Showing papers by "Christine A. Peschken published in 2013"
McGill University Health Centre1, Northwestern University2, McGill University3, Johns Hopkins University School of Medicine4, NHS Lanarkshire5, Allegheny General Hospital6, Toronto Western Hospital7, Laval University8, SUNY Downstate Medical Center9, University of California, San Francisco10, Hanyang University11, University of California, Los Angeles12, University of Calgary13, University of Copenhagen14, University of Birmingham15, University of North Carolina at Chapel Hill16, University of Manitoba17, Dalhousie University18, University of Alabama at Birmingham19, Lund University20, University College London21, Hannover Medical School22, North Shore-LIJ Health System23, Medical University of South Carolina24, New York University25, Université de Montréal26, University of Western Ontario27, University of British Columbia28, Copenhagen University Hospital29, Royal University Hospital30
TL;DR: There is clearly an increased risk of NHL, and cancers of the vulva, lung, thyroid, and possibly liver in SLE relative to the general population, and it remains unclear to what extent the association with NHL is mediated by innate versus exogenous factors.
236 citations
University of Manchester1, University of Toronto2, Central Manchester University Hospitals NHS Foundation Trust3, Hanyang University4, University of Birmingham5, University of California, Los Angeles6, McGill University7, SUNY Downstate Medical Center8, University College London9, Oklahoma Medical Research Foundation10, University of Alabama at Birmingham11, Laval University12, Johns Hopkins University13, University of North Carolina at Chapel Hill14, University of Pennsylvania15, King's College London16, Northwestern University17, NHS Lanarkshire18, Lund University19, North Shore-LIJ Health System20, University of Barcelona21, Karolinska Institutet22, University of California, San Diego23, Emory University24, Medical University of South Carolina25, University of Manitoba26, Istanbul University27
TL;DR: Renal lupus, higher corticosteroid doses, Korean and Hispanic ethnicity, and immunosuppressant use are associated with MetS in SLE patients, andBalancing disease control and minimising cortICosteroid exposure should be at the forefront of personalised treatment decisions in Sle patients.
Abstract: Background The metabolic syndrome (MetS) may contribute to increased cardiovascular risk in systemic lupus erythematosus (SLE). We aimed to examine the association of demographic factors, lupus phenotype and therapy exposure with the presence of MetS. Methods The Systemic Lupus International Collaborating Clinics Registry for Atherosclerosis inception cohort enrolled recently diagnosed ( Results We studied 1686 patients, of whom 1494 (86.6%) had sufficient data to determine their MetS status. The mean (SD) age at enrolment and disease duration was 35.2 years (13.4) and 24.1 weeks (18.0), respectively. MetS was present at the enrolment visit in 239 (16%). In backward stepwise multivariable regression analysis, higher daily average prednisolone dose (mg) (OR 1.02, 95% CI 1.00 to 1.03), older age (years) (OR 1.04, 95% CI 1.03 to 1.06), Korean (OR 6.33, 95% CI 3.68 to 10.86) and Hispanic (OR 6.2, 95% CI 3.78 to 10.12) ethnicity, current renal disease (OR 1.79, 95% CI 1.14 to 2.80) and immunosuppressant use (OR 1.81, 95% CI 1.18 to 2.78) were associated with MetS. Conclusions Renal lupus, higher corticosteroid doses, Korean and Hispanic ethnicity are associated with MetS in SLE patients. Balancing disease control and minimising corticosteroid exposure should therefore be at the forefront of personalised treatment decisions in SLE patients.
93 citations
Queen Elizabeth II Health Sciences Centre1, University of Toronto2, University of Cambridge3, University of Birmingham4, Hanyang University5, McGill University6, Cedars-Sinai Medical Center7, SUNY Downstate Medical Center8, University College London9, Oklahoma Medical Research Foundation10, Johns Hopkins University11, Laval University12, University of Alabama at Birmingham13, University of Manchester14, University of North Carolina at Chapel Hill15, King's College London16, Northwestern University17, University of Pittsburgh18, Lund University19, NHS Lanarkshire20, Karolinska Institutet21, University of Barcelona22, North Shore-LIJ Health System23, University of the Basque Country24, University of California, San Diego25, Emory University26, Istanbul University27, Medical University of South Carolina28, University of Manitoba29, University of Copenhagen30
TL;DR: Headache is frequent in SLE, but overall, it is not associated with global disease activity or specific autoantibodies, and although headaches are associated with a lower HRQOL, the majority of headaches resolve over time, independent of lupus-specific therapies.
