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Systemic Lupus Erythematosus: HELP
Articles by Chris Theriault
Based on 9 articles published since 2009
(Why 9 articles?)
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Between 2009 and 2019, C. Theriault wrote the following 9 articles about Lupus Erythematosus, Systemic.
 
+ Citations + Abstracts
1 Article Cerebrovascular Events in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study. 2018

Hanly, John G / Li, Qiuju / Su, Li / Urowitz, Murray B / Gordon, Caroline / Bae, Sang-Cheol / Romero-Diaz, Juanita / Sanchez-Guerrero, Jorge / Bernatsky, Sasha / Clarke, Ann E / Wallace, Daniel J / Isenberg, David A / Rahman, Anisur / Merrill, Joan T / Fortin, Paul / Gladman, Dafna D / Bruce, Ian N / Petri, Michelle / Ginzler, Ellen M / Dooley, M A / Steinsson, Kristjan / Ramsey-Goldman, Rosalind / Zoma, Asad A / Manzi, Susan / Nived, Ola / Jonsen, Andreas / Khamashta, Munther A / Alarcón, Graciela S / Chatham, Winn / van Vollenhoven, Ronald F / Aranow, Cynthia / Mackay, Meggan / Ruiz-Irastorza, Guillermo / Ramos-Casals, Manuel / Lim, S Sam / Inanc, Murat / Kalunian, Kenneth C / Jacobsen, Soren / Peschken, Christine A / Kamen, Diane L / Askanase, Anca / Theriault, Chris / Farewell, Vernon. ·Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada. · MRC Biostatistics Unit, Institute of Public Health, University of Cambridge, Cambridge, UK. · Toronto Western Hospital and University of Toronto, Ontario, Canada. · University of Birmingham, College of Medical and Dental Sciences, Birmingham, UK. · Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea. · Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico. · McGill University, Montreal, Quebec, Canada. · University of Calgary, Alberta, Canada. · Cedars-Sinai Medical Center and University of California at Los Angeles, David Geffen School of Medicine, Los Angeles. · University College London, London, UK. · Oklahoma Medical Research Foundation, Oklahoma City. · Centre Hospitalier Universitaire de Québec et Université Laval, Quebec City, Canada. · Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK, and Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK. · Johns Hopkins University School of Medicine, Baltimore, Maryland. · State University of New York Downstate Medical Center, Brooklyn. · University of North Carolina, Chapel Hill. · Landspitali University Hospital, Reykjavik, Iceland. · Northwestern University and Feinberg School of Medicine, Chicago, Illinois. · Lanarkshire Centre for Rheumatology and Hairmyres Hospital, East Kilbride, Scotland UK. · Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania. · Lund University, Lund, Sweden. · Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London, UK. · University of Alabama at Birmingham, Birmingham. · Karolinska Institute, Stockholm, Sweden. · Feinstein Institute for Medical Research, Manhasset, New York. · Hospital Universitario Cruces and University of the Basque Country, Barakaldo, Spain. · Institut d'Investigacions Biomèdiques August Pi I Sunyer, IDIBAPS, Hospital Clínic, Barcelona, Spain. · Emory University, Atlanta, Georgia. · Istanbul University, Istanbul, Turkey. · University of California at San Diego, La Jolla. · Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. · University of Manitoba, Winnipeg, Manitoba, Canada. · Medical University of South Carolina, Charleston. · New York University, New York, New York. ·Arthritis Care Res (Hoboken) · Pubmed #29316357.

ABSTRACT: OBJECTIVE: To determine the frequency, characteristics, and outcomes of cerebrovascular events (CerVEs), as well as clinical and autoantibody associations in a multiethnic/racial inception cohort of patients with systemic lupus erythematosus (SLE). METHODS: A total of 1,826 patients were assessed annually for 19 neuropsychiatric (NP) events, including 5 types of CerVEs: 1) stroke, 2) transient ischemia, 3) chronic multifocal ischemia, 4) subarachnoid/intracranial hemorrhage, and 5) sinus thrombosis. Global disease activity (Systemic Lupus Erythematosus Disease [SLE] Activity Index 2000), damage scores (SLE International Collaborating Clinics/American College of Rheumatology Damage Index), and Short Form 36 (SF-36) scores were collected. Time to event, linear and logistic regressions, and multistate models were used as appropriate. RESULTS: CerVEs were the fourth most frequent NP event: 82 of 1,826 patients had 109 events; of these events, 103 were attributed to SLE, and 44 were identified at the time of enrollment. The predominant events were stroke (60 of 109 patients) and transient ischemia (28 of 109 patients). CerVEs were associated with other NP events attributed to SLE, non-SLE-attributed NP events, African ancestry (at US SLICC sites), and increased organ damage scores. Lupus anticoagulant increased the risk of first stroke and sinus thrombosis and transient ischemic attack. Physician assessment indicated resolution or improvement in the majority of patients, but patients reported sustained reduction in SF-36 summary and subscale scores following a CerVE. CONCLUSION: CerVEs, the fourth most frequent NP event in SLE, are usually attributable to lupus. In contrast to good physician-reported outcomes, patients reported a sustained reduction in health-related quality of life following a CerVE.

