Data from a prospective study of the features of systemic lupus erythematosus in patients of Kyrgyzstan (Eurasian RENAISSANCE Register)

Objective: to study and analyze the clinical and laboratory manifestations, course, and outcome of systemic lupus erythematosus (SLE) in patients living in Kyrgyzstan.

Patients and methods. The prospective study included 150 young patients aged 34 [26, 44] years in a Kyrgyz cohort (KC) with SLE, the disease of which was 3.0 [0.7; 10] years. All clinical, laboratory, and instrumental data of patients, health-related quality of life (HRQOL) indicators, and treatment regimens were recorded in the international research base, such as British Lupus Integrated Prospective System (BLIPS). SLE activity was assessed using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K). At the end of the observation, the investigators assessed the following indicators: the number of exacerbations of SLE by the SELENA Flare Index (SFI); the onset of complete or drug-induced remission; the number of deaths; and the development of irreversible organ damages (IOD) according to the damage index (DI).

Results and discussion. When seeing the physician for the first time, the KC included more patients with high (n=61 (40.66%)) and very high (n=40 (26.67%)) disease activity. Most (n=60 (40%)) patients were observed to have a subacute type of the course of the disease. At the first visit, the most common manifestations of SLE were damages to the skin (n=99 (72.67%)), serous membranes (n=91 (60.67%)), and lupus nephritis (n=79 (52.67%)). IODs were identified in 15.33% of the patients and were absent in 84.67%. IODs were more often due to the administration of glucocorticoids (GCs) in 43.48% of cases. However, GC therapy was not a predictor of organ damages (relative risk, 0.91; p>0.05). In the KC, the significant predictors of adverse outcomes were old-age onset SLE and its high activity, acute course, and frequent exacerbations.

Conclusion. The KC patients had high and very high clinical and laboratory activities (40.6 and 26.6%, respectively), mainly those of acute and subacute SLE (32 and 40%, respectively), obvious immunological disorders. There was a preponderance of damages to the skin (73%), serous membranes (61%), and kidney (53%) among the clinical manifestations of SLE. IODs were found in 15.33% of patients at their study inclusion. These were more frequently represented by GC-induced changes. However, the ongoing GC therapy in the KC patients was not a predictor of organ damages. The significant predictors of an adverse outcome in our patients were old-age onset SLE and its high activity, acute course, and frequent exacerbations. 

1. Nasonov EL. Klinicheskie rekomendatsii po revmatologii [Clinical recommendations for rheumatology]. Moscow: GEOTAR-Media; 2010. P. 429-81 (In Russ.).

2. Ivanova MM. The prognosis of the disease and treatment features of patients with systemic lupus erythematosus in various age groups. Terapevticheskiy Arkhiv. 1985;(6): 125-8 (In Russ.).

3. Villa-Blanco I, Calvo-Alen J. Utilizing registries in systemic lupus erythematosus clinical research. Expert Rev Clin Immunol. 2012; 8:353-60. doi: 10.1586/eci.12.20

4. Pego-Reigosa JM, Rua-Figueroa I, LopezLongo FJ, et al. Analysis of disease activity and response to treatment in a large Spanish cohort of patients with systemic lupus erythematosus. Lupus. 2014;0:1-10.

5. Pons-Ester GJ, Saurit V, Alarson GS, et al. The impact of systemic lupus erythematosus: data from a multiethnic Latin American cohort. Lupus. 2012;21(13):1397-404. doi: 10.1177/0961203312458465. Epub 2012 Aug. 31.

6. Ihes L, Silva C, Galindo M, et al. Classification of systemic lupus erythematosus: Systemic lupus International Collaboratimg Clinics Versus Ameican College of Rheumatology Criteria. A comporative study of 2,055 patients from a real-life, international systemic lupus erythematosus cohort. Arthritis Care Res (Hoboken). 2015 Aug;67(8):1180-5. doi: 10.1022/acr.22539

7. Kasitanon N, Intaniwet T, Wangkaew S, et al. The clinically quiescent phase in early-diagnosed SLE patients: inseption cohort study. Rheumatology (Oxford). 2015 May;54(5): 868-75. doi: 10.1039/rheumatology/key 406. Epub 2014 Oct. 21.

8. Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;40(9):1725. doi: 10.1002/art.1780400928

9. Petri M, Orbai A, Alarson G, et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics Classification Criteria for Systemic lupus erythematosus. Arthritis Rheum. 2012;64(8): 2677-86. doi: 10.1002/art.34473

10. Gladman DD, Ibanez D, Urowitz MB. Systemic lupus erythematosus disease activity index 2000. J Rheumatol. 2002;29:288-91.

11. Nived O, Jonsen A, Bengtsson A, et al. High predictive value of Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index for survival in systemic lupus erythematosus. J Rheumatol. 2002;29:398-400.

12. The American of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum. 1999;42:599-608. doi: 10.1002/1529-0131 (199904)42:43.0.CO;2-F

13. Тареева ИЕ, Янушкевич ТН. Волчаночный нефрит у мужчин и женщин. Ревматология. 1985;(2):14-6. [Tareeva IE, Yanushkevich TN. Lupus nephritis in men and women. Revmatologiya. 1985;(2):14-6 (In Russ.)].

14. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2013;3 Suppl:1-150.

15. Akbarian M, Faezi ST, Gharibdoost F, Shahram F. Systemic lupus erythematosus in Iran: A study of 2280 patients over 33 years. Int J Rheum Dis. 2010;13(4):374-9. doi: 10.1111/j.1756-185X.2010.01547.x

16. Flower C, Hennis AJ, Hambleton IR, et al. Systemic lupus erythematosus in an African Caribbean population: Incidence, clinical manifestations, and survival in the Barbados National Lupus Registry. Arthritis Care Res. 2012;64(8):1151-8. doi: 10.1002/acr.21656

17. Peschken CA, Katz SJ, Silverman E, Pope JE. The 1000 Canadian faces of lupus: Determinants of disease outcome in a large multiethnic cohort. J Rheumatol. 2009;36(6): 1200-8. doi: 10.3899/jrheum.080912

18. Cervera R, Khamashta MA, Font J. Morbidity and mortality in lupus erythematosus during a 5-year period: a multicenter prospective study of 1000 patients. European working party on systemic lupus erythematosus. Medicine (Baltimore). 1999;78:167-75. doi: 10.1097/00005792-199905000-00003

19. Uramoto KM, Michet CJ, Thumboo J, et al. Trends in the incidence and mortality of systemic lupus erythematosus 1950–1992. Arthritis Rheum. 1999;42:46-50. doi: 10.1002/1529-0131(199901)42:13.0.CO;2-2

20. Kammer GM, Mishra N. Systemic lupus erythematosus in the elderly. Rheum Dis Clin North Am. 2000;26:475-92. doi: 10.1016/S0889-857X (05)70152-6

21. Alarcon GS, McGwin G Jr, Bastian HM, et al. Systemic lupus erythematosus in three ethnic groups. VII (correction of VIII). Predictors of early mortality in the LUMINA cohort. LUMINA Study Group. Arthritis Rheum. 2001;45:191-202. doi: 10.1002/1529-0131(200104)45:23.0. CO;2-2 Erratum in: Arthritis Rheum 2001;45:306.

22. Alarcon GS, Roseman J, Bartolucci AA, et al. Systemic lupus erythematosus in three ethnic groups: II. Features predictive of disease activity early in its course. LUMINA Study Group. Lupus in minority populations, nature versus nurture. Arthritis Rheum. 1998; 41:1173-80. doi: 10.1002/1529-0131(199807) 41:73.0.CO;2-A

23. Petri M, Genovese M. Incidence of and risk factors for hospitalizations in systemic lupus erythematosus: a prospective study of the Hopkins Lupus Cohort. J Rheumatol. 1992;19:1559-65.

