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Ugarte-Gil, M. F.; Hanly, J.; Urowitz, M. B.; Gordon, C.; Bae, S. C.; Romero-Diaz, J.; Sanchez-Guerrero, J.; Bernatsky, S.; Clarke, A. E.; Wallace, D. J.; Isenberg, D.; Rahman, A.; Merrill, J. T.; Fortin, P.; Gladman, D. D.; Bruce, I. N.; Petri, M. A.; Ginzler, E. M.; Dooley, M. A.; Ramsey-Goldman, R.; Manzi, S.; Jonsen, A.; Van Vollenhoven, R.; Aranow, C.; Mackay, M.; Ruiz-Irastorza, G.; Lim, S. S.; Inanc, M.; Kalunian, K. C.; Jacobsen, S.; Peschken, C.; Kamen, D. L.; Askanase, A.; Pons-Estel, B.; Alarcon, G. S.
ISSN: 0003-4967
CID: 5017572

Accrual of atherosclerotic vascular events in a multicentre inception SLE cohort

Urowitz, M B; Gladman, D D; Farewell, V; Su, J; Romero-Diaz, J; Bae, S C; Fortin, P R; Sanchez-Guerrero, J; Clarke, A E; Bernatsky, S; Gordon, C; Hanly, J G; Wallace, D J; Isenberg, D; Rahman, A; Merrill, J; Ginzler, E; Alarcón, G S; Chatham, W W; Petri, M; Bruce, I N; Khamashta, M; Aranow, C; Dooley, M; Manzi, S; Ramsey-Goldman, R; Nived, O; Jönsen, A; Steinsson, K; Zoma, A; Ruiz-Irastorza, G; Lim, S; Kalunian, K C; Ỉnanç, M; van Vollenhoven, R; Ramos-Casals, M; Kamen, D L; Jacobsen, S; Peschken, C; Askanase, A; Stoll, T
BACKGROUND/PURPOSE/OBJECTIVE:In previously published work, atherosclerotic vascular events (AVE) occurred in approximately 10% of patients with SLE. We aimed to investigate the annual occurrence and potential risk factors for AVE in a multinational, multiethnic inception cohort of patients with SLE. METHODS:A large 33-centre cohort of SLE patients was followed yearly between 1999-2017. AVEs were attributed to atherosclerosis on the basis of SLE being inactive at the time of the AVE, and typical atherosclerotic changes on imaging or pathology, and/or evidence of atherosclerosis elsewhere. Analysis included descriptive statistics, rate of AVE's per 1000 patient-years, and univariable and multivariable relative risk regression models. RESULTS:Of the 1848 patients enrolled in the cohort, 1710 had at least one follow up visit after enrolment, for a total of 13,666 patient-years. Of 1710, 3.6% had one or more AVEs attributed to atherosclerosis, for an event rate of 4.6 per 1000 patient-years. In multivariable analyses, lower AVE rates were associated with antimalarials (HR: 0.54[95% CI 0.32, 0.91]) while higher AVE rates were associated with any prior vascular event (VE) (HR: 4.00[1.55,10.30]) and body mass index (BMI) >40 (HR: 2.74[1.04,7.18]) A prior AVE increased the risk for subsequent AVE (HR 5.42[3.17,9.27], p<0.001). CONCLUSION/CONCLUSIONS:The prevalence of AVE and rate of AVE accrual in this study is much lower than that seen in previously published data. This may be related to better control of both the disease activity and classic risk factors.
PMID: 32515554
ISSN: 2326-5205
CID: 4491642

Glucocorticosteroid usage and major organ damage in patients with systemic lupus erythematosus-meta-analyses of observational studies published between 1979 and 2018 [Meeting Abstract]