2 Article Economic Evaluation of Lupus Nephritis in the Systemic Lupus International Collaborating Clinics Inception Cohort Using a Multistate Model Approach. 2018

Barber, Megan R W / Hanly, John G / Su, Li / Urowitz, Murray B / St Pierre, Yvan / Romero-Diaz, Juanita / Gordon, Caroline / Bae, Sang-Cheol / Bernatsky, Sasha / Wallace, Daniel J / Isenberg, David A / Rahman, Anisur / Ginzler, Ellen M / Petri, Michelle / Bruce, Ian N / Fortin, Paul R / Gladman, Dafna D / Sanchez-Guerrero, Jorge / Ramsey-Goldman, Rosalind / Khamashta, Munther A / Aranow, Cynthia / Mackay, Meggan / Alarcón, Graciela S / Manzi, Susan / Nived, Ola / Jönsen, Andreas / Zoma, Asad A / van Vollenhoven, Ronald F / Ramos-Casals, Manuel / Ruiz-Irastorza, Guillermo / Lim, S Sam / Kalunian, Kenneth C / Inanc, Murat / Kamen, Diane L / Peschken, Christine A / Jacobsen, Soren / Askanase, Anca / Theriault, Chris / Farewell, Vernon / Clarke, Ann E. ·University of Calgary, Alberta, Canada. · Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada. · MRC Biostatistics Unit, University of Cambridge, Cambridge, UK. · Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada. · Research Institute of the McGill University Health Center, Montreal, Quebec, Canada. · Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico. · Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. · Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea. · McGill University Health Centre, Montreal, Quebec, Canada. · Cedars-Sinai/David Geffen School of Medicine at the University of California, Los Angeles. · University College London, London, UK. · State University of New York Downstate Medical Center, Brooklyn, New York. · Johns Hopkins University School of Medicine, Baltimore, Maryland. · Arthritis Research UK Epidemiology Unit, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, the University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK. · CHU de Québec-Université Laval, Quebec City, Canada. · Northwestern University and Feinberg School of Medicine, Chicago, Illinois. · Lupus Research Unit, The Rayne Institute, St Thomas's Hospital, King's College London School of Medicine, London, UK. · Feinstein Institute for Medical Research, Manhasset, New York. · University of Alabama at Birmingham. · University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. · Lund University, Lund, Sweden. · Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland, UK. · Karolinska Institute, Stockholm, Sweden. · Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain. · BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain. · Emory University School of Medicine, Atlanta, Georgia. · University of California Los Angeles School of Medicine, La Jolla. · Istanbul University, Istanbul, Turkey. · Medical University of South Carolina, Charleston. · University of Manitoba, Winnipeg, Manitoba, Canada. · Copenhagen Lupus and Vasculitis Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. · Hospital for Joint Diseases, New York University Seligman Center for Advanced Therapeutics, New York, New York. ·Arthritis Care Res (Hoboken) · Pubmed #29193883.

ABSTRACT: OBJECTIVE: Little is known about the long-term costs of lupus nephritis (LN). The costs were compared between patients with and without LN using multistate modeling. METHODS: Patients from 32 centers in 11 countries were enrolled in the Systemic Lupus International Collaborating Clinics inception cohort within 15 months of diagnosis and provided annual data on renal function, hospitalizations, medications, dialysis, and selected procedures. LN was diagnosed by renal biopsy or the American College of Rheumatology classification criteria. Renal function was assessed annually using the estimated glomerular filtration rate (GFR) or estimated proteinuria. A multistate model was used to predict 10-year cumulative costs by multiplying annual costs associated with each renal state by the expected state duration. RESULTS: A total of 1,545 patients participated; 89.3% were women, the mean ± age at diagnosis was 35.2 ± 13.4 years, 49% were white, and the mean followup duration was 6.3 ± 3.3 years. LN developed in 39.4% of these patients by the end of followup. Ten-year cumulative costs were greater in those with LN and an estimated glomerular filtration rate (GFR) <30 ml/minute ($310,579 2015 Canadian dollars versus $19,987 if no LN and estimated GFR >60 ml/minute) or with LN and estimated proteinuria >3 gm/day ($84,040 versus $20,499 if no LN and estimated proteinuria <0.25 gm/day). CONCLUSION: Patients with estimated GFR <30 ml/minute incurred 10-year costs 15-fold higher than those with normal estimated GFR. By estimating the expected duration in each renal state and incorporating associated annual costs, disease severity at presentation can be used to anticipate future health care costs. This is critical knowledge for cost-effectiveness evaluations of novel therapies.

