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1. Clinical characteristics and outcome of Spanish patients with ANCA-associated vasculitides: Impact of the vasculitis type, ANCA specificity, and treatment on mortality and morbidity

Author

Solans-Laqué R, Fraile G, Rodriguez-Carballeira M, Caminal L, Castillo MJ, Martínez-Valle F, Sáez L, Rios JJ, Solanich X, Oristrell J, Pasquau F, Fonseca E, Zamora M, Callejas JL, Frutos B, Abdilla M, Fanlo P, García-Sánchez I, López-Dupla M, Sopeña B, Pérez-Iglesias A, Bosch JA, Spanish Registry of systemic vasculitis (REVAS) from the Autoimmune Diseases Stu, Spanish Registry of systemic vasculitis (REVAS) from the Autoimmune Diseases Study Group (GEAS) of the Spanish Society of Internal Medicine (SEMI), [Solans-Laqué,R, Martínez-Valle,F, Bosch,JA] Hospital Valle Hebrón, Barcelona. [Fraile,G] Hospital Ramón y Cajal, Madrid. [Rodriguez-Carballeira,M] Mutua Terrassa, Barcelona. [Caminal,L] Hospital Central de Asturias. [Castillo,MJ] Hospital Virgen del Rocío, Sevilla. [Sáez,L] Hospital Miguel Servet, Zaragoza. [Rios,JJ] Hospital La Paz, Madrid. [Solanich,X] Hospital Bellvitge. [Oristrell,J] Hospital Parc Tauli Sabadell, Barcelona. [Pasquau.F] Hospital Marina Baixa, Villajoyosa, Alicante. [Fonseca,E] Hospital Cabueñes, Asturias. [Zamora,M] Hospital Virgen de las Nieves. [Callejas,JL] Hospital Clínico San Cecilio, Granada. [Frutos,B] Hospital Fuenlabrada, Madrid. [Abdilla,O] Hospital La Ribera, Alzira, Valencia. [Fanlo,P] Clínica de Navarra. [García-Sánchez,I] Hospital Infanta Leonor, Madrid. [López-Dupla,M] Hospital Joan XXIII, Tarragona. [Sopeña,B] Centro Hospitalário Vigo. [Pérez-Iglesias,A] Hospital Ourense, Galicia, Spain. [Bosch,JA] Spanish Registry of systemic vasculitis (REVAS) from the Autoimmune Diseases Study Group (GEAS) of the Spanish Society of Internal Medicine (SEMI)., Institut Català de la Salut, [Solans-Laqué R] Hospital Universitari Vall d'Hebron, Barcelona, Spain. [Fraile G] Hospital Ramón y Cajal, Madrid, Spain. [Rodriguez-Carballeira M] Mútua Terrassa, Barcelona, Spain. [Caminal L] Hospital Central de Asturias, Oviedo, Spain. [Castillo MJ] Hospital Virgen del Rocío, Sevilla, Spain. [Martínez-Valle F, Zamora M, Bosch JA] Hospital Universitari Vall d'Hebron, Barcelona, Spain., and Vall d'Hebron Barcelona Hospital Campus

