2013 Update: Hopkins Lupus Cohort

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Abstract

The Hopkins lupus cohort is a longitudinal cohort study of over 2,000 systemic lupus erythematosus (SLE) patients, who are seen quarterly. This review covers ten important clinically-relevant studies of the cohort. These studies include the function of prednisone in atherosclerosis and thrombosis, the preventive function of hydroxychloroquine, new insights into rare neurological manifestations, and treatment of flares with bursts of steroids rather than maintenance steroids.

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Most cited references 37

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Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study.

S Manzi, E Meilahn, J. E Rairie … (1997)

The authors ascertained cardiovascular events (myocardial infarction and angina pectoris) in 498 women with systemic lupus erythematosus seen at the University of Pittsburgh Medical Center from 1980 to 1993 (3,522 person-years). Subjects were stratified by age, and cardiovascular event incidence rates were determined. The authors compared these rates with cardiovascular event rates were determined. The authors compared these rates with cardiovascular event rates occurring over the same time period in 2,208 women of similar age participating in the Framingham Offspring Study (17,519 person-years). Age-specific rate ratios were computed to determine whether the cardiovascular events in the lupus cohort were greater than expected. The risk factors associated with cardiovascular events in women with lupus were determined. There were 33 first events (11 myocardial infarction, 10 angina pectoris, and 12 both angina pectoris and myocardial infarction) after the diagnosis of lupus: two thirds were under the age of 55 years at the time of event. Women with lupus in the 35- to 44-year age group were over 50 times more likely to have a myocardial infarction than were women of similar age in the Framingham Offspring Study (rate ratio = 52.43, 95% confidence interval 21.6-98.5). Older age at lupus diagnosis, longer lupus disease duration, longer duration of corticosteroid use, hypercholesterolemia, and postmenopausal status were more common in the women with lupus who had a cardiovascular event than in those who did not have an event. Premature cardiovascular disease is much more common in young premenopausal women with lupus than in a population sample. With the increased life expectancy of lupus patients due to improved therapy, cardiovascular disease has emerged as a significant threat to the health of these women. The impact of this problem has been underrecognized, with little focus placed on aggressive management of hypercholesterolemia and other possible risk factors.

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Combined oral contraceptives in women with systemic lupus erythematosus.

Michelle Petri, Mimi Y. Kim, Kenneth Kalunian … (2005)

Oral contraceptives are rarely prescribed for women with systemic lupus erythematosus, because of concern about potential negative side effects. In this double-blind, randomized, noninferiority trial, we prospectively evaluated the effect of oral contraceptives on lupus activity in premenopausal women with systemic lupus erythematosus. A total of 183 women with inactive (76 percent) or stable active (24 percent) systemic lupus erythematosus at 15 U.S. sites were randomly assigned to receive either oral contraceptives (triphasic ethinyl estradiol at a dose of 35 microg plus norethindrone at a dose of 0.5 to 1 mg for 12 cycles of 28 days each; 91 women) or placebo (92 women) and were evaluated at months 1, 2, 3, 6, 9, and 12. Subjects were excluded if they had moderate or high levels of anticardiolipin antibodies, lupus anticoagulant, or a history of thrombosis. The primary end point, a severe lupus flare, occurred in 7 of 91 subjects receiving oral contraceptives (7.7 percent) as compared with 7 of 92 subjects receiving placebo (7.6 percent). The 12-month rates of severe flare were similar: 0.084 for the group receiving oral contraceptives and 0.087 for the placebo group (P=0.95; upper limit of the one-sided 95 percent confidence interval for this difference, 0.069, which is within the prespecified 9 percent margin for noninferiority). Rates of mild or moderate flares were 1.40 flares per person-year for subjects receiving oral contraceptives and 1.44 flares per person-year for subjects receiving placebo (relative risk, 0.98; P=0.86). In the group that was randomized to receive oral contraceptives, there was one deep venous thrombosis and one clotted graft; in the placebo group, there was one deep venous thrombosis, one ocular thrombosis, one superficial thrombophlebitis, and one death (after cessation of the trial). Our study indicates that oral contraceptives do not increase the risk of flare among women with systemic lupus erythematosus whose disease is stable. Copyright 2005 Massachusetts Medical Society.

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Vitamin D and autoimmunity: new aetiological and therapeutic considerations.

Y Arnson, Howard Amital, Yehuda Shoenfeld (2007)

Vitamin D is frequently prescribed by rheumatologists to prevent and treat osteoporosis. Several observations have shown that vitamin D inhibits proinflammatory processes by suppressing the enhanced activity of immune cells that take part in the autoimmune reaction. Moreover, recent evidence strongly suggests that vitamin D supplementation may be therapeutically beneficial, particularly for Th1-mediated autoimmune disorders. Some reports imply that vitamin D may even be preventive in certain disorders such as multiple sclerosis and diabetes type 1. It seems that vitamin D has crossed the boundaries of calcium metabolism and has become a significant factor in a number of physiological functions, specifically as a biological inhibitor of inflammatory hyperactivity.

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Author and article information

Contributors

: +1-410-9553823 , +1-410-6140498 , mpetri@jhmi.edu

Journal

Journal ID (nlm-ta): Curr Rheumatol Rep

Journal ID (iso-abbrev): Curr Rheumatol Rep

Title: Current Rheumatology Reports

Publisher: Springer US (Boston )

ISSN (Print): 1523-3774

ISSN (Electronic): 1534-6307

Publication date (Electronic): 26 July 2013

Publication date PMC-release: 26 July 2013

Publication date (Print): 2013

Volume: 15

Electronic Location Identifier: 360

Affiliations

Division of Rheumatology, Johns Hopkins University School of Medicine, 1830 East Monument St Suite 7500, Baltimore, MD 21205 USA

Article

Publisher ID: 360

DOI: 10.1007/s11926-013-0360-0

PMC ID: 3756858

PubMed ID: 23888367

SO-VID: 3aedeaca-4790-41f6-b9f3-b85dc2d43e2d

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Open Access This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

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ScienceOpen disciplines: Rheumatology

Keywords: systemic lupus erythematosus,sle,hopkins lupus cohort,prednisone,organ damage,hydroxychloroquine,thrombosis,lupus nephritis,lupus anticoagulant,cardiovascular disease,cognitive impairment,sle myelitis,small fiber neuropathy,vitamin d,flares

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ScienceOpen disciplines: Rheumatology

Keywords: systemic lupus erythematosus, sle, hopkins lupus cohort, prednisone, organ damage, hydroxychloroquine, thrombosis, lupus nephritis, lupus anticoagulant, cardiovascular disease, cognitive impairment, sle myelitis, small fiber neuropathy, vitamin d, flares

2013 Update: Hopkins Lupus Cohort

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Most cited references 37

Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study.

Combined oral contraceptives in women with systemic lupus erythematosus.

Vitamin D and autoimmunity: new aetiological and therapeutic considerations.

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Contributors

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