3 Article A Longitudinal Analysis of Outcomes of Lupus Nephritis in an International Inception Cohort Using a Multistate Model Approach. 2016

Hanly, John G / Su, Li / Urowitz, Murray B / Romero-Diaz, Juanita / Gordon, Caroline / Bae, Sang-Cheol / Bernatsky, Sasha / Clarke, Ann E / Wallace, Daniel J / Merrill, Joan T / Isenberg, David A / Rahman, Anisur / Ginzler, Ellen M / Petri, Michelle / Bruce, Ian N / Dooley, M A / Fortin, Paul / Gladman, Dafna D / Sanchez-Guerrero, Jorge / Steinsson, Kristjan / Ramsey-Goldman, Rosalind / Khamashta, Munther A / Aranow, Cynthia / Alarcón, Graciela S / Fessler, Barri J / Manzi, Susan / Nived, Ola / Sturfelt, Gunnar K / Zoma, Asad A / van Vollenhoven, Ronald F / Ramos-Casals, Manuel / Ruiz-Irastorza, Guillermo / Lim, S Sam / Kalunian, Kenneth C / Inanc, Murat / Kamen, Diane L / Peschken, Christine A / Jacobsen, Soren / Askanase, Anca / Theriault, Chris / Farewell, Vernon. ·Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada. · Institute of Public Health and University of Cambridge, University Forvie Site, Cambridge, UK. · Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada. · Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico. · University of Birmingham, College of Medical and Dental Sciences, Birmingham, UK. · Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea. · McGill University Health Centre, Montreal, Quebec, Canada. · University of Calgary, Calgary, Alberta, Canada. · Cedars-Sinai Medical Center and University of California, Los Angeles, David Geffen School of Medicine. · Oklahoma Medical Research Foundation, Oklahoma City. · University College London, London, UK. · State University of New York Downstate Medical Center, Brooklyn. · Johns Hopkins University School of Medicine, Baltimore, Maryland. · Arthritis Research UK Epidemiology Unit, Manchester Academic Health Sciences Centre, University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, and Manchester Academic Health Science Centre, Manchester, UK. · University of North Carolina, Chapel Hill. · Centre Hospitalier Universitaire de Québec and Université Laval, Quebec City, Canada. · Landspitali University Hospital, Reykjavik, Iceland. · Northwestern University Feinberg School of Medicine, Chicago, Illinois. · The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK. · Feinstein Institute for Medical Research, Manhasset, New York. · University of Alabama at Birmingham. · University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. · University Hospital Lund, Lund, Sweden. · Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, UK. · Karolinska Institute, Stockholm, Sweden. · Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Barcelona, Spain. · BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain. · Emory University School of Medicine, Atlanta, Georgia. · University of California at San Diego, La Jolla. · Istanbul University, Istanbul, Turkey. · Medical University of South Carolina, Charleston. · University of Manitoba, Winnipeg, Manitoba, Canada. · Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. · Hospital for Joint Diseases, New York University, Seligman Centre for Advanced Therapeutics, New York, New York. ·Arthritis Rheumatol · Pubmed #26991067.