Subjects
Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Disease Attributes::Recurrence [Medical Subject Headings], Male, Other subheadings::Other subheadings::/epidemiology [Other subheadings], calidad, acceso y evaluación de la atención sanitaria::calidad de la atención sanitaria::factores epidemiológicos::comorbilidad [ATENCIÓN DE SALUD], Phenomena and Processes::Physical Phenomena::Time::Time Factors [Medical Subject Headings], España, Comorbidity, Estudios longitudinales, ANCA-associated vasculitides, Gastroenterology, Anticuerpos anticitoplasma de neutrófilos, Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], 0302 clinical medicine, Longitudinal Studies, Young adult, Anciano de 80 o más años, Masculino, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Morbidity::Prevalence [Medical Subject Headings], Adolescente, Aged, 80 and over, General Medicine, eosinophilic granulomatosis with polyangiitis, Geographic Locations::Europe::Spain [GEOGRAPHICALS], Cohort, Microscopic polyangiitis, Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Blood Proteins::Immunoproteins::Immunoglobulins::Antibodies::Autoantibodies::Antibodies, Antineutrophil Cytoplasmic [Medical Subject Headings], Vasculitis asociada a anticuerpos citoplasmáticos antineutrófilos, medicine.medical_specialty, mortality predictors, Anciano, Recurrencia, Check Tags::Male [Medical Subject Headings], 03 medical and health sciences, Estudios retrospectivos, Other subheadings::Other subheadings::Other subheadings::/mortality [Other subheadings], Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies [Medical Subject Headings], Humans, Persons::Persons::Age Groups::Adult [Medical Subject Headings], Aged, Retrospective Studies, Mediana edad, Otros calificadores::Otros calificadores::Otros calificadores::/mortalidad [Otros calificadores], granulomatosis with polyangiitis, Eosinophilic granulomatosis with polyangiitis, Persons::Persons::Age Groups::Adult::Middle Aged [Medical Subject Headings], Mortality predictors, medicine.disease, Diseases::Immune System Diseases::Autoimmune Diseases::Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis [Medical Subject Headings], Check Tags::Female [Medical Subject Headings], Persons::Persons::Age Groups::Adult::Aged::Aged, 80 and over [Medical Subject Headings], Granulomatosis with polyangiitis, Other subheadings::Other subheadings::/physiopathology [Other subheadings], Time Factors, Cardiovascular Diseases::Vascular Diseases::Vasculitis::Systemic Vasculitis::Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis [DISEASES], Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Case-Control Studies::Retrospective Studies [Medical Subject Headings], Adulto joven, Recurrence, Health Care::Health Care Quality, Access, and Evaluation::Quality of Health Care::Epidemiologic Factors::Comorbidity [Medical Subject Headings], Prevalence, 030212 general & internal medicine, infections, Persons::Persons::Age Groups::Adult::Aged [Medical Subject Headings], microscopic polyangiitis, Adulto, Otros calificadores::Otros calificadores::/epidemiología [Otros calificadores], Femenino, Middle Aged, Comorbilidad, enfermedades cardiovasculares::enfermedades vasculares::vasculitis::vasculitis sistémica::vasculitis asociada a anticuerpos anticitoplasma de neutrófilos [ENFERMEDADES], Treatment Outcome, outcome, Ubicaciones Geográficas::Europa (Continente)::España [DENOMINACIONES GEOGRÁFICAS], Female, Estudios de seguimiento, Vasculitis, Persons::Persons::Age Groups::Adult::Young Adult [Medical Subject Headings], medicine.drug, Research Article, Adult, Otros calificadores::Otros calificadores::/fisiopatología [Otros calificadores], Cyclophosphamide, Adolescent, Spanish people, Observational Study, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis, Infections, Persons::Persons::Age Groups::Adolescent [Medical Subject Headings], Antibodies, Antineutrophil Cytoplasmic, Young Adult, Comorbiditat, Internal medicine, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Follow-Up Studies [Medical Subject Headings], medicine, Health Care Quality, Access, and Evaluation::Quality of Health Care::Epidemiologic Factors::Comorbidity [HEALTH CARE], Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment Outcome [Medical Subject Headings], 030203 arthritis & rheumatology, Geographical Locations::Geographic Locations::Europe::Spain [Medical Subject Headings], business.industry, Retrospective cohort study, Surgery, Outome, Spain, Factores de tiempo, Vasculitis - Espanya, Resultado del tratamiento, business, Prevalencia, Follow-Up Studies
Abstract

