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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EPatients with systemic lupus erythematosus (SLE) are at heightened risk of thrombosis [Mok CC et al. \u003Cem\u003EArthritis Rheum\u003C\/em\u003E 2005] and mortality [Cervera R et al. \u003Cem\u003EMedicine (Baltimore)\u003C\/em\u003E 2003]. Additionally, women with SLE are also 2.05 to 2.27 times more likely to have a cerebral vascular accident)\/myocardial infarction [Ward MM. \u003Cem\u003EArthritis Rheum\u003C\/em\u003E 1999 (Feb)]. This article discusses the use of hydroxychloroquine for the reduction of thrombosis in systemic lupus patients, and lymphoma risk in systemic lupus.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ELymphatic Diseases\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ELupus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EThrombotic Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EThrombophilia\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EHydroxychloroquine Reduces Thrombosis in Systemic Lupus Patients\u003C\/h2\u003E\n         \u003Cp id=\u0022p-2\u0022\u003EPatients with systemic lupus erythematosus (SLE) are at heightened risk of thrombosis [Mok CC et al. \u003Cem\u003EArthritis Rheum\u003C\/em\u003E 2005] and mortality [Cervera R et al. \u003Cem\u003EMedicine (Baltimore)\u003C\/em\u003E 2003]. Additionally, women with SLE are also 2.05 to 2.27 times more likely to have a cerebral vascular accident (CVA)\/myocardial infarction (MI) [Ward MM. \u003Cem\u003EArthritis Rheum\u003C\/em\u003E 1999 (Feb)].\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EGenevieve Law, MD, PhD, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, explained that thrombotic risk factors include demographic and cardiovascular traits, acquired thrombosis triggers, genetic hypercoagulable states, acquired lupus-specific risk factors, and persistent antiphospholipid antibodies. Prednisone is also a risk factor for thrombosis.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EIn the Study of the Predictors of the Course and Early Outcome of Patients with Systemic Lupus Erythematosus: Nature Versus Nurture [LUMINA] cohort, the highest dose of prednisone was associated with thrombosis [Burgos P et al. \u003Cem\u003ERheumatology\u003C\/em\u003E 2010]. Dr. Law said prednisone may be a proxy for disease activity. Conversely, hydroxychloroquine (HCQ) has antithrombotic effects [Rand JH et al. \u003Cem\u003EBlood\u003C\/em\u003E 2008; Edwards MH et al. \u003Cem\u003ECirculation\u003C\/em\u003E 1997].\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EIn this study, objectives were to explore risk factors for incident thromboses in a large SLE cohort, and to examine the use of prednisone and HCQ as factors that predict or protect against thrombosis. Patients from the Hopkins Lupus cohort who had never had thrombosis were enrolled between 1987 and October 2011. They were reviewed for arterial and venous thrombotic events (VTE). Univariate and multivariate modeling were used to assess the data.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EOf the study subjects (n=1795), 93.3% were female, 56% were Caucasian, and 37% were African American. The mean age was 37.0\u00b112.5 years. In over 10,508 person-years of follow-up, 193 VTEs were observed: 106 arterial (50% CVA, 30% MI), 83 venous, and 4 both. The incident rate of thrombosis was 18.4\/1000 person-years.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003E\n            \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E shows the current and cumulative prednisone use and risk of thrombosis. The risk of VTEs was significantly lower among those who were currently taking HCQ, eg, 14.6% rate of events\/1000 patient-years (rate ratio, 0.5; 95% CI, 0.4 to 0.7; p\u0026lt;0.0001) and likewise for \u0026gt;6 months of current use (13.8 rate of events\/1000 patient-years; rate ratio, 0.5; 95% CI, 0.3 to 0.7; p\u0026lt;0.0003). \u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E shows the multivariate model hazard ratios and p values.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11710\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11710\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11710\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003ECurrent and Cumulative Prednisone Use and Risk of Thrombosis.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11711\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11711\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11711\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003EMultivariate Model Hazard Ratios and p Values.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EDr. Law concluded that current prednisone was a stronger predictor of thrombosis than cumulative prednisone; that current HCQ use decreased the risk of thrombosis, particularly in individuals with positive antiphospholipid antibodies; that nonsteroidal anti-inflammatory use (primarily naproxen) was associated with a lower thrombotic risk in univariate analysis; and that aspirin use was not protective, likely due to the bias of indication.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ELymphoma Risk in Systemic Lupus\u003C\/h2\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EData have shown that people with SLE have both a heightened risk of developing non-Hodgkin lymphoma (NHL) and of dying from it [Bernatsky S et al. \u003Cem\u003EArthritis Rheum\u003C\/em\u003E 2006].\u003C\/p\u003E\n         \u003Cp id=\u0022p-14\u0022\u003ESasha Bernatsky, MD, PhD, McGill University, Montreal, Quebec, Canada, presented new data regarding the relative importance of drugs versus disease activity in mediating the increased risk of lymphoma in SLE patients. Along with Drs. Ann Clarke and Rosalind Ramsey-Goldman and colleagues from the Systemic Lupus International Clinics, Dr. Bernatsky previously demonstrated that risk of hematologic malignancies were substantially increased in SLE patients (standardized incident rate [SIR], 3.01; 95% CI, 2.47 to 3.62), particularly NHL (SIR, 4.36; 95% CI, 3.43 to 5.47) and leukemia (SIR, 1.76; 95% CI, 1.04 to 2.78) [Bernatsky S et al. \u003Cem\u003EJ Autoimmun\u003C\/em\u003E 2013. In press].\u003C\/p\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EThe recent case-cohort analyses were performed within the multisite SLE cohort (n=30) used to evaluate cancer risk. Adjusted hazard ratios for lymphoma were generated from multivariate models. Drugs assessed included cyclophosphamide, azathioprine, methotrexate, mycophenolate, antimalarials, and glucocorticoids. Medications were treated categorically (ever\/never) and as cumulative doses.\u003C\/p\u003E\n         \u003Cp id=\u0022p-16\u0022\u003EIn total, 75 (72 NHL; 3 Hodgkin lymphoma) and 4961 cancer-free controls were studied. Most lymphomas were of B-cell origin. As in the general population, lymphoma risk in SLE was higher in males versus females and increased with age. Lymphomas occurred a mean of 12.4 years (median 10.9) after SLE diagnosis.\u003C\/p\u003E\n         \u003Cp id=\u0022p-17\u0022\u003EResults from adjusted and unadjusted analyses failed to show a clear association of disease activity with lymphoma risk. Prof. Bernatsky and colleagues could not conclude that any one drug was an independent risk factor, although there was a trend to greater use of cyclophosphamide use in lymphoma cases than in controls. Correlation made it difficult to differentiate the effects of medications from disease activity. However, the authors suggest that the data offer some reassurance for SLE patients who take immunosuppressive drugs since most of the lymphomas in SLE did not seem to be caused by these medications. Even in SLE patients exposed to cyclophosphamide, the absolute risk of lymphoma was relatively low (about 1 case per 1000 person-years of follow-up).\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/19\/23.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn5hd\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzn5hd\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}