Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Patients with systemic lupus erythematosus (SLE) have a significantly increased risk of developing cardiovascular disease. The presence of chronic inflammation which characterizes SLE disease activity may contribute to this risk. Apolipoprotein A1 (ApoA1) plays a protective role against atherosclerosis. Anti-ApoA1 antibodies have been described in patients with coronary disease. Our previous cross-sectional studies showed that anti-apoA1 levels are raised in patients with current and persistent disease activity but there are few longitudinal data. This abstract describes the result of longitudinal studies of anti-ApoA1 levels and measures of disease activity, serological profile and treatment in patients with SLE.
Methods:
Longitudinal serum samples (n= 398) were selected retrospectively from a cohort of 49 patients with SLE with a mean of 8 samples per patient (SD 2.16; min 3; max 14) and a mean follow-up of 89 months (SD 46; min 14; max 180). Serum from 40 healthy controls and 15 patients with rheumatoid arthritis (RA) was also tested. Anti-ApoA1 levels were measured using a direct ELISA. Using the British Isles Lupus Assessment Group (BILAG) index, we categorized the samples by disease activity as follows.
Current activity was defined as high if global BILAG score was ≥5 and low if it was <5). Disease activity over the most recent 4 assessments was characterized as persistently low (all systems BILAG C, D or E) or persistently moderate-high (A or ≥1 B in any BILAG system on at least 2/4 occasions). 90% of all samples fell into one of those two categories and the rest were excluded.
Anti-dsDNA was defined as high or normal based on a cut-off of 50IU/ml. C3 was defined as low or normal based on a cut-off of 0.9g/l.
Data on the treatment at the time of each individual sample were also obtained, considering prednisolone dose and whether either immunosuppressants (IS) or hydroxychloroquine (HCQ) were used.
Results:
42% of the samples tested were positive for anti-ApoA1 (greater than mean + 3SD of healthy controls). Patients with SLE had significantly higher anti-ApoA1 levels than healthy controls and patients with RA (p< 0.0001). No association between either sex or ethnicity and anti-ApoA1 levels was found. Higher anti-ApoA1 levels were significantly associated with the following factors:
- Low complement levels (p= 0.017).
- Persistent disease activity (p=0.04)
- Disease activity on date of sample (p=0.04)
- Not being on HCQ (p<0.0001)
- Prednisolone dose< 5mg/day (p= 0.0067)
We found no association between anti-ApoA1 and positivity for anti-dsDNA or ENA and no significant association with use of IS.
Conclusion:
The presence of anti-ApoA1 antibodies has been shown in patients with SLE and may play a role in disturbing the normal lipid homeostasis which in turn may contribute to the increased cardiovascular risk associated with this disease. We have found that anti-ApoA1 levels are increased in patients with SLE compared to healthy controls and patients with RA. Anti-ApoA1 levels appear to be associated with both clinical and serological disease activity measures. The use of HCQ seems to be associated with lower anti-ApoA1 levels.
Disclosure:
S. Croca,
None;
I. Giles,
None;
D. A. Isenberg,
None;
Y. Ioannou,
None;
A. Rahman,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/anti-apoa1-antibodies-associate-with-disease-activity-in-lupus-and-are-lower-in-patients-taking-hydroxychloroquine-a-longitudinal-analysis-of-398-samples/