Mak, A; Cheung, M W L; Leong, W Y J; Dharmadhikari, B; Kow, N Y; Petri, M; Manzi, S; Clarke, A; Aranow, C; Arnaud, L; Askanase, A; Bae, S -C; Bernatsky, S; Bruce, I; Buyon, J; Chatham, W W; Costedoat-Chalumeau, N; Dooley, M A; Fortin, P; Ginzler, E M; Gladman, D; Gordon, C; Hanly, J G; Inanc, M; Isenberg, D A; Jacobsen, S; James, J; Jonsen, A; Kalunian, K C; Kamen, D; Lim, S S; Morand, E; Peschken, C; Pons-Estel, B A; Rahman, A; Ramsey-Goldman, R; Romero-Diaz, J; Ruiz-Irastorza, G; Sanchez-Guerrero, J; Steinsson, K; Svenungsson, E; Urowitz, M; Van, Vollenhoven R; Vinet, E; Voskuyl, A; Wallace, D J; Alarcon, G
Background/Purpose : The impact of glucocorticoid (GC) use on major organ damage in SLE patients has not been formally studied by amalgamating the relevant data published in the literature over the past 40 years. We aimed to study the association between GC use and the occurrence of major organ damage in SLE patients by performing meta-analyses of observational studies published between 1970 and December 2018. Methods : Literature search on PubMed (from 1966 to December 2018) for prevalence and longitudinal studies which reported GC exposure (proportion of GC users in the cohort [%GC use] and/or GC use in defined doses) and the occurrence (prevalence/incidence) of major organ damage in SLE patients using the keywords cataract, cerebrovascular (CVA), stroke, cardiovascular (CVS), angina, myocardial infarction (MI), coronary artery bypass, osteoporosis, avascular necrosis (AVN) and osteonecrosis in respective combinations with lupus was conducted. Studies with sample size < 50 and observation duration < 12 months were excluded. The logit of the proportion of patients with disease damage was modelled as a random effect in the meta-analysis, which was employed to study the association between the proportion of patients with organ damage and variables of GC use (mean daily [mg/day] and cumulative [gm] prednisone [PDN] doses and %GC use). A 2-stage estimation of the random-effects logistic regression models was used with restricted maximum likelihood estimation. Univariate associations between organ damage and moderators were examined for statistical significance, and variables related to GC use were adjusted for SLE disease duration in multivariate models if their univariate P values were < 0.2. Results : Out of 8,882 publications screened, 212 articles involving 205,619 SLE patients were eligible for the metaanalyses (Figure 1), of which 97 were prevalence and 115 were longitudinal studies. Univariate analyses of prevalence studies revealed that mean daily PDN dose (odds ratio [OR]=1.10, p=0.007) and lower proportion of female in the cohort (OR=0.002, p=0.002) were associated with the prevalence of overall CVS events. Mean daily PDN dose (OR=1.52, p< 0.001) and %GC use (OR=2,255.2, p< 0.001) were associated with the prevalence of AVN. A significant association between cumulative PDN dose and prevalence of CVA was found after multivariate adjustment for SLE disease duration (OR=1.07, p=0.017). In longitudinal studies, a significant association was identified between cumulative PDN dose and incidence of cataracts after adjustment for SLE disease duration (OR=1.04, p=0.013). While the incidence of MI in SLE patients has dropped over the past 40 years (OR=0.94, p=0.002), it was associated with % GC use after adjustment for SLE disease duration (OR=8.18, p=0.012). Interestingly, significant univariate associations were found between antimalarial use and lower prevalence of MI (OR=0.05, p=0.002) and lower incidence of CVA (OR=0.20, p=0.032). Conclusion : Independent of SLE disease duration, cumulative PDN dose was associated with higher prevalence of CVA and incidence of cataracts, and higher incidence of MI was associated with overall GC use
ISSN: 2326-5205
CID: 4633432

Cancer risk in a large inception SLE cohort: Effects of age, smoking, and medications [Meeting Abstract]