ABSTRACT: OBJECTIVE: To study bidirectional change and predictors of change in estimated glomerular filtration rate (GFR) and proteinuria in lupus nephritis (LN) using a multistate modeling approach. METHODS: Patients in the Systemic Lupus International Collaborating Clinics inception cohort were classified annually into estimated GFR state 1 (>60 ml/minute), state 2 (30-60 ml/minute), or state 3 (<30 ml/minute) and estimated proteinuria state 1 (<0.25 gm/day), state 2 (0.25-3.0 gm/day), or state 3 (>3.0 gm/day), or end-stage renal disease (ESRD) or death. Using multistate modeling, relative transition rates between states indicated improvement and deterioration. RESULTS: Of 1,826 lupus patients, 700 (38.3%) developed LN. During a mean ± SD follow-up of 5.2 ± 3.5 years, the likelihood of improvement in estimated GFR and estimated proteinuria was greater than the likelihood of deterioration. After 5 years, 62% of patients initially in estimated GFR state 3 and 11% of patients initially in estimated proteinuria state 3 transitioned to ESRD. The probability of remaining in the initial states 1, 2, and 3 was 85%, 11%, and 3%, respectively, for estimated GFR and 62%, 29%, and 4%, respectively, for estimated proteinuria. Male sex predicted improvement in estimated GFR states; older age, race/ethnicity, higher estimated proteinuria state, and higher renal biopsy chronicity scores predicted deterioration. For estimated proteinuria, race/ethnicity, earlier calendar years, damage scores without renal variables, and higher renal biopsy chronicity scores predicted deterioration; male sex, presence of lupus anticoagulant, class V nephritis, and mycophenolic acid use predicted less improvement. CONCLUSION: In LN, the expected improvement or deterioration in renal outcomes can be estimated by multistate modeling and is preceded by identifiable risk factors. New therapeutic interventions for LN should meet or exceed these expectations.

4 Article The frequency and outcome of lupus nephritis: results from an international inception cohort study. 2016

Hanly, John G / O'Keeffe, Aidan G / Su, Li / Urowitz, Murray B / Romero-Diaz, Juanita / Gordon, Caroline / Bae, Sang-Cheol / Bernatsky, Sasha / Clarke, Ann E / Wallace, Daniel J / Merrill, Joan T / Isenberg, David A / Rahman, Anisur / Ginzler, Ellen M / Fortin, Paul / Gladman, Dafna D / Sanchez-Guerrero, Jorge / Petri, Michelle / Bruce, Ian N / Dooley, Mary Anne / Ramsey-Goldman, Rosalind / Aranow, Cynthia / Alarcón, Graciela S / Fessler, Barri J / Steinsson, Kristjan / Nived, Ola / Sturfelt, Gunnar K / Manzi, Susan / Khamashta, Munther A / van Vollenhoven, Ronald F / Zoma, Asad A / Ramos-Casals, Manuel / Ruiz-Irastorza, Guillermo / Lim, S Sam / Stoll, Thomas / Inanc, Murat / Kalunian, Kenneth C / Kamen, Diane L / Maddison, Peter / Peschken, Christine A / Jacobsen, Soren / Askanase, Anca / Theriault, Chris / Thompson, Kara / Farewell, Vernon. ·Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada, john.hanly@cdha.nshealth.ca. · Department of Statistical Science, University College London, London. · MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Cambridge, UK. · Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada. · Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico. · Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. · Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea. · Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre. · Division of Rheumatology, University of Calgary, Alberta, Canada. · Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, CA. · Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA. · Centre for Rheumatology, Department of Medicine, University College London, UK. · Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA. · Division of Rheumatology, Centre Hospitalier Universitaire de Québec et Université Laval, Quebec City, Canada. · Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Arthritis Research UK Epidemiology Unit, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK. · Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC. · Northwestern University and Feinberg School of Medicine, Chicago, IL. · Feinstein Institute for Medical Research, Manhasset, NY. · Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. · Center for Rheumatology Research, Landspitali University Hospital, Reykjavik, Iceland. · Department of Rheumatology, University Hospital Lund, Lund, Sweden. · Division of Rheumatology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. · Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK. · Unit for Clinical Therapy Research, Karolinska Institute, Stockholm, Sweden. · Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland, UK. · Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain. · Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain. · Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia, USA. · Kantonsspital Geissbergstr, Schaffhausen, Switzerland. · Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey. · UCSD School of Medicine, La Jolla, CA. · Medical University of South Carolina, Charleston, SC, USA. · Ysbyty Gwynedd Bangor, Gwynedd, North Wales, UK. · University of Manitoba, Winnipeg, Manitoba, Canada. · Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. · Hospital for Joint Diseases, NYU, Seligman Centre for Advanced Therapeutics, New York, NY, USA and. · Department of Medicine, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada. ·Rheumatology (Oxford) · Pubmed #26342222.

