Background/Purpose: This study describes the disease patterns, flare incidence, hospitalizations and causes of mortality in a cohort of Filipino patients with systemic lupus erythematosus (SLE), observed over a period of 1 year at a single tertiary care center.

Methods: Included were SLE patients consecutively seen at the Rheumatology Lupus Clinics of the University of Santo Tomas Hospital in Manila, Philippines from 2012 to 2014 who were assessed over a period of at least 1 year up to May 2015. Data were obtained at minimum 3 time-points: baseline, 12 + 1 month from baseline, and at least 1 clinic visit or hospitalization within the 12-month period. Demographics, SLE disease characteristics, SLICC/ACR Damage Index (SDI), and medications history were obtained at baseline. SLE Disease Activity Index (SLEDAI), SLE flare index (SFI) and flare characteristics, reasons for hospitalizations and causes of mortality when applicable, were obtained at each clinic or hospital visit.  

Results: 162 SLE patients (148, 91% females) participated in this study, with mean 27.96 years + 10.09 SD (range 5-59) age at diagnosis and mean 8.51 + 6.24 SD (range 1-32) years disease duration.  Mucocutaneous (151, 93%), musculoskeletal (142, 88%) and renal (107, 66%) were the most common organ system involvement. Cataracts were the most common SDI involvement (23, 19%), followed by cerebrovascular accident (CVA) (18, 15%) and avascular necrosis (15, 13%). Mean cumulative prednisone / equivalent dose was 29.07 g+ 24.58 SD. Other medications included hydroxychloroquine (86%), mycophenolate mofetil (57%), cyclophosphamide (44%), azathioprine (22.6%), tacrolimus (4.8%), belimumab (3.6%) and rituximab (2.4%). Over the 1 year observation period, there were total 89 flares in 74 (46%) patients, 27 of which were characterized as severe; 35 (44%) of flares involved the kidneys. Sixty-five (40%) were identified to have relapsing/remitting course, 57 (35%) had chronic active disease and 16 (10%) had long quiescent disease; 24 (15%) were in remission ie without corticosteroids and immunosuppressants.  Of 11 patients who were hospitalized, 5 were due to infection, 4 for disease flare, and 2 for infection with concommitant disease activity. In addition, 6 patients died during the 1 year study period, 5 of whom had active disease and/ or systemic infection at the time of death.  

Conclusion: This prospective observational study describes disease patterns, morbidity and mortality in a cohort of Filipino SLE patients, reflecting the high costs of health resource utilization and burden of illness among these patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/disease-patterns-flare-incidence-and-organ-damage-among-filipino-patients-with-systemic-lupus-erythematosus-a-one-year-observational-study/