Bernatsky, S; Ramsey-Goldman, R; Urowitz, M; Hanly, J; Gordon, C; Petri, M; Ginzler, E M; Wallace, D J; Bae, S -C; Romero-Diaz, J; Dooley, M A; Peschken, C; Isenberg, D A; Rahman, A; Manzi, S; Jacobsen, S; Lim, S S; Van, Vollenhoven R F; Nived, O; Kamen, D; Aranow, C; Buyon, J; Ruiz-Irastorza, G; Bruce, I; Gladman, D; Fortin, P; Merrill, J T; Sanchez-Guerrero, J; Kalunian, K C; Steinsson, K; Ramos, M; Zoma, A; Stoll, T; Khamashta, M A; Inanc, M; Clarke, A E
Background/Purpose : Many studies of cancer risk in SLE are limited by small sample size or use of administrative data, which rely on billing code diagnoses instead of clinical data. No studies to date focused on incident SLE. We studied cancer risk in the largest-ever cohort of clinically confirmed incident SLE patients. Methods : Patients meeting ACR criteria for new-onset SLE (within 15 months of diagnosis) were enrolled into the SLICC Inception Cohort, across 32 centres. Patients are followed yearly using a standard protocol, with detailed data collection including SLE Disease Activity Index-2000 (SLEDAI-2K) and damage, and drugs in the past year. New cancer diagnoses are recorded by the examining physician at the annual study visit, and confirmed with chart review including pathology reports. Multivariate proportional hazard regression was performed, using baseline variables for demographics (age at SLE onset, sex, race/ethnicity), and time-dependent variables for drugs (corticosteroids, anti-malarial drugs, immunosup-pressive drugs), smoking, and SLEDAI-2K. As well as cancer over-all, we evaluated risk factors for the most common cancer types. Results : Of 1848 new-onset SLE patients enrolled between 1999-2011, 1668 had at least one follow-up; these were the sample for the current analysis. End date was the first of death, last visit, or end of study interval for this analysis (Aug. 2015). Baseline demographics are shown in Table 1. Over 14,215 years (mean 8.5 years) there were 60 cancers (incidence 4. 2 events per 1,000 patient-years). This included 12 breast cancers, 9 non-melanoma skin, 7 lung, 6 hematological, 5 melanoma, 5 prostate, 3 cervical, 3 renal, 2 gastric, 2 head and neck, 2 thyroid, and one each rectal, sarcoma, thymoma, and uterine. Almost half of the cancer cases (including all of the lung cancers) were associated with baseline smoking, versus only one-third of those patients who did not develop cancer. Univariate analyses of all cancer types suggested a higher risk of cancer among patients of white race/ethnicity and among those with the highest quartile of disease activity at cohort entry. However, the multivariate proportional hazard regression indicated that among SLE patients, the over-all cancer risk was related primarily to male sex and older age at SLE diagnosis. In those analyses, the effect of race/ethnicity was not clearly evident, and the point estimate for highest quartile of disease activity actually reversed to suggest a nonsignificant trend towards lower cancer risk. In the multivariate analyses specifically for breast cancer, age at SLE diagnoses remained a risk factor, and antimalarials were associated with a decreased risk. This effect of anti-malarials was not clearly seen for any other cancer type. For non-melanoma skin cancer, both age at SLE diagnosis and cyclophosphamide were strongly linked with risk. Conclusion : This is the first large, multicentre cohort study to clearly show how different cancer types in SLE are associated with specific risk factors. Additional follow-up may allow additional determination of the possible effects of disease activity and drugs on cancer subtypes
ISSN: 2326-5205
CID: 4633802

Dietary intake regulates the circulating inflammatory monocyte pool [Meeting Abstract]

Jordan, S.; Tung, N.; Casanova-Acebes, M.; Chang, C.; Cantoni, C.; Zhang, D.; Wirtz, T.; Naik, S.; Rose, S.; Brocker, C.; Gainullina, A.; Maier, B.; LeRoith, D.; Gonzalez, F.; Meissner, F.; Ochando, J.; Rahman, A.; Chipuk, J.; Artyomov, M.; Frenette, P.; Piccio, L.; Horng, S.; Berres, M. L.; Gallagher, E.; Merad, M.
ISSN: 0014-2980
CID: 4124732

Economic evaluation of damage accrual in an international sle inception cohort [Meeting Abstract]