ABSTRACT: OBJECTIVE: To determine nephritis outcomes in a prospective multi-ethnic/racial SLE inception cohort. METHODS: Patients in the Systemic Lupus International Collaborating Clinics inception cohort (≤15 months of SLE diagnosis) were assessed annually for estimated glomerular filtration rate (eGFR), proteinuria and end-stage renal disease (ESRD). Health-related quality of life was measured by the Short Form (36 questions) health survey questionnaire (SF-36) subscales, mental and physical component summary scores. RESULTS: There were 1827 patients, 89% females, mean (s.d.) age 35.1 (13.3) years. The mean (s.d.) SLE duration at enrolment was 0.5 (0.3) years and follow-up 4.6 (3.4) years. LN occurred in 700 (38.3%) patients: 566/700 (80.9%) at enrolment and 134/700 (19.1%) during follow-up. Patients with nephritis were younger, more frequently men and of African, Asian and Hispanic race/ethnicity. The estimated overall 10-year incidence of ESRD was 4.3% (95% CI: 2.8%, 5.8%), and with nephritis was 10.1% (95% CI: 6.6%, 13.6%). Patients with nephritis had a higher risk of death (HR = 2.98, 95% CI: 1.48, 5.99; P = 0.002) and those with eGFR <30 ml/min at diagnosis had lower SF-36 physical component summary scores (P < 0.01) and lower Physical function, Physical role and Bodily pain scores. Over time, patients with abnormal eGFR and proteinuria had lower SF-36 mental component summary (P ≤ 0.02) scores compared to patients with normal values. CONCLUSION: LN occurred in 38.3% of SLE patients, frequently as the initial presentation, in a large multi-ethnic inception cohort. Despite current standard of care, nephritis was associated with ESRD and death, and renal insufficiency was linked to lower health-related quality of life. Further advances are required for the optimal treatment of LN.

5 Article Mood Disorders in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study. 2015

Hanly, John G / Su, Li / Urowitz, Murray B / Romero-Diaz, Juanita / Gordon, Caroline / Bae, Sang-Cheol / Bernatsky, Sasha / Clarke, Ann E / Wallace, Daniel J / Merrill, Joan T / Isenberg, David A / Rahman, Anisur / Ginzler, Ellen M / Petri, Michelle / Bruce, Ian N / Dooley, M A / Fortin, Paul / Gladman, Dafna D / Sanchez-Guerrero, Jorge / Steinsson, Kristjan / Ramsey-Goldman, Rosalind / Khamashta, Munther A / Aranow, Cynthia / Alarcón, Graciela S / Fessler, Barri J / Manzi, Susan / Nived, Ola / Sturfelt, Gunnar K / Zoma, Asad A / van Vollenhoven, Ronald F / Ramos-Casals, Manuel / Ruiz-Irastorza, Guillermo / Lim, S Sam / Kalunian, Kenneth C / Inanc, Murat / Kamen, Diane L / Peschken, Christine A / Jacobsen, Soren / Askanase, Anca / Theriault, Chris / Thompson, Kara / Farewell, Vernon. ·Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada. · Institute of Public Health and University of Cambridge, University Forvie Site, Cambridge, UK. · Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada. · Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico. · University of Birmingham, College of Medical and Dental Sciences, Birmingham, UK. · Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea. · McGill University Health Centre, Montreal, Quebec, Canada. · University of Calgary, Calgary, Alberta, Canada. · Cedars-Sinai Medical Center and University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California. · Oklahoma Medical Research Foundation, Oklahoma City. · University College London, London, UK. · State University of New York Downstate Medical Center, Brooklyn. · Johns Hopkins University, Baltimore, Maryland. · Manchester Academic Health Sciences Centre, University of Manchester, and Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK. · University of North Carolina, Chapel Hill. · Centre Hospitalier Universitaire de Québec, Université Laval, Quebec City, Quebec, Canada. · Landspitali University Hospital, Reykjavik, Iceland. · Northwestern University and Feinberg School of Medicine, Chicago, Illinois. · The Rayne Institute, St. Thomas' Hospital, and King's College London School of Medicine, London, UK. · Feinstein Institute for Medical Research, Manhasset, New York. · University of Alabama at Birmingham. · University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. · University Hospital Lund, Lund, Sweden. · Lanarkshire Centre for Rheumatology and Hairmyres Hospital, East Kilbride, UK. · Karolinska Institute, Stockholm, Sweden. · Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Barcelona, Spain. · Hospital de Cruces and University of the Basque Country, Barakaldo, Spain. · Emory University, Atlanta, Georgia. · University of California at San Diego, La, Jolla. · Istanbul University, Istanbul, Turkey. · Medical University of South Carolina, Charleston. · University of Manitoba, Winnipeg, Manitoba, Canada. · Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. · New York University, New York, New York. ·Arthritis Rheumatol · Pubmed #25778456.