The aim of this study was to describe the clinical characteristics of ANCA-associated vasculitides (AAV) at presentation, in a wide cohort of Spanish patients, and to analyze the impact of the vasculitis type, ANCA specificity, prognostic factors, and treatments administered at diagnosis, in the outcome. A total of 450 patients diagnosed between January 1990 and January 2014 in 20 Hospitals from Spain were included. Altogether, 40.9% had granulomatosis with polyangiitis (GPA), 37.1% microscopic polyangiitis (MPA), and 22% eosinophilic granulomatosis with polyangiitis (EGPA). The mean age at diagnosis was 55.6 +/- 17.3 years, patients with MPA being significantly older (P < 0.001). Fever, arthralgia, weight loss, respiratory, and ear-nose-throat (ENT) symptoms, were the most common at disease onset. ANCAs tested positive in 86.4% of cases: 36.2% C-ANCA-PR3 and 50.2% P-ANCA-MPO. P-ANCA-MPO was significantly associated with an increased risk for renal disease (OR 2.6, P < 0.001) and alveolar hemorrhage (OR 2, P = 0.010), while C-ANCA-PR3 was significantly associated with an increased risk for ENT (OR 3.4, P < 0.001) and ocular involvement (OR 2.3, P = 0.002). All patients received corticosteroids (CS) and 74.9% cyclophosphamide (CYC). The median follow-up was 82 months (IQR 100.4). Over this period 39.9% of patients suffered bacterial infections and 14.6% opportunistic infections, both being most prevalent in patients with high-cumulated doses of CYC and CS (P < 0.001). Relapses were recorded in 36.4% of cases with a mean rate of 2.5 +/- 2.3, and were more frequent in patients with C-ANCA-PR3 (P = 0.012). The initial disease severity was significantly associated with mortality but not with the occurrence of relapses. One hundred twenty-nine (28.7%) patients (74 MPA, 41 GPA, 14 EGPA) died. The mean survival was 58 months (IQR 105) and was significantly lower for patients with MPA (P < 0.001). Factors independently related to death were renal involvement (P = 0.010), cardiac failure (P = 0.029) and age over 65 years old (P < 0.001) at disease onset, and bacterial infections (P < 0.001). An improved outcome with significant decrease in mortality and treatment-related morbidity was observed in patients diagnosed after 2000, and was related to the implementation of less toxic regimens adapted to the disease activity and stage, and a drastic reduction in the cumulated CYC and CS dose.

Published
2017

2. KCNA5 gene is not confirmed as a systemic sclerosis-related pulmonary arterial hypertension genetic susceptibility factor

Author

Bossini Castillo, L, Simeon, Cp, Beretta, L, Broen, J, Vonk, Mc, Callejas, Jl, Carreira, P, Rodriguez Rodriguez, L, Garcia Portales, R, Gonzalez Gay MA, Castellvi, I, Camps, Mt, Tolosa, C, Vicente Rabaneda, E, Egurbide, Mv, Ssg, Ss, Schuerwegh, Aj, Hesselstrand, R, Lunardi, Claudio, van Laar JM, Shiels, P, Herrick, A, Worthington, J, Denton, C, Radstake, Tr, Fonseca, C, and Martin, J.

Subjects
medicine.medical_specialty, Pathology, Linkage disequilibrium, Genotype, systemic sclerosis, Hypertension, Pulmonary, Immunology, Population, Polymorphism, Single Nucleotide, Gastroenterology, Linkage Disequilibrium, White People, Cohort Studies, Kv1.5 Potassium Channel, Gene Frequency, Rheumatology, pulmonary arterial hypertension, Internal medicine, Odds Ratio, medicine, Humans, Immunology and Allergy, SNP, Genetic Predisposition to Disease, Potassium voltage-gated channel shaker-related subfamily member 5, education, skin and connective tissue diseases, Allele frequency, Netherlands, Rheumatology and Autoimmunity, Sweden, education.field_of_study, Scleroderma, Systemic, integumentary system, business.industry, Autoantibody, Odds ratio, medicine.disease, Pulmonary hypertension, United Kingdom, Italy, Spain, Genetic marker, business, Research Article
Abstract

