In recent years, there have been a number of really promising advancements made in the treatment of systemic lupus erythematosus. Unfortunately, patients who have developed this autoimmune disorder are still at risk for sustaining disease damage, especially if they are older and are taking corticosteroids for their condition.
In a recent clinical study on lupus, researchers found that the risk of disease damage was about three times as high for older patients who had been diagnosed with lupus after the age of 70, compared to lupus patients who were younger than 40. This lupus clinical trial was conducted by a research team from Johns Hopkins University under the command of Michele Petri, MD.
Are Current Lupus Treatments Meeting Their Goals?
Further analysis showed that the risk was even higher for those older patients who were currently taking at least 20 mg/day of corticosteroids. Interestingly enough, these types of treatments are used to try and minimize the disease's activity, while also preventing further damage that lupus could cause to the organs such as the heart, kidneys, or even the nervous system.
While conducting this lupus clinical study, Petri and her colleagues wanted to assess the degree to which these lupus treatment goals are being met by current practices. In order to get the clearest picture, the analyzed data that was obtained from the Hopkins Lupus Cohort, a program which started enrolling patients in 1987 and now has compiled more than 2,054 patients. More than half of this patient population is white, and nearly all of them are women.
The Hopkins Lupus Cohort
The patients who have enrolled in the cohort at Hopkins must come in for a checkup four times each year. During these routine visits, doctors will assess the level of disease activity, the damage caused by this autoimmune disease, and the therapeutic and serologic factors.
Medical researchers were able to set a mean rate of increase in the lupus disease damage index that was based on the follow-up periods. They reported that for an average follow-up schedule of 6.4 years, the mean rate for this index was 0.13 points per year.
However, they did observe higher annual damage scores among the male and African American patients, anyone who had tested positive for lupus anticoagulant, people who also had hypertension and proteinuria, and patients that possessed lower education or income levels.
What Impacted Disease Damage Risk?
Utilizing a univariate analysis of characteristics that vary over time, researchers noticed that patients with high rates of lupus activity, anti-double stranded DNA antibodies, and a low complement also possessed a higher risk of sustaining new damage during a given month. They also noticed that medications had an impact on damage risk (there were higher risks for patients taking cyclophosphamide and lower risks for patients taking hydroxychloroquine).
Following this lupus clinical trial, the research team noted that previous studies have identified African American lupus patients as being at a high risk for experiencing greater damage from this autoimmune disease. While this wasn't concluded in the multivariate analysis, it was supported by the univariate analysis of this cohort.
Other Important Findings from this Study
One other important finding from this study was that the presence of lupus anticoagulant was a better predictor of potential disease damage than the presence of anti-double stranded DNA. To medical researchers and scientists, this means that the antiphospholipid antibody has a bigger role to play in thrombotic events.
In the end, the most important result was that corticosteroids have been linked to a higher risk of organ damage for people living with lupus. In fact, this remains true for other medical conditions as well, including coronary artery disease, osteoporosis, and even stroke. Based off these results, this research team would conclude that less reliance on corticosteroid treatments and better control of the symptoms of lupus may help to limit future organ damage.
(Caution: the results of this study may be slightly skewed, given that members of this cohort are seen on a quarterly basis by their rheumatologist. This analysis may not play out accurately for a general population of lupus patients.)
In a recent clinical study on lupus, researchers found that the risk of disease damage was about three times as high for older patients who had been diagnosed with lupus after the age of 70, compared to lupus patients who were younger than 40. This lupus clinical trial was conducted by a research team from Johns Hopkins University under the command of Michele Petri, MD.
Are Current Lupus Treatments Meeting Their Goals?
Further analysis showed that the risk was even higher for those older patients who were currently taking at least 20 mg/day of corticosteroids. Interestingly enough, these types of treatments are used to try and minimize the disease's activity, while also preventing further damage that lupus could cause to the organs such as the heart, kidneys, or even the nervous system.
While conducting this lupus clinical study, Petri and her colleagues wanted to assess the degree to which these lupus treatment goals are being met by current practices. In order to get the clearest picture, the analyzed data that was obtained from the Hopkins Lupus Cohort, a program which started enrolling patients in 1987 and now has compiled more than 2,054 patients. More than half of this patient population is white, and nearly all of them are women.
The Hopkins Lupus Cohort
The patients who have enrolled in the cohort at Hopkins must come in for a checkup four times each year. During these routine visits, doctors will assess the level of disease activity, the damage caused by this autoimmune disease, and the therapeutic and serologic factors.
Medical researchers were able to set a mean rate of increase in the lupus disease damage index that was based on the follow-up periods. They reported that for an average follow-up schedule of 6.4 years, the mean rate for this index was 0.13 points per year.
However, they did observe higher annual damage scores among the male and African American patients, anyone who had tested positive for lupus anticoagulant, people who also had hypertension and proteinuria, and patients that possessed lower education or income levels.
What Impacted Disease Damage Risk?
Utilizing a univariate analysis of characteristics that vary over time, researchers noticed that patients with high rates of lupus activity, anti-double stranded DNA antibodies, and a low complement also possessed a higher risk of sustaining new damage during a given month. They also noticed that medications had an impact on damage risk (there were higher risks for patients taking cyclophosphamide and lower risks for patients taking hydroxychloroquine).
Following this lupus clinical trial, the research team noted that previous studies have identified African American lupus patients as being at a high risk for experiencing greater damage from this autoimmune disease. While this wasn't concluded in the multivariate analysis, it was supported by the univariate analysis of this cohort.
Other Important Findings from this Study
One other important finding from this study was that the presence of lupus anticoagulant was a better predictor of potential disease damage than the presence of anti-double stranded DNA. To medical researchers and scientists, this means that the antiphospholipid antibody has a bigger role to play in thrombotic events.
In the end, the most important result was that corticosteroids have been linked to a higher risk of organ damage for people living with lupus. In fact, this remains true for other medical conditions as well, including coronary artery disease, osteoporosis, and even stroke. Based off these results, this research team would conclude that less reliance on corticosteroid treatments and better control of the symptoms of lupus may help to limit future organ damage.
(Caution: the results of this study may be slightly skewed, given that members of this cohort are seen on a quarterly basis by their rheumatologist. This analysis may not play out accurately for a general population of lupus patients.)
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