ABSTRACT: OBJECTIVE: To examine the frequency, characteristics, and outcome of mood disorders, as well as clinical and autoantibody associations, in a multiethnic/racial, prospective inception cohort of patients with systemic lupus erythematosus (SLE). METHODS: Patients were assessed annually for mood disorders (4 types, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and 18 other neuropsychiatric 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 subscales, mental and physical component summary scores were collected. Time to event, linear and ordinal regressions, and multi-state models were used as appropriate. RESULTS: Among the 1,827 patients with SLE, 88.9% were female, and 48.9% were Caucasian. The mean ± SD age of the patients was 35.1 ± 13.3 years, disease duration was 5.6 ± 4.8 months, and the length of followup was 4.7 ± 3.5 years. During the course of the study, 863 (47.2%) of the 1,827 patients had 1,627 neuropsychiatric events. Mood disorders occurred in 232 (12.7%) of 1,827 patients, and 98 (38.3%) of 256 mood disorder events were attributed to SLE. The estimated cumulative incidence of any mood disorder after 10 years was 17.7% (95% confidence interval 15.1, 20.2%). A greater risk of mood disorder was associated with concurrent neuropsychiatric events (P ≤ 0.01), and a lower risk was associated with Asian race/ethnicity (P = 0.01) and treatment with immunosuppressive drugs (P = 0.003). Mood disorders were associated with lower mental health and mental component summary scores but not with the SLEDAI-2K, SDI, or lupus autoantibodies. Among the 232 patients with depression, 168 (72.4%) were treated with antidepressants. One hundred twenty-six (49.2%) of 256 mood disorders resolved in 117 (50.4%) of 232 patients. CONCLUSION: Mood disorders, the second most frequent neuropsychiatric event in patients with SLE, have a negative impact on health-related quality of life and improve over time. The lack of association with global SLE disease activity, cumulative organ damage, and lupus autoantibodies emphasizes the multifactorial etiology of mood disorders and a role for non-lupus-specific therapies.

6 Article Headache in systemic lupus erythematosus: results from a prospective, international inception cohort study. 2013

Hanly, John G / Urowitz, Murray B / O'Keeffe, Aidan G / Gordon, Caroline / Bae, Sang-Cheol / Sanchez-Guerrero, Jorge / Romero-Diaz, Juanita / Clarke, Ann E / Bernatsky, Sasha / Wallace, Daniel J / Ginzler, Ellen M / Isenberg, David A / Rahman, Anisur / Merrill, Joan T / Petri, Michelle / Fortin, Paul R / Gladman, Dafna D / Fessler, Barri J / Alarcón, Graciela S / Bruce, Ian N / Dooley, Mary Anne / Steinsson, Kristjan / Khamashta, Munther A / Ramsey-Goldman, Rosalind / Manzi, Susan / Sturfelt, Gunnar K / Nived, Ola / Zoma, Asad A / van Vollenhoven, Ronald F / Ramos-Casals, Manuel / Aranow, Cynthia / Mackay, Meggan / Ruiz-Irastorza, Guillermo / Kalunian, Kenneth C / Lim, S Sam / Inanc, Murat / Kamen, Diane L / Peschken, Christine A / Jacobsen, Soren / Theriault, Chris / Thompson, Kara / Farewell, Vernon. ·Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada. ·Arthritis Rheum · Pubmed #24166793.

ABSTRACT: OBJECTIVE: To 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). METHODS: A 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. RESULTS: Among 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. CONCLUSION: Headache 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.

7 Article Seizure disorders in systemic lupus erythematosus results from an international, prospective, inception cohort study. 2012

Hanly, John G / Urowitz, Murray B / Su, Li / Gordon, Caroline / Bae, Sang-Cheol / Sanchez-Guerrero, Jorge / Romero-Diaz, Juanita / Wallace, Daniel J / Clarke, Ann E / Ginzler, Em / Merrill, Joan T / Isenberg, David A / Rahman, Anisur / Petri, M / Fortin, Paul R / Gladman, Dd / Bruce, Ian N / Steinsson, Kristjan / Dooley, Ma / Khamashta, Munther A / Alarcón, Graciela S / Fessler, Barri J / Ramsey-Goldman, Rosalind / Manzi, Susan / Zoma, Asad A / Sturfelt, Gunnar K / Nived, Ola / Aranow, Cynthia / Mackay, Meggan / Ramos-Casals, Manuel / van Vollenhoven, Rf / Kalunian, Kenneth C / Ruiz-Irastorza, Guillermo / Lim, Sam / Kamen, Diane L / Peschken, Christine A / Inanc, Murat / Theriault, Chris / Thompson, Kara / Farewell, Vernon. ·Division of Rheumatology, Nova Scotia Rehabilitation Centre (2nd Floor), 1341 Summer Street, Halifax, Nova Scotia B3H 4K4, Canada. john.hanly@cdha.nshealth.ca ·Ann Rheum Dis · Pubmed #22492779.