Abstract: ObjectiveTo examine the frequency and characteristics of headaches and their association with global disease activity and health-related quality of life (HRQOL) in patients with systemic lupus erythematosus (SLE). MethodsA disease inception cohort was assessed annually for headache (5 types) and 18 other neuropsychiatric (NP) events. Global disease activity scores (SLE Disease Activity Index 2000 [SLEDAI-2K]), damage scores (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]), and Short Form 36 (SF-36) mental and physical component summary scores were collected. Time to first headache and associations with SF-36 scores were analyzed using Cox proportional hazards and linear regression models with generalized estimating equations. ResultsAmong the 1,732 SLE patients enrolled, 89.3% were female and 48.3% were white. The mean SD age was 34.6 +/- 13.4 years, duration of disease was 5.6 +/- 5.2 months, and length of followup was 3.8 +/- 3.1 years. At enrollment, 17.8% of patients had headache (migraine [60.7%], tension [38.6%], intractable nonspecific [7.1%], cluster [2.6%], and intracranial hypertension [1.0%]). The prevalence of headache increased to 58% after 10 years. Only 1.5% of patients had lupus headache, as identified in the SLEDAI-2K. In addition, headache was associated with other NP events attributed to either SLE or non-SLE causes. There was no association of headache with SLEDAI-2K scores (without the lupus headache variable), SDI scores, use of corticosteroids, use of antimalarials, use of immunosuppressive medications, or specific autoantibodies. SF-36 mental component scores were lower in patients with headache compared with those without headache (mean +/- SD 42.5 +/- 12.2 versus 47.8 +/- 11.3; P < 0.001), and similar differences in physical component scores were seen (38.0 +/- 11.0 in those with headache versus 42.6 +/- 11.4 in those without headache; P < 0.001). In 56.1% of patients, the headaches resolved over followup. ConclusionHeadache is frequent in SLE, but overall, it is not associated with global disease activity or specific autoantibodies. Although headaches are associated with a lower HRQOL, the majority of headaches resolve over time, independent of lupus-specific therapies. (Less)
83 citations
TL;DR: To examine the association between smoking and cutaneous involvement in systemic lupus erythematosus (SLE), a large number of smokers and non-smokers were surveyed over a two-year period.
Abstract: Objective
To examine the association between smoking and cutaneous involvement in systemic lupus erythematosus (SLE).
Methods
We analyzed data from a multicenter Canadian SLE cohort. Mucocutaneous involvement was recorded at the most recent visit using the Systemic Lupus Erythematosus Disease Activity Index 2000 Update (rash, alopecia, and oral ulcers), Systemic Lupus International Collaborating Clinics/American College of Rheumatology (ACR) Damage Index (alopecia, extensive scarring, and skin ulceration), and the ACR revised criteria for SLE (malar rash, discoid rash, photosensitivity, and mucosal involvement). Multivariate logistic regression models were used to estimate the independent association between mucocutaneous involvement and cigarette smoking, age, sex, ethnicity, lupus duration, medications, and laboratory data.
