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Author: search.filters.author.Bernardo A Pons-EstelSubject: search.filters.subject.disease activity

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    Time to diagnosis in systemic lupus erythematosus: Associated factors and its impact on damage accrual and mortality. Data from a multi-ethnic, multinational Latin American lupus cohort
    (2024)
    Romina Nieto
    ;
    Rosana Quintana
    ;
    Ernesto Zavala-Flores
    ;
    Rosa Serrano
    ;
    Karen Roberts
    <jats:sec><jats:title>Background</jats:title><jats:p> Systemic lupus erythematosus (SLE) often mimics symptoms of other diseases, and the interval between symptom onset and diagnosis may be long in some of these patients. Aims: To describe the characteristics associated with the time to SLE diagnosis and its impact on damage accrual and mortality in patients with SLE from a Latin American inception cohort. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Patients were from a multi-ethnic, multi-national Latin-American SLE inception cohort. All participating centers had specialized lupus clinics. Socio-demographic, clinical/laboratory, disease activity, damage, and mortality between those with a longer and a shorter time to diagnosis were compared using descriptive statistical tests. Multivariable Cox regression models with damage accrual and mortality as the end points were performed, adjusting for age at SLE diagnosis, gender, ethnicity, level of education, and highest dose of prednisone for damage accrual, plus highest dose of prednisone, baseline SLEDAI, and baseline SDI for mortality. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Of the 1437 included in these analyses, the median time to diagnosis was 6.0 months (Q1–Q3 2.4–16.2); in 721 (50.2%) the time to diagnosis was longer than 6 months. Patients whose diagnosis took longer than 6 months were more frequently female, older at diagnosis, of Mestizo ethnicity, not having medical insurance, and having “non-classic” SLE symptoms. Longer time to diagnosis had no impact on either damage accrual (HR 1.09, 95% CI 0.93–1.28, p = 0.300) or mortality (HR 1.37, 95% CI 0.88–2.12, p = 0.200). </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> In this inception cohort, a maximum time of 24 months with a median of 6 months to SLE diagnosis had no apparent negative impact on disease outcomes (damage accrual and mortality). </jats:p></jats:sec>
    Scopus© Citations 8  1
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    Factors associated with neuropsychiatric involvement in Latin American patients with systemic lupus erythematosus
    (2021)
    Leonor A Barile-Fabris
    ;
    Hilda Fragoso-Loyo
    ;
    Daniel Wojdyla
    ;
    Rosana Quintana
    ;
    Guillermo J Pons-Estel
    <jats:sec><jats:title>Introduction</jats:title><jats:p> Factors related to presentation of neuropsychiatric (NP) SLE manifestations, early in the course of the disease, and during follow up have not been clearly established. </jats:p></jats:sec><jats:sec><jats:title>Purpose</jats:title><jats:p> To identify disease and non-disease related factors associated with NP manifestations in early SLE. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> We included 1193 patients from the GLADEL inception cohort free of NP involvement at cohort entry. We evaluated the association of demographic, clinical and laboratory data with NP involvement during follow-up. </jats:p></jats:sec><jats:sec><jats:title>Statistical methods</jats:title><jats:p> Independent factors associated with NP involvement were identified using a multivariable Cox regression model. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Factors independently associated with NP manifestations were: mestizo ethnicity (HR 1.701, 95% CI 1.282–2.258, p = 0.0002), myalgias/myositis (HR 1.832, 95% CI 1.335–2.515, p = 0.0002), pneumonitis (HR 2.476, 95% CI 1.085–5.648, p = 0.0312), shrinking lung (HR 2.428, 95% CI 1.074–5.493, p = 0.0331) and hemolytic anemia (HR 1.629, 95% CI 1.130–2.347, p = 0.0089). Longer disease duration at cohort entry (13 to 24 months) was associated with a lower risk of developing NP manifestations (HR 0.642, 95% CI 0.441–0.934, p = 0.0206). </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Patients with myalgias/myositis, pneumonitis, shrinking lung and hemolytic anemia are at higher risk of NP involvement, whereas longer disease duration at cohort entry is associated with a lower risk of developing NP involvement. </jats:p></jats:sec>
      15Scopus© Citations 3