ABSTRACT: OBJECTIVE: The aim of this study was to describe the frequency, attribution, outcome and predictors of seizures in systemic lupus erythematosus (SLE). METHODS: The Systemic Lupus International Collaborating Clinics, or SLICC, performed a prospective inception cohort study. Demographic variables, global SLE disease activity (SLE Disease Activity Index 2000), cumulative organ damage (SLICC/American College of Rheumatology Damage Index (SDI)) and neuropsychiatric events were recorded at enrolment and annually. Lupus anticoagulant, anticardiolipin, anti-β(2) glycoprotein-I, antiribosomal P and anti-NR2 glutamate receptor antibodies were measured at enrolment. Physician outcomes of seizures were recorded. Patient outcomes were derived from the SF-36 (36-Item Short Form Health Survey) mental component summary and physical component summary scores. Statistical analyses included Cox and linear regressions. RESULTS: The cohort was 89.4% female with a mean follow-up of 3.5±2.9 years. Of 1631 patients, 75 (4.6%) had ≥1 seizure, the majority around the time of SLE diagnosis. Multivariate analysis indicated a higher risk of seizures with African race/ethnicity (HR (CI): 1.97 (1.07 to 3.63); p=0.03) and lower education status (1.97 (1.21 to 3.19); p<0.01). Higher damage scores (without neuropsychiatric variables) were associated with an increased risk of subsequent seizures (SDI=1:3.93 (1.46 to 10.55); SDI=2 or 3:1.57 (0.32 to 7.65); SDI≥4:7.86 (0.89 to 69.06); p=0.03). There was an association with disease activity but not with autoantibodies. Seizures attributed to SLE frequently resolved (59/78 (76%)) in the absence of antiseizure drugs. There was no significant impact on the mental component summary or physical component summary scores. Antimalarial drugs in the absence of immunosuppressive agents were associated with reduced seizure risk (0.07 (0.01 to 0.66); p=0.03). CONCLUSION: Seizures occurred close to SLE diagnosis, in patients with African race/ethnicity, lower educational status and cumulative organ damage. Most seizures resolved without a negative impact on health-related quality of life. Antimalarial drugs were associated with a protective effect.

8 Article Autoantibodies as biomarkers for the prediction of neuropsychiatric events in systemic lupus erythematosus. 2011

Hanly, J G / Urowitz, M B / Su, L / Bae, S-C / Gordon, C / Clarke, A / Bernatsky, S / Vasudevan, A / Isenberg, D / Rahman, A / Wallace, D J / Fortin, P R / Gladman, D / Romero-Diaz, J / Sanchez-Guerrero, J / Dooley, M A / Bruce, I / Steinsson, K / Khamashta, M / Manzi, S / Ramsey-Goldman, R / Sturfelt, G / Nived, O / van Vollenhoven, R / Ramos-Casals, M / Aranow, C / Mackay, M / Kalunian, K / Alarcón, G S / Fessler, B J / Ruiz-Irastorza, G / Petri, M / Lim, S / Kamen, D / Peschken, C / Farewell, V / Thompson, K / Theriault, C / Merrill, J T. ·Department of Medicine, Division of Rheumatology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada. john.hanly@cdha.nshealth.ca ·Ann Rheum Dis · Pubmed #21893582.

