Abstract

Systemic Lupus Erythematosus (SLE) is a prototypical multiorgan autoimmune disease with a fluctuating and chronic disease course. As an emerging disease in this century, SLE will burden stakeholders and the country. This study was conducted to determine the prognostic factors for SLE worsening, especially in ambulatory patients. This ambispective study used logistic regression to view the risk factors for worsening SLE in patients. Anemia, age, body mass index, education level, employment status, marital status, hydroxychloroquine, and immunosuppressants were the independent variables in this study. This study concludes that anemia is statistically significant and, therefore, a risk factor for worsening SLE in patients (RR = 5.31; p-value

References

1. Lupus Foundation of America. Lupus facts and statistics: How common is lupus and who does it affect? Washington, DC: Lupus Foundation of America; 2021.

2. Kasper DL, Braunwald E, Hauser S. Harrison’s Principles of Internal Medicine. 16th ed. McGraw-Hill Professional; 2004.

3. Brinks R, Hoyer A, Weber S, et al. Age-specific and sex-specific incidence of systemic lupus erythematosus: An estimate from crosssectional claims data of 2.3 million people in the German statutory health insurance 2002. Lupus Sci Med. 2016; 3 (1): e000181. DOI: 10.1136/lupus-2016-000181

4. Mallavarapu RK, Grimsley EW. The history of lupus erythematosus. South Med J. 2007; 100 (9): 896-898. DOI: 10.1097/SMJ.0b013e318073c9eb

5. Uribe AG, Vilá LM, McGwin G Jr, et al. The Systemic Lupus Activity Measure-revised, the Mexican Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and a modified SLEDAI-2K are adequate instruments to measure disease activity in systemic lupus erythematosus. J Rheumatol. 2004; 31 (10): 1934-1940.

6. Ponticelli C, Moroni G. Hydroxychloroquine in systemic lupus erythematosus (SLE). Expert Opin Drug Saf. 2017; 16 (3): 411-419. DOI: 10.1080/14740338.2017.1269168

7. Kasturi S, Sammaritano LR. Corticosteroids in Lupus. Rheum Dis Clin North Am. 2016; 42 (1): 47-62, viii. DOI: 10.1016/j.rdc.2015.08.007

8. Kementerian Kesehatan Republik Indonesia. Situasi Lupus di Indonesia. Jakarta: Kementerian Kesehatan Republik Indonesia; 2013.

9. Fatoye F, Gebrye T, Mbada C. Global and regional prevalence and incidence of systemic lupus erythematosus in low-and-middle income countries: A systematic review and meta-analysis. Rheumatol Int.2022; 42 (12): 2097-2107. DOI: 10.1007/s00296-022-05183-4

10. Mok MY, Li WL. Do Asian patients have worse lupus? Lupus. 2010; 19 (12): 1384-1390. DOI: 10.1177/0961203310375832

11. Ward MM. Education level and mortality in systemic lupus erythematosus (SLE): Evidence of underascertainment of deaths due to SLE in ethnic minorities with low education levels. Arthritis Rheum. 2004; 51 (4): 616-624. DOI: 10.1002/art.20526

12. Adamichou C, Bertsias G. Flares in systemic lupus erythematosus: Diagnosis, risk factors and preventive strategies. Mediterr J Rheumatol. 2017; 28 (1): 4-12. DOI: 10.31138/mjr.28.1.4

13. Crampton SP, Morawski PA, Bolland S. Linking susceptibility genes and pathogenesis mechanisms using mouse models of systemic lupus erythematosus. Dis Model Mech. 2014; 7 (9): 1033-1046. DOI: 10.1242/dmm.016451

14. Al-Motwee S, Jawdat D, Jehani GS, et al. Association of HLADRB1*15 and HLADQB1*06 with SLE in Saudis. Ann Saudi Med. 2013; 33 (3): 229-234. DOI: 10.5144/0256-4947.2013.229

15. Azizah MR, Ainol SS, Kong NC, et al. HLA antigens in Malay patients with systemic lupus erythematosus: Association with clinical and autoantibody expression. Korean J Intern Med. 2001; 16 (2): 123-q31. DOI: 10.3904/kjim.2001.16.2.123

16. Weckerle CE, Niewold TB. The unexplained female predominance of systemic lupus erythematosus: Clues from genetic and cytokine studies. Clin Rev Allergy Immunol. 2011; 40 (1): 42-49. DOI: 10.1007/s12016-009-8192-4

17. Brinks R, Fischer-Betz R, Sander O, et al. Age-specific prevalence of diagnosed systemic lupus erythematosus in Germany 2002 and projection to 2030. Lupus. 2014; 23 (13): 1407-1411. DOI: 10.1177/0961203314540352

18. Ståhl-Hallengren C, Jönsen A, Nived O, Sturfelt G. Incidence studies of systemic lupus erythematosus in Southern Sweden: Increasing age, decreasing frequency of renal manifestations and good prognosis. J Rheumatol. 2000; 27 (3): 685-691.

19. Ohta A, Nagai M, Nishina M, et al. Age at onset and gender distribut - ion of systemic lupus erythematosus, polymyositis/derma to myositis, and systemic sclerosis in Japan. Mod Rheumatol. 2013; 23 (4): 759- 764. DOI: 10.1007/s10165-012-0733-7

20. Zen M, Bassi N, Nalotto L, et al. Disease activity patterns in a monocentric cohort of SLE patients: A seven-year follow-up study. Clin Exp Rheumatol. 2012; 30 (6): 856-863.

21. Conti F, Ceccarelli F, Perricone C, et al. Flare, persistently active disease, and serologically active clinically quiescent disease in systemic lupus erythematosus: A 2-year follow-up study. PLoS One. 2012; 7 (9): e45934. DOI: 10.1371/journal.pone.0045934

22. Voulgarelis M, Kokori SI, Ioannidis JP, et al. Anaemia in systemic lupus erythematosus: Aetiological profile and the role of erythropoietin. Ann Rheum Dis. 2000; 59 (3): 217-222. DOI: 10.1136/ard.59.3.217

23. Djulbegovic B. Autoimmune hemolytic anemia (Coombs’positive). In: Reasoning and decision making in hematology. New York: Churchill Livingstone; 1992. 51–6 p.

24. Kementerian Kesehatan Republik Indonesia. Pedoman Pencegahan dan Penanggulangan Anemia pada Remaja Putri dan Wanita Usia Subur (WUS). Jakarta: Kementerian Kesehatan Republik Indonesia; 2018.

25. Niu Z, Zhang P, Tong Y. Value of HLA-DR genotype in systemic lupus erythematosus and lupus nephritis: A meta-analysis. Int J Rheum Dis. 2015; 18 (1): 17-28. DOI: 10.1111/1756-185X.12528

26. Williams TM. Human leukocyte antigen gene polymorphism and the histocompatibility laboratory. J Mol Diagn. 2001; 3 (3): 98-104. DOI: 10.1016/S1525-1578(10)60658-7

27. Alcina A, Abad-Grau Mdel M, Fedetz M, et al. Multiple sclerosis risk variant HLA-DRB1*1501 associates with high expression of DRB1 gene in different human populations. PLoS One. 2012; 7 (1): e29819. DOI: 10.1371/journal.pone.0029819

Included in

Epidemiology Commons

Share

COinS