Introduction Potassium voltage-gated channel shaker-related subfamily member 5 (KCNA5) is implicated in vascular tone regulation, and its inhibition during hypoxia produces pulmonary vasoconstriction. Recently, a protective association of the KCNA5 locus with systemic sclerosis (SSc) patients with pulmonary arterial hypertension (PAH) was reported. Hence, the aim of this study was to replicate these findings in an independent multicenter Caucasian SSc cohort. Methods The 2,343 SSc cases (179 PAH positive, confirmed by right-heart catheterization) and 2,690 matched healthy controls from five European countries were included in this study. Rs10744676 single-nucleotide polymorphism (SNP) was genotyped by using a TaqMan SNP genotyping assay. Results Individual population analyses of the selected KCNA5 genetic variant did not show significant association with SSc or any of the defined subsets (for example, limited cutaneous SSc, diffuse cutaneous SSc, anti-centromere autoantibody positive and anti-topoisomerase autoantibody positive). Furthermore, pooled analyses revealed no significant evidence of association with the disease or any of the subsets, not even the PAH-positive group. The comparison of PAH-positive patients with PAH-negative patients showed no significant differences among patients. Conclusions Our data do not support an important role of KCNA5 as an SSc-susceptibility factor or as a PAH-development genetic marker for SSc patients., This work was supported by the following grants: JM was funded by GEN-FER from the Spanish Society of Rheumatology, SAF2009-11110 from the Spanish Ministry of Science, CTS-4977 from Junta de Andalucía, Spain, in part by Redes Temáticas de Investigación Cooperativa Sanitaria Program, RD08/0075 (RIER) from Instituto de Salud Carlos III (ISCIII), Spain, and by Fondo Europeo de Desarrollo Regional (FEDER). TRDJR was funded by the VIDI laureate from the Dutch Association of Research (NWO) and Dutch Arthritis Foundation (National Reumafonds). JM and TRDJR were sponsored by the Orphan Disease Program grant from the European League Against Rheumatism (EULAR). BPCK is supported by the Dutch Diabetes Research Foundation (grant 2008.40.001) and the Dutch Arthritis Foundation (Reumafonds, grant NR 09-1-408). This study was also funded by PI-0590-2010, Consejería de Salud, Junta de Andalucía, Spain.

Published
2012

5. First month prednisone dose predicts prednisone burden during the following 11 months: an observational study from the RELES cohort