ABSTRACT: OBJECTIVE: Neuropsychiatric events occur unpredictably in systemic lupus erythematosus (SLE) and most biomarker associations remain to be prospectively validated. This study examined a disease inception cohort of 1047 SLE patients to determine which autoantibodies at enrolment predicted subsequent neuropsychiatric events. METHODS: Patients with a recent SLE diagnosis were assessed prospectively for up to 10 years for neuropsychiatric events using the American College of Rheumatology case definitions. Decision rules of graded stringency determined whether neuropsychiatric events were attributable to SLE. Associations between the first neuropsychiatric event and baseline autoantibodies (lupus anticoagulant (LA), anticardiolipin, anti-β(2) glycoprotein-I, anti-ribosomal P and anti-NR2 glutamate receptor) were tested by Cox proportional hazards regression. RESULTS: Disease duration at enrolment was 5.4 ± 4.2 months, follow-up was 3.6 ± 2.6 years. Patients were 89.1% female with mean (±SD) age 35.2 ± 13.7 years. 495/1047 (47.3%) developed one or more neuropsychiatric event (total 917 events). Neuropsychiatric events attributed to SLE were 15.4% (model A) and 28.2% (model B). At enrolment 21.9% of patients had LA, 13.4% anticardiolipin, 15.1% anti-β(2) glycoprotein-I, 9.2% anti-ribosomal P and 13.7% anti-NR2 antibodies. LA at baseline was associated with subsequent intracranial thrombosis (total n=22) attributed to SLE (model B) (HR 2.54, 95% CI 1.08 to 5.94). Anti-ribosomal P antibody was associated with subsequent psychosis (total n=14) attributed to SLE (model B) (HR 3.92, 95% CI 1.23 to 12.5, p=0.02). Other autoantibodies did not predict neuropsychiatric events. CONCLUSION: In a prospective study of 1047 recently diagnosed SLE patients, LA and anti-ribosomal P antibodies are associated with an increased future risk of intracranial thrombosis and lupus psychosis, respectively.

9 Article Measurement of autoantibodies using multiplex methodology in patients with systemic lupus erythematosus. 2010

Hanly, John G / Thompson, Kara / McCurdy, Grace / Fougere, Lisa / Theriault, Chris / Wilton, Kathleen. ·Division of Rheumatology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada. john.hanly@cdha.nshealth.ca ·J Immunol Methods · Pubmed #19836394.

ABSTRACT: Autoantibodies are central to the diagnosis and assessment of systemic lupus erythematosus (SLE). A recent technique for the measurement of autoantibodies utilizes addressable laser bead immunoassay technology (BioPlex 2200) which permits the simultaneous detection of multiple autoantibodies and improved efficiency due to the shorter time to perform the assay and low volume of test samples and reagents. In the current study we have compared this technique to more traditional measures of autoantibody detection. The clinical and laboratory data and stored serum samples from the enrollment visit into a long-term lupus registry at a single academic medical center were used. Sera were examined for a panel of autoantibodies using the BioPlex ANA screen. The results were compared to the historical data on autoantibody profiles using indirect immunofluorescence (IIF) and ELISA. The association with global and organ specific SLE disease activity (nephritis) was also examined. The study consisted of 192 patients who were predominantly female (87%) and Caucasian (91%) with mean disease duration of 8.8 years. The frequency of ANA and anti-dsDNA by IIF and ELISA was 81.3% and 46.6% respectively and was higher than that found with BioPlex (75.5% and 31.8%). The latter detected a higher proportion of patients with autoantibodies to Sm (7.5% vs 16.7%), RNP (21.8% vs 24.0%), Ro (37.4% vs 41.7) and La (13.9% vs 23.4%). Overall agreement between assays varied between 71.4% and 92.5%. Additional autoantibodies identified by BioPlex were anti-chromatin antibodies which were similar in frequency to anti-dsDNA antibodies (33.9% and 31.8% respectively). There was a low frequency of anti-ribosomal P (6.8%), anti-Scl-70 (5.2%), anti-centromere B (3.7%) and anti-Jo-1 (0.5%). Several autoantibodies revealed significant associations with SLEDAI scores but in a multivariate analysis the only autoantibodies that approached statistical significance were anti-Sm (p=0.094) measured by ELISA and anti-dsDNA (p=0.082) measured by BioPlex. There was no association between any of the autoantibodies regardless of the method of detection and cumulative organ damage scores. Fifty-three patients (27.6%) had lupus nephritis of which 17 (32%) had active nephritis at the time of autoantibody determination. There was no significant association between a positive ANA (IIF) and any autoantibodies detected by ELISA with either the cumulative occurrence of lupus nephritis or active nephritis. In contrast, there was an association between BioPlex detected anti-dsDNA with the cumulative occurrence of nephritis (p=0.074) which reached statistical significance with active nephritis at the time of antibody testing (p=0.012). This was confirmed by multivariate analysis (p=0.047). These results suggest reasonable agreement between the detection of lupus autoantibodies by ELISA and BioPlex. The latter demonstrated a better correlation with lupus nephritis.