Clarke, A E; Bruce, I N; Urowitz, M B; Hanly, J G; Romero-Diaz, J; Gordon, C; Bae, S -C; Bernatsky, S; Wallace, D J; Merrill, J T; Isenberg, D A; Rahman, A; Ginzler, E M; Petri, M; Dooley, M A; Fortin, P; Gladman, D D; Sanchez-Guerrero, J; Steinsson, K; Ramsey-Goldman, R; Khamashta, M A; Aranow, C; Alarcon, G S; Manzi, S; Nived, O; Zoma, A A; Van, Vollenhoven R F; Ramos-Casals, M; Ruiz-Irastorza, G; Sam, Lim S; Kalunian, K C; Inanc, M; Kamen, D L; Peschken, C A; Jacobsen, S; Askanase, A; Pierre, Y S; Su, L; Farewell, V
Background Little is known about the association of healthcare costs with damage accrual in SLE. We describe the costsassociated with damage progression using multi-statemodeling.Methods Patients fulfilling the revised ACR Classification Criteria for SLE from 32 centres in 11 countries were enrolledin the Systemic Lupus International Collaborating Clinics(SLICC) inception cohort within 15 months of diagnosis.Annual data on demographics, SLE disease activity (SLEDAI-2K), damage (SLICC/ACR Damage Index [SDI] if-6 monthsfrom diagnosis), hospitalizations, medications, dialysis, and utilization of selected medical/surgical procedures were collected.Annual health resource utilization was costed using 2017Canadian prices. Annual costs associated with SDI states wereobtained from multiple regressions adjusting for age, sex, race/ethnicity, and disease duration. As there were relatively fewtransitions to SDI states 5 11, these were merged into a singleSDI state. Five and 10 year cumulative costs were estimatedby multiplying annual costs associated with each SDI state bythe expected duration in each state, which was forecastedusing a multi-state model and longitudinal SDI data from theSLICC Inception Cohort (Bruce IN et al. Ann Rheum Dis2015;74:1706 13). Future costs were discounted at a yearlyrate of 3%.Results 1676 patients participated, 88.7% female, 49.2% Caucasian, mean age at diagnosis 34.6 years (SD 13.4), mean disease duration at enrollment 0.5 years (range 0 1.3 years), andmean follow up 7.8 years (range 0.6 16.9 years). Healthresource utilization and annual costs (after adjustment usingregression) were markedly higher in those with higher SDIs(SDI=0, annual costs $1847, 95% CI $1120 to $2574;SDI-5, annual costs $26 772, 95% CI $19 631 to $33 813).At SDI<=2, hospitalizations and medications accounted for97.1% of direct costs, whereas at SDI-3, dialysis was responsible for 55.0%.Five and 10 year cumulative costs stratified by baseline SDIwere calculated by multiplying the annual costs associatedwith each SDI by the expected duration in that state. Fiveand 10 year costs were greater in those with the highest SDIsat baseline (table 1).Conclusions Patients with the highest baseline SDIs incurannual costs and 10 year cumulative costs that are at least 10-fold higher than those with the lowest baseline SDI. By estimating the expected duration in each SDI state and incorporating annual costs, disease severity at presentation can beused to predict future healthcare costs, critical knowledge forcost-effectiveness evaluations of novel therapies
ISSN: 2053-8790
CID: 3729952

Evolution of disease burden over five years in a multicenter inception systemic lupus erythematosus cohort

Urowitz, M B; Gladman, D D; Ibañez, D; Fortin, P R; Bae, S C; Gordon, C; Clarke, A; Bernatsky, S; Hanly, J G; Isenberg, D; Rahman, A; Sanchez-Guerrero, J; Wallace, D J; Ginzler, E; Alarcón, G S; Merrill, J T; Bruce, I N; Sturfelt, G; Nived, O; Steinsson, K; Khamashta, M; Petri, M; Manzi, S; Ramsey-Goldman, R; Dooley, M A; van Vollenhoven, R F; Ramos, M; Stoll, T; Zoma, A; Kalunian, K; Aranow, C
OBJECTIVE:We describe disease activity, damage, and the accrual of key autoantibodies in an inception systemic lupus erythematosus (SLE) cohort. METHODS:The Systemic Lupus International Collaborating Clinics (SLICC) International Research Network, comprising 27 centers from 11 countries, has followed an inception cohort of SLE patients yearly according to a standardized protocol. Of these patients, 298 were followed for a minimum of 5 years and constitute the study population. Disease activity was assessed using the SLE Disease Activity Index 2000 (SLEDAI-2K) and damage was assessed using the SLICC/American College of Rheumatology Damage Index (SDI). Antinuclear antibody (ANA), anti-DNA, and anticardiolipin antibody (aCL) levels and lupus anticoagulant were assessed yearly. Descriptive statistics were generated and repeated-measures general linear models were used to evaluate SLEDAI-2K and SDI over time between whites and nonwhites. RESULTS:Of the 298 patients, 87% were women, 55% were white, 12% were African American, 14% were Asian, 16% were Hispanic, and 2% were categorized as "other." At enrollment, the mean age was 35.3 years, the mean SLEDAI-2K score was 5.9, and the mean disease duration was 5.5 months. Mean SLEDAI-2K scores decreased in the first year and then remained low. SLEDAI-2K scores were significantly lower at each year in whites compared to nonwhites. Mean SDI scores increased progressively over 5 years; there was no significant difference between whites and nonwhites. As expected, ANA positivity was high and anti-DNA positivity was relatively low at enrollment, and both increased over 5 years. Although lupus anticoagulant increased slightly over 5 years, aCL positivity did not. CONCLUSION/CONCLUSIONS:Disease activity in newly diagnosed patients decreases over their first 5 years, while damage increases. Antibody positivity ran variable courses over this period.
PMID: 21954226
ISSN: 2151-4658
CID: 4874502

