ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2068

Low Complement Is Associated with SLE Classification Criteria and Organ Damage

Laura Durcan1, Wei Fu2 and Michelle Petri1, 1Rheumatology, Johns Hopkins University Hospital, Baltimore, MD, 2Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords:

Session Information

Date: Monday, November 9, 2015

Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment III: Biomarkers

Session Type: ACR Concurrent Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose:

Low complements are included in the SLICC classification criteria for systemic lupus erythematosus (SLE) but are not considered in the ACR classification. As a result, the importance of low complement and its relationship to cumulative organ damage has not been systematically investigated. We evaluated the relationship between low complement, C3 and C4, SLICC criteria and organ damage in SLE. 

Methods:

As part of a longitudinal lupus cohort, damage accrual and organ manifestations were evaluated quarterly. Damage was measured using SLICC/ACR Damage Index (SDI). C3 and C4 were measured as part of standard clinical care. Those with and without a history of low complement were compared and an odds ratio calculated and adjusted for ethnicity. 

Results:

2399 patients were included in this analysis. 53% were Caucasian and 38% African American, the remainder had other ethnicity, mostly Asian. Low C4 was demonstrated in 47% and low C3 in 55%.  The relationship between low complement and the SLICC Classification Criteria is outlined in Table 1. Low complement was more common in those with serositis, renal involvement, hematologic and neurologic criteria.

Addressing the SDI, both low C3 and low C4 associated significantly with stroke, pulmonary hypertension, valvular heart disease and all renal damage parameters. Avascular necrosis, hypertension and osteoporosis were also more common in those who had low complement. Significant relationships were demonstrated between low C4 in particular and seizures, scarring of the panniculum and mesenteric insufficiency while diminished C3 associated with pleural fibrosis and cardiomyopathy.  These odds ratios remained significant when adjusted for ethnicity. 

Conclusion:

Low complement associated strongly with the components of the SLICC criteria. There was also more damage accrual in those with low complement. This was particularly true in terms of renal outcome but also when considering those components of the damage index which associate with prednisone exposure.  This points towards a more severe spectrum of disease in those with low complement and highlights the importance of these serological markers in the diagnosis and prediction of long-term outcomes in SLE. The relationship between low complement, stroke, valvular disease and pulmonary hypertension has not previously been described, but is fascinating given the concern for complement activation as part of antiphospholipid syndrome. 

Table 1. The relationship between low C3 and C4 and the SLICC Classification Criteria.

SLICC CRITERIA

Low C3 OR (CI)

Low C4 OR (CI)

Malar rash

1.22 (1.04-1.43)

1.24 (1.06-1.46)

Discoid rash

1.36 (1.11-1.1.67)

1.12 (0.92-1.38)

Photosensitivity

0.8 (0.68-0.94)

0.92 (0.78-1.08)

Oral/Nasal Ulcers

0.74 (0.63-0.87)

0.86 (0.73-1.01)

Arthritis

1.05 (0.88-1.25)

1.31 (1.1-1.57)

Serositis

Pleurisy

1.47 (1.25-1.73)

1.44 (1.23-1.7)

Pericarditis

1.78 (1.46-2.18)

1.69 (1.39-2.05)

Renal disorder

3.77 (3.14-4.48)

3.22 (2.72-3.81)

Neurologic

Seizures

1.51 (1.14-2.00)

1.54 (1.17-2.02)

Acute confusional state

2.39 (1.52-3.77)

1.98 (1.31-3.01)

Hematologic

Hemolytic anemia

3.63 (2.61-5.04)

2.99 (2.23-4.01)

Leukopenia

2.45 (2.08-2.89)

2.09 (1.77-2.46)

Lymphopenia

2.13 (1.80-2.86)

2.13 (1.81-2.52)

Thrombocytopenia

2.31 (1.87-2.86)

2.08 (1.70-2.55)

Immunologic

Anti-dsDNA

4.97 (4.16,5.94)

5.28 (4.39,6.35)

Anti Sm

3.65 (2.89,4.61)

2.96 (2.39,3.66)

Anti- phospholipid

Anti-cardiolipin

1.76 (1.49-2.08)

1.84 (1.56-2.17)

Anti- B2 Gly

1.97 (1.56-2.50)

1.81 (1.44-2.27)

False positive RPR

2.24 (1.72,2.93)

2.97 (2.29,3.87)

LAC

1.49 (1.23-1.79)

1.49 (1.24-1.79)

ANA

2.1 (1.34,3.3)

2.97 (1.78,4.94)

Table 2. SLE Damage index and relationship to low C3 and low C4.

