Predicting lupus flares: epidemiological and disease related risk factors

ABSTRACT

Introduction: Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder, characterized by a relapsing and remitting pattern of disease activity in majority of the patients. Areas covered: This narrative review provides an overview of flare definition, major flare mimics, and the burden of flares in SLE. The authors highlight epidemiology and disease-related risk factor for flares and discuss strategies to reduce flares in SLE. Articles were selected from Pubmed searches conducted between June 2020 and September 2020. Expert opinion: Prolonged clinical remission is observed in approximately 20% of SLE patients flare over the course of the disease. Studies have shown that low disease activity is a good target in SLE, with similar risk of flares, mortality, and quality of life when compared to patients in remission. Clinical and immunological features have shown inconsistent results to identify patients at risk of flares in different cohorts. Cytokine, in serum and urine, has shown promising results to predict flares. However to be useful in clinical practice, they have to be simple, easy, and cost-effective. Future efforts in this direction will allow a more personalized treatment plan for SLE patients, reducing the burden associated with flares.

KEYWORDS:

• Systemic lupus erythematosus
• flare
• risk factors
• mimics

Article highlights

• Flares are frequently observed during SLE course

• Not a single laboratory or immunological parameter is sensitive and specific sufficient for flare diagnosis.

• In SLE patients with flares, flares mimics, and non-adherence has to be discarded.

• HCQ in therapeutic levels is associated with significant reduction of flare rate

• Serum or urinary cytokines have been shown to predict flares in different populations.

• INF-inducible genes are upregulated in SLE flares and may help identifying patients at risk to flare.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was funded by grants from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) – Financial Code 001; Fundação Apoio À Pesquisa Estado São Paulo-Brasil (FAPESP - 2019/06632-5), Conselho Nacional Pesquisa Desenvolvimento-Brasil CNPq 306723/2019-0).