Autoantibodies as biomarkers for the prediction of neuropsychiatric events in systemic lupus erythematosus

Hanly, J G; Urowitz, M B; Su, L; Bae, S-C; Gordon, C; Clarke, A; Bernatsky, S; Vasudevan, A; Isenberg, D; Rahman, A; Wallace, D J; Fortin, P R; Gladman, D; Romero-Diaz, J; Romero-Dirz, J; Sanchez-Guerrero, J; Dooley, M A; Bruce, I; Steinsson, K; Khamashta, M; Manzi, S; Ramsey-Goldman, R; Sturfelt, G; Nived, O; van Vollenhoven, R; Ramos-Casals, M; Aranow, C; Mackay, M; Kalunian, K; Alarcón, G S; Fessler, B J; Ruiz-Irastorza, G; Petri, M; Lim, S; Kamen, D; Peschken, C; Farewell, V; Thompson, K; Theriault, C; Merrill, J T
OBJECTIVE:Neuropsychiatric events occur unpredictably in systemic lupus erythematosus (SLE) and most biomarker associations remain to be prospectively validated. This study examined a disease inception cohort of 1047 SLE patients to determine which autoantibodies at enrolment predicted subsequent neuropsychiatric events. METHODS:Patients with a recent SLE diagnosis were assessed prospectively for up to 10 years for neuropsychiatric events using the American College of Rheumatology case definitions. Decision rules of graded stringency determined whether neuropsychiatric events were attributable to SLE. Associations between the first neuropsychiatric event and baseline autoantibodies (lupus anticoagulant (LA), anticardiolipin, anti-β(2) glycoprotein-I, anti-ribosomal P and anti-NR2 glutamate receptor) were tested by Cox proportional hazards regression. RESULTS:Disease duration at enrolment was 5.4 ± 4.2 months, follow-up was 3.6 ± 2.6 years. Patients were 89.1% female with mean (±SD) age 35.2 ± 13.7 years. 495/1047 (47.3%) developed one or more neuropsychiatric event (total 917 events). Neuropsychiatric events attributed to SLE were 15.4% (model A) and 28.2% (model B). At enrolment 21.9% of patients had LA, 13.4% anticardiolipin, 15.1% anti-β(2) glycoprotein-I, 9.2% anti-ribosomal P and 13.7% anti-NR2 antibodies. LA at baseline was associated with subsequent intracranial thrombosis (total n=22) attributed to SLE (model B) (HR 2.54, 95% CI 1.08 to 5.94). Anti-ribosomal P antibody was associated with subsequent psychosis (total n=14) attributed to SLE (model B) (HR 3.92, 95% CI 1.23 to 12.5, p=0.02). Other autoantibodies did not predict neuropsychiatric events. CONCLUSION/CONCLUSIONS:In a prospective study of 1047 recently diagnosed SLE patients, LA and anti-ribosomal P antibodies are associated with an increased future risk of intracranial thrombosis and lupus psychosis, respectively.
PMID: 21893582
ISSN: 1468-2060
CID: 4874492

SF-36 summary and subscale scores are reliable outcomes of neuropsychiatric events in systemic lupus erythematosus

