al Daabil, M.; Massarotti, E. M.; Fine, A.; Tsao, H.; Ho, P.; Schur, P. H.; Bermas, B. L.; Costenbader, Karen H.

In: International Journal of Clinical Practice, Vol. 68, No. 12, 01.01.2014, p. 1508-1513.

Research output: Contribution to journalArticle

Al Daabil, M, Massarotti, EM, Fine, A, Tsao, H, Ho, P, Schur, PH, Bermas, BL & Costenbader, KH 2014, 'Development of SLE among "potential SLE" patients seen in consultation: Long-term follow-up', International Journal of Clinical Practice, vol. 68, no. 12, pp. 1508-1513. https://doi.org/10.1111/ijcp.12466
Al Daabil, M. ; Massarotti, E. M. ; Fine, A. ; Tsao, H. ; Ho, P. ; Schur, P. H. ; Bermas, B. L. ; Costenbader, Karen H. / Development of SLE among "potential SLE" patients seen in consultation : Long-term follow-up. In: International Journal of Clinical Practice. 2014 ; Vol. 68, No. 12. pp. 1508-1513.
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title = "Development of SLE among {"}potential SLE{"} patients seen in consultation: Long-term follow-up",
abstract = "Methods We identified patients first seen at the Brigham and Women's Hospital Lupus Center between 1 January 1992 and 31 December 2012 and thought to have potential SLE by a board-certified rheumatologist. All had 1-3 SLE ACR criteria at initial visit and > 2 follow-up visits ≥ 3 months apart. We reviewed medical records through 15 May 2013 for: SLE signs and symptoms, autoimmune serologies, prescriptions and diagnoses by board-certified rheumatologists. Bivariable analyses and multivariable logistic regression models were used to identify independent predictors of developing SLE.Objective To identify factors associated with development of systemic lupus erythematosus (SLE) among patients evaluated at a tertiary care Lupus Center for potential SLE.Results Two hundred and sixty four patients met inclusion criteria. At initial visit, mean age was 39.2 (SD 12.4) years, 94{\%} were female and 67{\%} white. Mean number of SLE ACR criteria was 2.7 (SD 1.0) and 88{\%} were antinuclear antibody (ANA) positive at initial consultation. Mean follow-up time was 6.3 (SD 4.3) years and 67{\%} were prescribed hydroxychloroquine in follow-up. At most recent visit, 56 (21{\%}) had been diagnosed with SLE; 47 (18{\%}) were thought not to have SLE and 161 (61{\%}) were still considered to have potential SLE. In multivariable regression models, oral ulcers (OR 2.40, 95{\%} CI 1.03-5.58), anti-dsDNA (OR 2.59, 95{\%} CI 1.25-5.35) and baseline proteinuria or cellular casts (OR 16.20, 95{\%} CI 1.63-161.02) were independent predictors of developing SLE. The most common other final diagnoses included fibromyalgia, Sj{\"o}gren's syndrome, mixed connective tissue disease and cutaneous lupus.Conclusion Among patients with potential SLE at initial consultation, 21{\%} were diagnosed with definite SLE within 6.3 years. Oral ulcers, anti-dsDNA and proteinuria or cellular casts were independent predictors of developing definite SLE. A better means of accurately identifying those who will develop SLE among those presenting with potential disease is necessary.",
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T1 - Development of SLE among "potential SLE" patients seen in consultation

T2 - Long-term follow-up

AU - Al Daabil, M.

AU - Massarotti, E. M.

AU - Fine, A.

AU - Tsao, H.

AU - Ho, P.

AU - Schur, P. H.

AU - Bermas, B. L.

AU - Costenbader, Karen H.

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N2 - Methods We identified patients first seen at the Brigham and Women's Hospital Lupus Center between 1 January 1992 and 31 December 2012 and thought to have potential SLE by a board-certified rheumatologist. All had 1-3 SLE ACR criteria at initial visit and > 2 follow-up visits ≥ 3 months apart. We reviewed medical records through 15 May 2013 for: SLE signs and symptoms, autoimmune serologies, prescriptions and diagnoses by board-certified rheumatologists. Bivariable analyses and multivariable logistic regression models were used to identify independent predictors of developing SLE.Objective To identify factors associated with development of systemic lupus erythematosus (SLE) among patients evaluated at a tertiary care Lupus Center for potential SLE.Results Two hundred and sixty four patients met inclusion criteria. At initial visit, mean age was 39.2 (SD 12.4) years, 94% were female and 67% white. Mean number of SLE ACR criteria was 2.7 (SD 1.0) and 88% were antinuclear antibody (ANA) positive at initial consultation. Mean follow-up time was 6.3 (SD 4.3) years and 67% were prescribed hydroxychloroquine in follow-up. At most recent visit, 56 (21%) had been diagnosed with SLE; 47 (18%) were thought not to have SLE and 161 (61%) were still considered to have potential SLE. In multivariable regression models, oral ulcers (OR 2.40, 95% CI 1.03-5.58), anti-dsDNA (OR 2.59, 95% CI 1.25-5.35) and baseline proteinuria or cellular casts (OR 16.20, 95% CI 1.63-161.02) were independent predictors of developing SLE. The most common other final diagnoses included fibromyalgia, Sjögren's syndrome, mixed connective tissue disease and cutaneous lupus.Conclusion Among patients with potential SLE at initial consultation, 21% were diagnosed with definite SLE within 6.3 years. Oral ulcers, anti-dsDNA and proteinuria or cellular casts were independent predictors of developing definite SLE. A better means of accurately identifying those who will develop SLE among those presenting with potential disease is necessary.

AB - Methods We identified patients first seen at the Brigham and Women's Hospital Lupus Center between 1 January 1992 and 31 December 2012 and thought to have potential SLE by a board-certified rheumatologist. All had 1-3 SLE ACR criteria at initial visit and > 2 follow-up visits ≥ 3 months apart. We reviewed medical records through 15 May 2013 for: SLE signs and symptoms, autoimmune serologies, prescriptions and diagnoses by board-certified rheumatologists. Bivariable analyses and multivariable logistic regression models were used to identify independent predictors of developing SLE.Objective To identify factors associated with development of systemic lupus erythematosus (SLE) among patients evaluated at a tertiary care Lupus Center for potential SLE.Results Two hundred and sixty four patients met inclusion criteria. At initial visit, mean age was 39.2 (SD 12.4) years, 94% were female and 67% white. Mean number of SLE ACR criteria was 2.7 (SD 1.0) and 88% were antinuclear antibody (ANA) positive at initial consultation. Mean follow-up time was 6.3 (SD 4.3) years and 67% were prescribed hydroxychloroquine in follow-up. At most recent visit, 56 (21%) had been diagnosed with SLE; 47 (18%) were thought not to have SLE and 161 (61%) were still considered to have potential SLE. In multivariable regression models, oral ulcers (OR 2.40, 95% CI 1.03-5.58), anti-dsDNA (OR 2.59, 95% CI 1.25-5.35) and baseline proteinuria or cellular casts (OR 16.20, 95% CI 1.63-161.02) were independent predictors of developing SLE. The most common other final diagnoses included fibromyalgia, Sjögren's syndrome, mixed connective tissue disease and cutaneous lupus.Conclusion Among patients with potential SLE at initial consultation, 21% were diagnosed with definite SLE within 6.3 years. Oral ulcers, anti-dsDNA and proteinuria or cellular casts were independent predictors of developing definite SLE. A better means of accurately identifying those who will develop SLE among those presenting with potential disease is necessary.

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