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Original article

Vol. 144 No. 3132 (2014)

The Swiss Systemic lupus erythematosus Cohort Study (SSCS) – cross-sectional analysis of clinical characteristics and treatments across different medical disciplines in Switzerland

  • Camillo Ribi
  • Marten Trendelenburg
  • Angèle Gayet-Ageron
  • Clemens Cohen
  • Eric Dayer
  • Ute Eisenberger
  • Thomas Hauser
  • Thomas Hunziker
  • Annette Leimgruber
  • Gregor Lindner
  • Katrin Koenig
  • Petra Otto
  • François Spertini
  • Thomas Stoll
  • Johannes Von Kempis
  • Carlo Chizzolini
  • Swiss Systemic Lupus Erythematosus Cohort Study Group
Cite this as:
Swiss Med Wkly. 2014;144:w13990


OBJECTIVES: To describe disease characteristics and treatment modalities in a multidisciplinary cohort of systemic lupus erythematosus (SLE) patients in Switzerland.

METHODS: Cross-sectional analysis of 255 patients included in the Swiss SLE Cohort and coming from centres specialised in Clinical Immunology, Internal Medicine, Nephrology and Rheumatology. Clinical data were collected with a standardised form. Disease activity was assessed using the Safety of Estrogens in Lupus Erythematosus National Assessment-SLE Disease Activity Index (SELENA-SLEDAI), an integer physician’s global assessment score (PGA) ranging from 0 (inactive) to 3 (very active disease) and the erythrocyte sedimentation rate (ESR). The relationship between SLE treatment and activity was assessed by propensity score methods using a mixed-effect logistic regression with a random effect on the contributing centre.

RESULTS: Of the 255 patients, 82% were women and 82% were of European ancestry. The mean age at enrolment was 44.8 years and the median SLE duration was 5.2 years. Patients from Rheumatology had a significantly later disease onset. Renal disease was reported in 44% of patients. PGA showed active disease in 49% of patients, median SLEDAI was 4 and median ESR was 14 millimetre/first hour. Prescription rates of anti-malarial drugs ranged from 3% by nephrologists to 76% by rheumatologists. Patients regularly using anti-malarial drugs had significantly lower SELENA-SLEDAI scores and ESR values.

CONCLUSION: In our cohort, patients in Rheumatology had a significantly later SLE onset than those in Nephrology. Anti-malarial drugs were mostly prescribed by rheumatologists and internists and less frequently by nephrologists, and appeared to be associated with less active SLE.