Results
In our cohort of 1,346 patients (91.0% women), the mean ± SD age was 47.1 ± 14.3 years and the mean ± SD disease duration was 13.2 ± 10.0 years. In total, 41.2% of patients were ever smokers, 14.0% current smokers, and 27.1% past smokers. Active mucocutaneous manifestations occurred in 28.4% of patients; cutaneous damage occurred in 15.4%. Regarding the ACR criteria, malar rash was noted in 59.5%, discoid rash in 16.9%, and photosensitivity in 55.7% of patients. In the multivariate analysis, current smoking was associated with active SLE rash (odds ratio [OR] 1.63 [95% confidence interval (95% CI) 1.07, 2.48]). Having ever smoked was associated with ACR discoid rash (OR 2.36 [95% CI 1.69, 3.29]) and photosensitivity (OR 1.47 [95% CI 1.11, 1.95]), and with the ACR total cutaneous score (OR 1.50 [95% CI 1.22, 1.85]). We did not detect any associations between previous smoking and active cutaneous manifestations. No association was found between smoking and cutaneous damage or mucosal ulcers. No interaction was seen between smoking and antimalarials.
Conclusion
Current smoking is associated with active SLE rash, and ever smoking with the ACR total cutaneous score. This provides additional motivation for smoking cessation in SLE.
61 citations
TL;DR: To determine the influence of ethnicity and sociodemographic factors on disease characteristics of the Canadian pediatric lupus population, a large sample of children born in Canada in the 1980s and 1990s were studied.
Abstract: Objective
To determine the influence of ethnicity and sociodemographic factors on disease characteristics of the Canadian pediatric lupus population.
Methods
Childhood-onset systemic lupus erythematosus (SLE) patients at 4 pediatric centers in Halifax, Montreal, Toronto, and Vancouver were consecutively recruited. Sociodemographics and disease data were collected. Patients were categorized by their primary self-selected ethnicity, and exploratory cluster analyses were examined for disease expression by ethnicity.
Results
We enrolled 213 childhood-onset SLE patients, and ethnicity data were available for 206 patients: white (31%), Asian (30%), South Asian (15%), black (10%), Latino/Hispanic (4%), Aboriginal (4%), and Arab/Middle Eastern (3%). The frequency of clinical classification criteria (malar rash, arthritis, serositis, and renal disease) and autoantibodies significantly differed among ethnicities. Medications were prescribed equally across ethnicities: 76% were taking prednisone, 86% antimalarials, and 56% required additional immunosuppressants. Cluster analysis partitioned into 3 main groups: mild (n = 50), moderate (n = 82), and severe (n = 68) disease clusters. Only 20% of white patients were in the severe cluster compared to 51% of Asian and 41% of black patients (P = 0.03). However, disease activity indices and damage scores were similar across ethnicities.
Conclusion
Canadian childhood-onset SLE patients reflect our multiethnic population, with differences in disease manifestations, autoantibody profiles, and severity of disease expression by ethnicity.
57 citations
McGill University Health Centre1, McGill University2, Johns Hopkins University3, Western Pennsylvania Hospital4, Toronto Western Hospital5, Laval University6, SUNY Downstate Medical Center7, Hanyang University8, University of California, Los Angeles9, University of Copenhagen10, University of North Carolina at Chapel Hill11, University of Manitoba12, University of Alabama at Birmingham13, Lund University14, University of California, San Francisco15
TL;DR: In this large SLE cohort, the most common non-lymphoma hematological malignancies were myeloid types (MDS and AML).
Abstract: Objective: To describe non-lymphoma hematological malignancies in systemic lupus erythematosus (SLE). Methods: A large SLE cohort was linked to cancer registries. We examined the types of non-lymphoma hematological cancers. Results: In 16,409 patients, 115 hematological cancers [including myelodysplastic syndrome (MDS)] occurred. Among these, 33 were non-lymphoma. Of the 33 non-lymphoma cases, 13 were of lymphoid lineage: multiple myeloma (n = 5), plasmacytoma (n = 3), B cell chronic lymphocytic leukemia (B-CLL; n = 3), precursor cell lymphoblastic leukemia (n = 1) and unspecified lymphoid leukemia (n = 1). The remaining 20 cases were of myeloid lineage: MDS (n = 7), acute myeloid leukemia (AML; n = 7), chronic myeloid leukemia (CML; n = 2) and 4 unspecified leukemias. Most of these malignancies occurred in female Caucasians, except for plasma cell neoplasms (4/5 multiple myeloma and 1/3 plasmacytoma cases occurred in blacks). Conclusions: In this large SLE cohort, the most common non-lymphoma hematological malignancies were myeloid types (MDS and AML). This is in contrast to the general population, where lymphoid types are 1.7 times more common than myeloid non-lymphoma hematological malignancies. Most (80%) multiple myeloma cases occurred in blacks; this requires further investigation. (C) 2013 S. Karger AG, Basel (Less)
28 citations
TL;DR: The mean annual rate of hospitalization attributed to lupus was lower than expected and in a regression model elevated BMI, more ACR criteria and psychosis were associated with hospitalization.
