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- Title
Clinical and Serologic Features in Patients With Incomplete Lupus Classification Versus Systemic Lupus Erythematosus Patients and Controls.
- Authors
Aberle, Teresa; Bourn, Rebecka L.; Munroe, Melissa E.; Chen, Hua; Roberts, Virginia C.; Guthridge, Joel M.; Bean, Krista; Robertson, Julie M.; Sivils, Kathy L.; Rasmussen, Astrid; Liles, Meghan; Merrill, Joan T.; Harley, John B.; Olsen, Nancy J.; Karp, David R.; James, Judith A.
- Abstract
<bold>Objective: </bold>Incomplete lupus erythematosus (ILE) involves clinical and/or serologic manifestations consistent with but insufficient for systemic lupus erythematosus (SLE) classification. Because the nature of ILE is poorly understood and no treatment recommendations exist, we examined the clinical manifestations, medication history, and immunologic features in a diverse collection of ILE and SLE patients.<bold>Methods: </bold>Medical records of subjects enrolled in the Lupus Family Registry and Repository were reviewed for medication history and American College of Rheumatology (ACR) classification criteria to identify ILE patients (3 ACR criteria; n = 440) and SLE patients (≥4 ACR criteria; n = 3,397). Participants completed the Connective Tissue Disease Screening Questionnaire. Anticardiolipin and plasma B lymphocyte stimulator (BLyS) were measured by enzyme-linked immunosorbent assay, antinuclear antibodies (ANAs) by indirect immunofluorescence, and 13 autoantibodies by bead-based assays.<bold>Results: </bold>On average, ILE patients were older than SLE patients (46.2 years versus 42.0 years; P < 0.0001), and fewer ILE patients were African American (23.9% versus 32.2%; P < 0.001). ILE patients exhibited fewer autoantibody specificities than SLE patients (1.3 versus 2.6; P < 0.0001) and were less likely to have ANA titers ≥1:1,080 (10.5% versus 19.5%; P < 0.0001). BLyS levels were intermediate in ILE patients (controls < ILE; P = 0.016; ILE < SLE; P = 0.008). Pericarditis, renal, or neurologic manifestations occurred in 12.5% of ILE patients and were associated with non-European American race/ethnicity (P = 0.012). Hydroxychloroquine use increased over time, but was less frequent in ILE than SLE patients (65.2% versus 83.1%; P < 0.0001).<bold>Conclusion: </bold>Although usually characterized by milder symptoms, ILE manifestations may require immunomodulatory treatments. Longitudinal studies are necessary to understand how ILE affects organ damage and future SLE risk, and to delineate molecular pathways unique to ILE.
- Subjects
PUERTO Rico; UNITED States; UNITED States Virgin Islands; WEST Indies; SYSTEMIC lupus erythematosus diagnosis; CHLOROQUINE; ANTIRHEUMATIC agents; AUTOANTIBODIES; COMPARATIVE studies; ENZYME-linked immunosorbent assay; ETHNIC groups; FLUORESCENT antibody technique; RESEARCH methodology; MEDICAL cooperation; POPULATION; QUESTIONNAIRES; RESEARCH; RESEARCH funding; SERODIAGNOSIS; SYSTEMIC lupus erythematosus; TERMS &; phrases; TUMOR necrosis factors; EVALUATION research; PREDICTIVE tests; ACQUISITION of data; SEVERITY of illness index; CASE-control method; THERAPEUTICS
- Publication
Arthritis Care & Research, 2017, Vol 69, Issue 12, p1780
- ISSN
2151-464X
- Publication type
journal article
- DOI
10.1002/acr.23201