Author

Ruiz-Irastorza, G., Garcia, M., Espinosa, G., Caminal, L., Mitjavila, F., Gonzalez-Leon, R., Sopena, B., Canora, J., Villalba, M. V., Rodriguez-Carballeira, M., Lopez-Dupla, J. M., Callejas, J. L., Castro, A., Tolosa, C., Sanchez-Garcia, M. E., Perez-Conesa, M., Navarrete-Navarrete, N., Rodriguez, A. P., Herranz, M. T., Pallares, L., RELES, Autoimmune Dis Study Grp GEAS, [Ruiz-Irastorza, G.] Univ Basque Country, Autoimmune Dis Res Unit, Dept Internal Med, BioCruces Hlth Res Inst,Hosp Univ Cruces, Baracaldo, Bizkaia, Spain, [Garcia, M.] Univ Basque Country, Autoimmune Dis Res Unit, Dept Internal Med, BioCruces Hlth Res Inst,Hosp Univ Cruces, Baracaldo, Bizkaia, Spain, [Espinosa, G.] Hosp Clin Barcelona, Dept Autoimmune Dis, Barcelona, Spain, [Caminal, L.] Hosp Univ Cent Asturias, Dept Internal Med, Oviedo, Asturias, Spain, [Mitjavila, F.] Hosp Univ Bellvitge, Dept Internal Med, Autoimmune Dis Unit, Barcelona, Spain, [Gonzalez-Leon, R.] Hosp Univ Virgen del Rocio, Dept Internal Med, Seville, Spain, [Sopena, B.] Complejo Hosp Univ Vigo, Dept Internal Med, Vigo, Spain, [Canora, J.] Hosp Univ Fuenlabrada, Dept Internal Med, Madrid, Spain, [Villalba, M. V.] Hosp Gen Univ Gregorio Maranon, Dept Internal Med, Madrid, Spain, [Rodriguez-Carballeira, M.] Hosp Univ Mutua Terrasa, Dept Internal Med, Barcelona, Spain, [Lopez-Dupla, J. M.] Hosp Univ Joan XXIII, Dept Internal Med, Tarragona, Spain, [Callejas, J. L.] Hosp Univ San Cecilio, Dept Internal Med, Granada, Spain, [Castro, A.] Hosp Univ St Joan de Reus, Dept Internal Med, Tarragona, Spain, [Tolosa, C.] Corporacio Sanitaria Parc Tauli, Dept Internal Med, Barcelona, Spain, [Sanchez-Garcia, M. E.] Hosp Univ Reina Sofia, Dept Internal Med, Autoimmune Dis Unit, Cordoba, Spain, [Perez-Conesa, M.] Hosp Univ Miguel Servet, Dept Internal Med, Zaragoza, Spain, [Navarrete-Navarrete, N.] Hosp Univ Virgen de las Nieves, Dept Internal Med, Granada, Spain, [Rodriguez, A. P.] Complejo Hosp Univ Ourense, Dept Internal Med, Orense, Spain, [Herranz, M. T.] Hosp JM Morales Meseguer, Dept Internal Med, Murcia, Spain, [Pallares, L.] Hosp Univ Son Espases, Dept Internal Med, Islas Baleares, Spain, Spanish Society of Internal Medicine, RELES, Autoimmune Diseases Study Group (GEAS), [Ruiz-Irastorza,G, Garcia,M] Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Bizkaia, Spain. [Espinosa,G] Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain. [Caminal,L] Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Asturias , Spain. [Mitjavila,F] Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. [González-León,R] Department of Internal Medicine , Hospital Universitario Virgen del Rocío, Sevilla, Spain. [Sopeña,B] Department of Internal Medicine, Complejo Hospitalario Universitario de Vigo, Pontevedra, Vigo , Spain. [Canora,J] Department of Internal Medicine, Hospital Universitario Fuenlabrada, Fuenlabrada, Madrid , Spain. [Villalba,MV] Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain. [Rodríguez-Carballeira,M] Department of Internal Medicine, Hospital Universitario Mutua de Terrasa, Barcelona, Spain. [López-Dupla,JM] Department of Internal Medicine, Hospital Universitario Joan XXIII, Tarragona, Spain. [Callejas,JL] Department of Internal Medicine, Hospital Universitario San Cecilio, Granada, Spain. [Castro,A] Department of Internal Medicine, Hospital Universitario Sant Joan de Reus, Reus, Tarragona , Spain. [Tolosa,C] Department of Internal Medicine, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain. [Sánchez-García,ME] Department of Internal Medicine, Autoimmune Diseases Unit, Hospital Universitario Reina Sofía , Córdoba, Spain. [Pérez-Conesa,M] Department of Internal Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain. [Navarrete-Navarrete,N] Department of Internal Medicine , Hospital Universitario Virgen de las Nieves, Granada, Spain. [Rodríguez,AP] Department of Internal Medicine, Complejo Hospitalario Universitario de Ourense, Ourense, Spain. [Herranz,MT] Department of Internal Medicine, Hospital J.M. Morales Meseguer, Murcia, Spain. [Pallarés,L] Department of Internal Medicine, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, Spain., and This study was supported by the Spanish Society of Internal Medicine.

