Early introduction of glucocorticoid (GC)-sparing agents may lessen severe hematologic disease in SLE, according to a study published in Lupus. Using data from a large cohort of patients with lupus,Dimitrios T. Boumpas, MD, and colleagues aimedto better understand severe hematologic manifestations among more than 300 patients, 41 of whom met criteria for severe. Hematologic manifestations preceded SLE diagnosis in 31.7% of patients,occurred throughout the course of the disease in29.3%, and were concomitant to SLEdiagnosisin 39%, with a mean (SD) disease duration of 8.7(5.5) years. The most common severe hematologic manifestation was thrombocytopenia (56.1%), followed by autoimmune hemolytic anemia (17.1%) and thrombotic thrombocytopenic purpura-likesyndrome (12.2%). Rituximab and cyclophosphamide were the most frequently used immunosuppressive agents, but initially, all patients were treated with GC. Relapse occurred in 53.7% of patientsfollowing initial treatment. Patients who relapsed had less often received concomitant immunosuppressive agents following treatment of the initialepisode when compared with patients who didnot relapse (29.4% vs 73.9%; P=0.005).