Abstract: ObjectivesHospitalization is a major factor in health care costs and a surrogate for worse outcomes in chronic disease. The aim of this study was to determine the frequency of hospitalization secondary to lupus flare, the causes of hospitalization, and to determine risk factors for hospitalization in patients with systemic lupus erythematosus (SLE).MethodsData were collected as part of the 1000 Canadian Faces of Lupus, a prospective cohort study, where annual major lupus flares including hospitalizations were recorded over a 3-year period.ResultsOf 665 patients with available hospitalization histories, 68 reported hospitalization related to a SLE flare over 3 years of follow-up. The average annual hospitalization rate was 7.6% (range 6.6–8.9%). The most common reasons for hospitalization were: hematologic (22.1%), serositis (20.6%), musculoskeletal (MSK) (16.2%), and renal (14.7%). Univariate risk factors for lupus hospitalization included (OR [95% CI]; p < 0.05): juvenile-onset lupus (2.2 [1.1–4.7]), num...
26 citations
McGill University1, Northwestern University2, University of Birmingham3, Yale University4, University of California, San Francisco5, Toronto Western Hospital6, Laval University7, University of California, Los Angeles8, Johns Hopkins University9, Allegheny General Hospital10, SUNY Downstate Medical Center11, University of Calgary12, University of North Carolina at Chapel Hill13, Université de Montréal14, University of Manitoba15, Hanyang University16, University College London17, Dalhousie University18, University of Copenhagen19, Lund University20, Hannover Medical School21
TL;DR: Evidence points to a decreased breast cancer risk in systemic lupus erythematosus (SLE), and though the results are not definitive, there may be a slight decrease in the ductal histological type in the breast cancers that occur in SLE.
Abstract: Objective: Evidence points to a decreased breast cancer risk in systemic lupus erythematosus (SLE). We analyzed data from a large multisite SLE cohort, linked to
26 citations
TL;DR: Describing the manifestations and symptoms of scleroderma in a group of 71 Native Canadians is described, which is the largest NAN cohort ever described with this relatively rare disease, and the authors suggest possible differences in the phenotype of SSc compared to white populations.
Abstract: In the last 10–15 years there has been increasing awareness of a high rheumatic disease burden in North American Natives (NAN), resulting in a growing number of studies describing clinical and serological phenotypes in these populations. But what is the value of these largely descriptive studies?
In this issue of The Journal , Bacher and colleagues add to the body of literature on rheumatic disease in NAN populations, describing the manifestations and symptoms of scleroderma (systemic sclerosis; SSc) in a group of 71 Native Canadians1. This is the largest NAN cohort ever described with this relatively rare disease, and the authors suggest possible differences in the phenotype of SSc compared to white populations.
Variability in the phenotypic expression of many autoimmune diseases between different ethnicities has long been recognized; in NAN populations autoimmune disease is generally recognized to be severe2,3,4. At the very least, descriptions of disparate burdens of disease can help guide public health policy, and direct increased health resources to affected ethnic groups. Ethnicity, however, is a complex concept, which includes racial designations or genotypic groupings, but transcends them, representing instead the aggregate of cultural practices, lifestyle patterns, social influences, religious pursuits, and racial characteristics that shape the distinctive identity of a community5. Autoimmune diseases, such as SSc and systemic lupus erythematosus (SLE), are known to arise from a complex interaction between genetic, environmental, socioeconomic, cultural, and …
Address correspondence to Dr. Peschken; E-mail: cpeschken{at}exchange.hsc.mb.ca
2 citations