Hanly, J G; Urowitz, M B; Jackson, D; Bae, S C; Gordon, C; Wallace, D J; Clarke, A; Bernatsky, S; Vasudevan, A; Isenberg, D; Rahman, A; Sanchez-Guerrero, J; Romero-Diaz, J; Merrill, J T; Fortin, P R; Gladman, D D; Bruce, I N; Steinsson, K; Khamashta, M; Alarcón, G S; Fessler, B; Petri, M; Manzi, S; Nived, O; Sturfelt, G; Ramsey-Goldman, R; Dooley, M A; Aranow, C; Van Vollenhoven, R; Ramos-Casals, M; Zoma, A; Kalunian, K; Farewell, V
OBJECTIVE:To examine change in health-related quality of life in association with clinical outcomes of neuropsychiatric events in systemic lupus erythematosus (SLE). METHODS:An international study evaluated newly diagnosed SLE patients for neuropsychiatric events attributed to SLE and non-SLE causes. The outcome of events was determined by a physician-completed seven-point scale and compared with patient-completed Short Form 36 (SF-36) health survey questionnaires. Statistical analysis used linear mixed-effects regression models with patient-specific random effects. RESULTS:274 patients (92% female; 68% Caucasian), from a cohort of 1400, had one or more neuropsychiatric event in which the interval between assessments was 12.3 ± 2 months. The overall difference in change between visits in mental component summary (MCS) scores of the SF-36 was significant (p<0.0001) following adjustments for gender, ethnicity, centre and previous score. A consistent improvement in neuropsychiatric status (N=295) was associated with an increase in the mean (SD) adjusted MCS score of 3.66 (0.89) in SF-36 scores. Between paired visits when the neuropsychiatric status consistently deteriorated (N=30), the adjusted MCS score decreased by 4.00 (1.96). For the physical component summary scores the corresponding changes were +1.73 (0.71) and -0.62 (1.58) (p<0.05), respectively. Changes in SF-36 subscales were in the same direction (p<0.05; with the exception of role physical). Sensitivity analyses confirmed these findings. Adjustment for age, education, medications, SLE disease activity, organ damage, disease duration, attribution and characteristics of neuropsychiatric events did not substantially alter the results. CONCLUSION/CONCLUSIONS:Changes in SF-36 summary and subscale scores, in particular those related to mental health, are strongly associated with the clinical outcome of neuropsychiatric events in SLE patients.
PMID: 21342917
ISSN: 1468-2060
CID: 4874472

Atherosclerotic vascular events in a multinational inception cohort of systemic lupus erythematosus

Urowitz, M B; Gladman, D; Ibañez, D; Bae, S C; Sanchez-Guerrero, J; Gordon, C; Clarke, A; Bernatsky, S; Fortin, P R; Hanly, J G; Wallace, D J; Isenberg, D; Rahman, A; Alarcón, G S; Merrill, J T; Ginzler, E; Khamashta, M; Nived, O; Sturfelt, G; Bruce, I N; Steinsson, K; Manzi, S; Ramsey-Goldman, R; Dooley, M A; Zoma, A; Kalunian, K; Ramos, M; Van Vollenhoven, R F; Aranow, C; Stoll, T; Petri, M; Maddison, P
OBJECTIVE:To describe vascular events during an 8-year followup in a multicenter systemic lupus erythematosus (SLE) inception cohort and their attribution to atherosclerosis. METHODS:Clinical data, including comorbidities, were recorded yearly. Vascular events were recorded and attributed to atherosclerosis or not. All of the events met standard clinical criteria. Factors associated with atherosclerotic vascular events were analyzed using descriptive statistics, t-tests, and chi-square tests. Stepwise multivariate logistic regression was used to assess the association of factors with vascular events attributed to atherosclerosis. RESULTS:Since 2000, 1,249 patients have been entered into the cohort. There have been 97 vascular events in 72 patients, including: myocardial infarction (n = 13), angina (n = 15), congestive heart failure (n = 24), peripheral vascular disease (n = 8), transient ischemic attack (n = 13), stroke (n = 23), and pacemaker insertion (n = 1). Fifty of the events were attributed to active lupus, 31 events in 22 patients were attributed to atherosclerosis, and 16 events were attributed to other causes. The mean +/- SD time from diagnosis to the first atherosclerotic event was 2.0 +/- 1.5 years. Compared with patients followed for 2 years without atherosclerotic events (n = 615), at enrollment, patients with atherosclerotic vascular events were more frequently white, men, older at diagnosis of SLE, obese, smokers, hypertensive, and had a family history of coronary artery disease. On multivariate analysis, only male sex and older age at diagnosis were associated factors. CONCLUSION/CONCLUSIONS:In an inception cohort with SLE followed for up to 8 years, there were 97 vascular events, but only 31 were attributable to atherosclerosis. Patients with atherosclerotic events were more likely to be men and to be older at diagnosis of SLE.
PMID: 20535799
ISSN: 2151-4658
CID: 4274352