SDI DAMAGE COMPONENT

C3 Odds Ratio (95%CI)

C4 Odds Ratio (95%CI)

Cataract

1.03 (0.83-1.28)

0.95 (0.78-1.82)

Retinal changes

1.24 (0.83-1.86)

0.81 (0.54-1.20)

Cognitive impairment

0.93 (0.60-1.27)

0.82 (0.59-1.27)

Seizure

1.22 (0.82-1.88)

1.53 (1.03-2.5)*

CVA

1.52 (1.12-2.07)*

1.50 (1.10-2.01)*

Cranial or Peripheral neuropathy

0.89 (0.68-1.18)

0.89 (0.67-1.18)

Transverse myelitis

2.89 (0.94-8.88)

1.30 (0.53-3.4)

GFR <50

3.70 (2.48-5.75)*

1.7 (1.21-2.50)*

Proteinuria

4.13 (2.20-5.57)*

1.92 (1.41-2.61)*

ESKD

3.51 (2.20-5.57)*

1.90 (1.25-2.7)*

Pulmonary hypertension

1.57 (1.05-2.33)*

1.32 (1.25-1.94)*

Pulmonary fibrosis

1.06 (0.78-1.46)

0.92 (0.67-1.26)

Shrinking lung

5.77 (0.79-46.7)

3.36 (0.66-16.38)

Pleural fibrosis

2.06 (1.20-3.54)*

1.45 (0.86-2.30)

Pulmonary infarction

2.74 (0.75-10.00)

1.24 (0.42-3.38)

Angina/CABG

0.79 (0.51-1.22)

0.72 (0.46-1.12)

Myocardial infarction

1.04 (0.69-1.55)

1.29 (0.84-1.98)

Cardiomyopathy

1.64 (1.05-2.57)*

1.29 (0.84-1.98)

Valvular heart disease

2.52 (1.45-4.47)*

1.81 (1.08-3.03)*

Pericarditis/pericardectomy

0.85 (0.46-1.59)

1.57 (0.59-2.91)

Claudication

1.17 (0.59-2.33)

1.39 (0.70-2.75)

Minor tissue loss

2.68 (0.87-8.25)

0.97 (0.57-2.91)

Significant tissue loss

1.64 (0.72-3.86)

1.29 (0.57-2.91)

DVT

1.34 ((0.86-2.07)

1.42 (0.92-2.18)

Lower GI surgery

0.76 (0.65-0.97)

0.89 (0.70-1.13)

Mesenteric insufficiency

1.64 (0.41-6.59)

8.80 (1.10-70.51)*

Chronic peritonitis

5.77 (0.70-47)

3.21 (0.66-16.37)

Upper GI surgery

1.15 (0.50-2.60)

1.09 (0.49-2.44)

Muscular atrophy/weakness

1.21 (0.73-2.00)

1.10 (0.94-1.84)

Arthritis

1.53 (1.08-2.17)

1.32 (0.94-1.84)

Osteoporosis

1.37 (1.07-1.77)*

1.33 (1.04-1.71)*

AVN

1.85 (1.40-2.43)*

1.49 (1.15-1.93)*

Osteomyelitis

1.23 (0.51-3.05)

1.10 (0.45-2.65)

Alopecia

1.20 (0.80-1.79)

1.12 (0.75-1.66)

Scarring of panniculum

1.66 (0.95-2.89)

1.70 (1.03-3.03)*

Skin ulceration

2.02 (0.93-4.42)

1.75 (0.84-3.63)

Premature gonadal failure

1.05 (0.72-1.53)

1.10 (0.75-1.60)

Diabetes

0.65 (0.48-0.87)

0.59 (0.43-0.81)

Malignancy

0.95 (0.73-1.24)

0.93 (0.72-1.21)

HTN

1.27 (1.07-1.51)*

1.21 (1.02-1.44)*

*=statistically significant.

Disclosure: L. Durcan, None; W. Fu, None; M. Petri, None.

To cite this abstract in AMA style:

Durcan L, Fu W, Petri M. Low Complement Is Associated with SLE Classification Criteria and Organ Damage [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/low-complement-is-associated-with-sle-classification-criteria-and-organ-damage/. Accessed .

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