24. Dooley MA, Hogan S, Jennette C, Falk R. Cyclophosphamide therapy for lupus nephritis: poor renal survival in black Americans. Glomerular Disease Collaborative Network. Kidney Int. 1997;51:1188-95. doi: 10.1038/ki.1997.162

25. Ward MM, Studenski S. Clinical manifestations of systemic lupus erythematosus. Identification of racial and socioeconomic influences. Arch Intern Med. 1990;150:849-53. doi: 10.1001/archinte.1990.00390160099020

26. Franco C, Yoo W, Franco D, Xu Z. Predictors of end stage renal disease in African Americans with lupus nephritis. Bull NY Hospital Joint Dis. 2010;68(4):251-6.

27. Rua-Figueroa I, Richi P, Lopez-Longo FJ, et al. Comprehensive Description of Clinical Characteristics of a Large Systemic Lupus Erythematosus Cohort from the Spanish Rheumatology Society Lupus Registry (RELESSER) With Emphasis on Complete Versus Incomplete Lupus Differences. Medicine (Baltimore). 2015 Jan;94(1):e267. doi: 10.1097/MD.0000000000000267

28. Joo YB, Bae SC. Assessment of clinical manifestations, disease activity and organ damage in 996 Korean patients with systemic lupus erythematosus: Comparison with other Asian populations. Int J Rheum Dis. 2015; 18(2):117-28. doi: 10.1111/1756-185X.12462

29. Khanfir MS, Houman MH, Cherif E, Hamzaoui A. TULUP (TUnisian LUPus): A multicentric study of systemic lupus erythematosus in Tunisia. Int J Rheum Dis. 2013;16(5): 539-46. doi: 10.1111/1756-185X.12152

30. Bertoli M, Alarcon GS, Tsokos GC, et al, editors. Epidemiology of systemic lupus erythematosus. Systemic lupus erythematosus, a Companion to Rheumatology. Philadelphia, PA: Mosby-Elsevier; 2007. P. 1-18.

31. Carreno L, Lopez-Longo FJ, Monteagudo I, et al. Immunological and clinical differences between juvenile and adult onset of systemic lupus erythematosus. Lupus. 1999;8:287-92. doi: 10.1191/096120399678847786

32. Sutton EJ, Davidson JE, Bruce IN. The systemic lupus international collaboratimg clinics (SLICC) damage index: a systematic literature review. Semin Arthritis Rheum. 2013 Dec;43(3):352-61. doi: 10.16/j.semarthrit.2013.05.003

33. Ravelli A, Duarte-Salazar C, Buratti S, et al. Assesssment of damage in juvenile – onset systemic lupus erythematosus: a multicenter cohort study. Arthritis Rheum. 2003; 49(4):501-7. doi: 10.1002/art.11205

34. Conti F, Ceccarelli F, Perricone C. The chronic damage in systemic lupus erythematosus is driven by flares, glucocorticoids and antiphospholipid antibodies: results from a monocentric cohort. Lupus. 2016;25(7): 719-26. doi: 10.1177/0961203315627199

35. Li M, Zhang W, Leng X, et al. Chienese SLE treatment and Research Group Registry III: Assocation on autoantibodies with Clinical manifestations in Chienese patients with systemic lupus erythematosus. J Immunolog Res. 2014;Article ID 809389, 8 p. doi: 10.1155/2014/809389

36. Goncalves MJ, Sousa S, Ines LS, et al. Characterization of damagr in Portuguese lupus patients: analysis of a national lupus registry. Lupus. 2015 Mar;24(3):256-62. doi: 10.1177/0961203314555172

37. Ribi C, Trendelenburg M, Gayet-Ageron A, et al. The Swiss systemic lupus erythematosus Cohort Study (SSCS)-cross-sectional analysis of clinical characteristics and treatments across different medical disciplines in Switzerland. Swiss Med Wkly. 2014;144:w13990. doi: 10.4414/smw.2014.13990

38. Ten CL, Ling GR, Aishan WS. The Sarawak lupus cohort: clinical features and disease patterns 0f 633 SLE patients in a single tertiary centre from East Malaysia. Rheumatol Int. 2015 Jan;35(1):153-7. doi: 10.1007/s00296-014-3057-4

39. Carli L, Tani C, Spera V, et al. Ris factors for osteoporosis and fragility in pateients with systemic lupus erythematosus. Lupus Sci Med. 2016;3(1):e000098. doi: 10.1136/lupus-2015-000098