Subjects
0301 basic medicine, Lupus nephritis, Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], 0302 clinical medicine, immune system diseases, Prednisone, Nefritis lúpica, Phenomena and Processes::Circulatory and Respiratory Physiological Phenomena::Cardiovascular Physiological Phenomena::Hemodynamics::Pulse [Medical Subject Headings], skin and connective tissue diseases, Diseases::Skin and Connective Tissue Diseases::Connective Tissue Diseases::Lupus Erythematosus, Cutaneous::Lupus Erythematosus, Discoid [Medical Subject Headings], Systemic lupus erythematosus, Lupus eritematoso discoide, Cumulative dose, General Medicine, Humanos, Chemicals and Drugs::Polycyclic Compounds::Steroids::Pregnanes::Pregnadienes::Pregnadienetriols::Prednisolone::Methylprednisolone [Medical Subject Headings], Cohort, Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Physiological Effects of Drugs::Immunologic Factors::Immunosuppressive Agents [Medical Subject Headings], Glucocorticoid, medicine.drug, medicine.medical_specialty, Antimaláricos, Immunology, Diseases::Skin and Connective Tissue Diseases::Connective Tissue Diseases::Lupus Erythematosus, Systemic::Lupus Nephritis [Medical Subject Headings], Brief Communication, Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Antiparasitic Agents::Antiprotozoal Agents::Antimalarials [Medical Subject Headings], Systemic Lupus Erythematosus, Disease activity, 03 medical and health sciences, Internal medicine, Lupus eritematoso sistémico, medicine, Corticosteroids, Metilprednisolona, Glucocorticoides, Disease Activity, 030203 arthritis & rheumatology, business.industry, Diseases::Skin and Connective Tissue Diseases::Connective Tissue Diseases::Lupus Erythematosus, Systemic [Medical Subject Headings], Inmunosupresores, Pulso arterial, medicine.disease, Chemicals and Drugs::Polycyclic Compounds::Steroids::Pregnanes::Pregnadienes::Pregnadienediols::Prednisone [Medical Subject Headings], Chemicals and Drugs::Hormones, Hormone Substitutes, and Hormone Antagonists::Hormones::Adrenal Cortex Hormones::Glucocorticoids [Medical Subject Headings], 030104 developmental biology, Endocrinology, Prednisona, Observational study, business
Abstract

Aim: To study the influence of prednisone dose during the first month after systemic lupus erythematosus (SLE) diagnosis (prednisone-1) on glucocorticoid burden during the subsequent 11 months (prednisone-2-12). Methods: 223 patients from the Registro Espanol de Lupus Eritematoso Sisternico inception cohort were studied. The cumulative dose of prednisone-1 and prednisone-2-12 were calculated and recoded into a four-level categorical variable: no prednisone, low dose (up to 7.5 mg/day), medium dose (up to 30 mg/day) and high dose (over 30 mg/day). The association between the cumulative prednisone-1 and prednisone-2-12 doses was tested. We analysed whether the four level prednisone-1 categorical variable was an independent predictor of an average dose >7.5 mg/day of prednisone-2-12. Adjusting variables included age, immunosuppressives, antimalarials, methyl-prednisolone pulses, lupus nephritis and baseline SLE Disease Activity Index (SLEDAI). Results: Within the first month, 113 patients (51%) did not receive any prednisone, 24 patients (11%) received average low doses, 46 patients (21%) received medium doses and 40 patients (18%) received high doses. There was a strong association between prednisone-1 and prednisone-2-12 dose categories (p7.5 mg/day, while patients receiving low dose prednisone-1 were not (adjusted OR 1.4, 95% CI 0. 0.38 to 5.2). If the analysis was restricted to the 158 patients with a baseline SLEDAI of >= 6, the model did not change. Conclusion: The dose of prednisone during the first month after the diagnosis of SLE is an independent predictor of prednisone burden during the following 11 months., This study was supported by the Spanish Society of Internal Medicine.

Published
2016

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