{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T19:28:16Z","timestamp":1790882896638,"version":"4.1.0"},"reference-count":36,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2020,6,29]],"date-time":"2020-06-29T00:00:00Z","timestamp":1593388800000},"content-version":"unspecified","delay-in-days":28,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"the SYSCID (A Systems Medicine Approach to Chronic Inflammatory Diseases) under the European Union\u2019s Horizon 2020 research","award":["733100"],"award-info":[{"award-number":["733100"]}]},{"DOI":"10.13039\/501100014034","name":"Foundation for Research in Rheumatology","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100014034","id-type":"DOI","asserted-by":"crossref"}]},{"name":"European Research Council (ERC) under the European Union\u2019s Horizon 2020 research","award":["742390"],"award-info":[{"award-number":["742390"]}]},{"name":"European Social Fund and National Resources, Aristeia I","award":["2344"],"award-info":[{"award-number":["2344"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Lupus Sci Med"],"accepted":{"date-parts":[[2020,5,18]]},"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Changes in the care of patients with SLE dictate a re-evaluation of its natural history and risk factors for disease deterioration and damage accrual. We sought to decipher factors predictive of a deterioration in phenotype (\u2018transition\u2019) in patients initially presenting with non-severe disease.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Patients from the \u2018Attikon\u2019 cohort with disease duration \u22651\u2009year were included. Disease at diagnosis was categorised as mild, moderate or severe, based on the British Isles Lupus Assessment Group manifestations and physician judgement. \u2018Transition\u2019 in severity was defined as an increase in category of severity at any time from diagnosis to last follow-up. Multivariable logistic regression was performed to identify baseline factors associated with this transition.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>462 patients were followed for a median (IQR) of 36 (120) months. At diagnosis, more than half (56.5%) had a mild phenotype. During disease course, transition to more severe forms was seen in 44.2%, resulting in comparable distribution among severity patterns at last follow-up (mild 28.4%, moderate 33.1%, severe 38.5%). Neuropsychiatric involvement at onset (OR 6.33, 95%\u2009CI 1.22 to 32.67), male sex (OR 4.53, 95%\u2009CI 1.23 to 16.60) and longer disease duration (OR 1.09 per 1\u2009year, 95%\u2009CI 1.04 to 1.14) were independently associated with transition from mild or moderate to severe disease. Patients with disease duration \u22653 years who progressed to more severe disease had more than 20-fold increased risk to accrue irreversible damage.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Almost half of patients with initially non-severe disease progress to more severe forms of SLE, especially men and patients with positive anti-double-stranded DNA or neuropsychiatric involvement at onset. These data may have implications for the management of milder forms of lupus.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/lupus-2020-000394","type":"journal-article","created":{"date-parts":[[2020,6,30]],"date-time":"2020-06-30T02:19:35Z","timestamp":1593483575000},"page":"e000394","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":26,"title":["Transition to severe phenotype in systemic lupus erythematosus initially presenting with non-severe disease: implications for the management of early disease"],"prefix":"10.1136","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9894-6966","authenticated-orcid":false,"given":"Dionysis S","family":"Nikolopoulos","sequence":"first","affiliation":[{"name":"4th Department of Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens, Athina, Athens, Greece"},{"name":"Laboratory of Immune regulation and Tolerance, Autoimmunity and Inflammation, Biomedical Research Foundation of the Academy of Athens, Athens, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myrto","family":"Kostopoulou","sequence":"additional","affiliation":[{"name":"4th Department of Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens, Athina, Athens, Greece"},{"name":"Department of Nephrology, Georgios Gennimatas Hospital, Athens, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antigoni","family":"Pieta","sequence":"additional","affiliation":[{"name":"4th Department of Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens, Athina, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Flouda","sequence":"additional","affiliation":[{"name":"4th Department of Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens, Athina, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katerina","family":"Chavatza","sequence":"additional","affiliation":[{"name":"4th Department of Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens, Athina, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aggelos","family":"Banos","sequence":"additional","affiliation":[{"name":"Laboratory of Immune regulation and Tolerance, Autoimmunity and Inflammation, Biomedical Research Foundation of the Academy of Athens, Athens, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Boletis","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Transplantation Unit, Laiko General Hospital, Athens, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pelagia","family":"Katsimbri","sequence":"additional","affiliation":[{"name":"4th Department of Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens, Athina, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9812-4671","authenticated-orcid":false,"given":"Dimitrios T","family":"Boumpas","sequence":"additional","affiliation":[{"name":"4th Department of Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens, Athina, Athens, Greece"},{"name":"Laboratory of Immune regulation and Tolerance, Autoimmunity and Inflammation, Biomedical Research Foundation of the Academy of Athens, Athens, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2696-031X","authenticated-orcid":false,"given":"Antonis","family":"Fanouriakis","sequence":"additional","affiliation":[{"name":"4th Department of Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens, Athina, Athens, Greece"},{"name":"Department of Rheumatology, \u201cAsklepieion\u201d General Hospital, Voula, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,6,29]]},"reference":[{"key":"2025091515022582000_7.1.e000394.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2011.10.020"},{"key":"2025091515022582000_7.1.e000394.2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2017-211663"},{"key":"2025091515022582000_7.1.e000394.3","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780350606"},{"key":"2025091515022582000_7.1.e000394.4","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1002\/art.40674","article-title":"Brief report: how do patients with newly diagnosed systemic lupus erythematosus present? 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Contribution of the initial features of systemic lupus erythematosus to the clinical evolution and survival of a cohort of Mediterranean patients. 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