背景:系统性红斑狼疮(SLE)通常模仿其他疾病的症状,在这些患者中,症状发作和诊断之间的间隔可能很长。目的:从拉丁美洲初始队列中描述与SLE诊断时间相关的特征及其对SLE患者损害累积和死亡率的影响。
方法:患者来自多种族,多国拉丁美洲SLE初始队列。所有参与中心都有专门的狼疮诊所。社会人口学,临床/实验室,疾病活动,损坏,使用描述性统计检验比较诊断时间较长和较短的患者的死亡率.以损害累积和死亡率为终点的多变量Cox回归模型,调整诊断为SLE的年龄,性别,种族,教育水平,和最大剂量的泼尼松对损害的累积,加上最高剂量的泼尼松,基线SLEDAI,和死亡率的基线SDI。
结果:在这些分析中包含的1437个中,中位诊断时间为6.0个月(Q1-Q32.4-16.2);721例患者(50.2%)的诊断时间超过6个月.诊断时间超过6个月的患者更常见的是女性,诊断时年龄较大,混血儿种族,没有医疗保险,并有“非经典”SLE症状。诊断时间延长对损害累积(HR1.09,95%CI0.93-1.28,p=0.300)或死亡率(HR1.37,95%CI0.88-2.12,p=0.200)均无影响。
结论:在这个初始队列中,SLE诊断的最长时间为24个月,中位时间为6个月,对疾病结局(损害累积和死亡率)没有明显的负面影响.
BACKGROUND: Systemic lupus erythematosus (SLE) often mimics symptoms of other diseases, and the interval between symptom onset and diagnosis may be long in some of these patients. Aims: To describe the characteristics associated with the time to SLE diagnosis and its impact on damage accrual and mortality in patients with SLE from a Latin American inception cohort.
METHODS: Patients were from a multi-ethnic, multi-national Latin-American SLE inception cohort. All participating centers had specialized lupus clinics. Socio-demographic, clinical/laboratory, disease activity, damage, and mortality between those with a longer and a shorter time to diagnosis were compared using descriptive statistical tests. Multivariable Cox regression models with damage accrual and mortality as the end points were performed, adjusting for age at SLE diagnosis, gender, ethnicity, level of education, and highest dose of prednisone for damage accrual, plus highest dose of prednisone, baseline SLEDAI, and baseline SDI for mortality.
RESULTS: Of the 1437 included in these analyses, the median time to diagnosis was 6.0 months (Q1-Q3 2.4-16.2); in 721 (50.2%) the time to diagnosis was longer than 6 months. Patients whose diagnosis took longer than 6 months were more frequently female, older at diagnosis, of Mestizo ethnicity, not having medical insurance, and having \"non-classic\" SLE symptoms. Longer time to diagnosis had no impact on either damage accrual (HR 1.09, 95% CI 0.93-1.28, p = 0.300) or mortality (HR 1.37, 95% CI 0.88-2.12, p = 0.200).
CONCLUSIONS: In this inception cohort, a maximum time of 24 months with a median of 6 months to SLE diagnosis had no apparent negative impact on disease outcomes (damage accrual and mortality).