  1. D’Cruz DP, Khamashta MA, Hughes GR. Systemic lupus erythematosus. Lancet. 2007;369(9561):587–96.
  2. Chizzolini C, Cohen CD, Eisenberger U, Hauser T, Hunziker T, Leimgruber A, et al. Towards the Swiss systemic lupus erythematosus cohort study (SSCS). Rev Med Suisse. 2009;5(199):808–11.
  3. Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;40(9):1725.
  4. Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1982;25(11):1271–7.
  5. Petri M, Kim MY, Kalunian KC, Grossman J, Hahn BH, Sammaritano LR, et al. Combined oral contraceptives in women with systemic lupus erythematosus. N Engl J Med. 2005;353(24):2550–8.
  6. Touma Z, Urowitz MB, Ibanez D, Gladman DD. SLEDAI-2K 10 days versus SLEDAI-2K 30 days in a longitudinal evaluation. Lupus. 2011;20(1):67–70.
  7. Yee CS, Farewell VT, Isenberg DA, Griffiths B, Teh LS, Bruce IN, et al. The use of Systemic Lupus Erythematosus Disease Activity Index-2000 to define active disease and minimal clinically meaningful change based on data from a large cohort of systemic lupus erythematosus patients. Rheumatology (Oxford).50(5):982–8.
  8. D’Agostino RB, Jr. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med. 1998;17(19):2265–81.
  9. Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, et al. Systemic lupus erythematosus: clinical and immunologic patterns of disease expression in a cohort of 1,000 patients. The European Working Party on Systemic Lupus Erythematosus. Medicine (Baltimore). 1993;72(2):113–24.
  10. Lalani S, Pope J, de Leon F, Peschken C, Members of Ca NFoL. Clinical features and prognosis of late-onset systemic lupus erythematosus: results from the 1000 faces of lupus study. J Rheumatol. 2010;37(1):38–44.
  11. Alonso MD, Martinez-Vazquez F, de Teran TD, Miranda-Filloy JA, Dierssen T, Blanco R, et al. Late-onset systemic lupus erythematosus in Northwestern Spain: differences with early-onset systemic lupus erythematosus and literature review. Lupus. 2012;21(10):1135–48.
  12. Seligman VA, Lum RF, Olson JL, Li H, Criswell LA. Demographic differences in the development of lupus nephritis: a retrospective analysis. Am J Med. 2002;112(9):726–9.
  13. Cervera R, Abarca-Costalago M, Abramovicz D, Allegri F, Annunziata P, Aydintug AO, et al. Systemic lupus erythematosus in Europe at the change of the millennium: lessons from the “Euro-Lupus Project”. Autoimmun Rev. 2006;5(3):180–6.
  14. Costedoat-Chalumeau N, Leroux G, Piette JC, Amoura Z. Why all systemic lupus erythematosus patients should be given hydroxychloroquine treatment? Joint Bone Spine. 2010;77(1):4–5.
  15. Lerang K, Gilboe IM, Gran JT. Differences between rheumatologists and other internists regarding diagnosis and treatment of systemic lupus erythematosus. Rheumatology (Oxford). 51(4):663–9.
  16. Schmajuk G, Yazdany J, Trupin L, Yelin E. Hydroxychloroquine treatment in a community-based cohort of patients with systemic lupus erythematosus. Arthritis Care Res (Hoboken). 62(3):386–92.
  17. Molina MJ, Mayor AM, Franco AE, Morell CA, Lopez MA, Vila LM. Utilization of health services and prescription patterns among lupus patients followed by primary care physicians and rheumatologists in Puerto Rico. Ethn Dis. 2008;18(2 Suppl 2):S2–205–10.
  18. Yazdany J, Gillis JZ, Trupin L, Katz P, Panopalis P, Criswell LA, et al. Association of socioeconomic and demographic factors with utilization of rheumatology subspecialty care in systemic lupus erythematosus. Arthritis Rheum. 2007;57(4):593–600.
  19. Scherbel AL. Use of synthetic antimalarial drugs and other agents for rheumatoid arthritis: historic and therapeutic perspectives. Am J Med. 1983;75(1A):1–4.
  20. Wallace DJ. The history of antimalarials. Lupus. 1996;5(Suppl 1):S2–3.
  21. D’Cruz D. Antimalarial therapy: a panacea for mild lupus? Lupus. 2001;10(3):148–51.
  22. Lee SJ, Silverman E, Bargman JM. The role of antimalarial agents in the treatment of SLE and lupus nephritis. Nat Rev Nephrol.7(12):718–29.
  23. Vila LM, Alarcon GS, McGwin G, Jr., Bastian HM, Fessler BJ, Reveille JD. Systemic lupus erythematosus in a multiethnic cohort (LUMINA): XXIX. Elevation of erythrocyte sedimentation rate is associated with disease activity and damage accrual. J Rheumatol. 2005;32(11):2150–5.
  24. Mirzayan MJ, Schmidt RE, Witte T. Prognostic parameters for flare in systemic lupus erythematosus. Rheumatology. 2000;39(12):1316–9.
  25. Zen M, Bassi N, Nalotto L, Canova M, Bettio S, Gatto M, et al. Disease activity patterns in a monocentric cohort of SLE patients: a seven-year follow-up study. Clin Exp Rheumatol. 2012;30(6):856–63.
  26. A randomized study of the effect of withdrawing hydroxychloroquine sulfate in systemic lupus erythematosus. The Canadian Hydroxychloroquine Study Group. N Engl J Med. 1991;324(3):150–4.
  27. Kasitanon N, Fine DM, Haas M, Magder LS, Petri M. Hydroxychloroquine use predicts complete renal remission within 12 months among patients treated with mycophenolate mofetil therapy for membranous lupus nephritis. Lupus. 2006;15(6):366–70.
  28. Munro R, Morrison E, McDonald AG, Hunter JA, Madhok R, Capell HA. Effect of disease modifying agents on the lipid profiles of patients with rheumatoid arthritis. Ann Rheum Dis. 1997;56(6):374–7.
  29. Kaiser R, Cleveland CM, Criswell LA. Risk and protective factors for thrombosis in systemic lupus erythematosus: results from a large, multi-ethnic cohort. Ann Rheum Dis. 2009;68(2):238–41.
  30. Wasko MC, Hubert HB, Lingala VB, Elliott JR, Luggen ME, Fries JF, et al. Hydroxychloroquine and risk of diabetes in patients with rheumatoid arthritis. JAMA. 2007;298(2):187–93.
  31. Mok CC, Mak A, Ma KM. Bone mineral density in postmenopausal Chinese patients with systemic lupus erythematosus. Lupus. 2005;14(2):106–12.
  32. Ruiz-Irastorza G, Ugarte A, Egurbide MV, Garmendia M, Pijoan JI, Martinez-Berriotxoa A, et al. Antimalarials may influence the risk of malignancy in systemic lupus erythematosus. Ann Rheum Dis. 2007;66(6):815–7.
  33. Fessler BJ, Alarcon GS, McGwin G, Jr., Roseman J, Bastian HM, Friedman AW, et al. Systemic lupus erythematosus in three ethnic groups: XVI. Association of hydroxychloroquine use with reduced risk of damage accrual. Arthritis Rheum. 2005;52(5):1473–80.
  34. Alarcon GS, McGwin G, Bertoli AM, Fessler BJ, Calvo-Alen J, Bastian HM, et al. Effect of hydroxychloroquine on the survival of patients with systemic lupus erythematosus: data from LUMINA, a multiethnic US cohort (LUMINA L). Ann Rheum Dis. 2007;66(9):1168–72.
  35. Ruiz-Irastorza G, Egurbide MV, Pijoan JI, Garmendia M, Villar I, Martinez-Berriotxoa A, et al. Effect of antimalarials on thrombosis and survival in patients with systemic lupus erythematosus. Lupus. 2006;15(9):577–83.
  36. Doria A, Gatto M, Zen M, Iaccarino L, Punzi L. Optimizing outcome in SLE: treating-to-target and definition of treatment goals. Autoimmunity reviews. 2014.

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