Article Text
PDF
Abstract
Objectives Systemic lupus erythematosus (SLE) is associated with a high degree of variability at onset that can sometimes delay early diagnosis. Moreover, in the last decades, early diagnosis and therapeutic advances have led to better improved outcomes. The aim of this study was to evaluate the changes in the onset pattern of SLE and for changes in assessment and therapy at diagnosis and during the f-up.
Methods Medical records of 125 patients diagnosed between 1970 to 2019 and regularly followed up were reviewed. Patients were divided into 4 groups based on the year of diagnosis: 1970-‘89, 1990-‘99, 2000-‘09, 2010-‘19. Disease activity, cumulative organ damage and treatments were recorded at the time of diagnosis (T0) and at 1 (T1), 5 (T2) and 10 (T3) years after.
Results Our cohort consisted of 119 females and 6 males; as shown in figure 1 mean age of onset, and consequently mean age of diagnosis has significantly increased in different groups. A decreasing trend in the mean diagnostic delay was observed, although without statistical significance. Concerning the clinical presentation at onset, the most frequent symptoms observed were musculoskeletal (78,2%) and mucocutaneous (71%).
At the time of the diagnosis, no significant changes in disease activity or damage through the different decades (figure 2) were found. The only significant difference is the early use of HCQ: from less than 50% before 1999, to more than 70% of patients. During follow-up, a significant variation in disease activity in different decades appears at T2 and confirmed at T3, with a reduction in SLEDAI and a higher number of patients reaching low disease activity and remission. As for the use of steroids, a significant reduction in daily dose was observed at T2 and T3. Finally, in patients with a more recent diagnosis, an increased use of HCQ and DMARDS was observed during f-up.
Conclusions Our preliminary data demonstrated a progressive increase in the mean age at the onset over the years; however, this does not deviate from the range in the literature. Moreover, our data reflect the therapeutic improvements of the past decades characterized by use of lower doses of GCs, increased use of HCQ and DMARDS and faster achievement of low disease activity/remission.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .