ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2940

Risk Factors for Late-Onset Thrombosis in Systemic Lupus Erythematosus (SLE)

Khawla Al-Ghanim1, Jiandong Su2, Stacey E. Morrison3, Samar Alharbi4, Mohammed Attar5, Dafna Gladman2, Murray Urowitz6,7 and Jorge Sánchez-Guerrero8, 1Rheumatology, TWH, Toronto, ON, Canada, 2Rheumatology, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada, 3Div Rheumatology Rm MP-10-304, Toronto Western Hospital, Toronto, ON, Canada, 4Rheumatology, University Health Network, Toronto, ON, Canada, 5Rheumatology, Toronto Western Hospital, Toronto, ON, Canada, 6University of Toronto, Toronto, ON, Canada, 7Rheumatology, U of Toronto, Toronto Western Hospital, Toronto, ON, Canada, 8Rheumatology, Mount Sinai Hospital and University Health Network, Toronto Canada, Toronto, ON, Canada

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: ,

Session Information

Date: Tuesday, November 10, 2015

Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment Poster Session III

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Thrombotic events (TE) cause great morbidity and mortality in SLE patients. Studies of TE in SLE focus on early-onset TE. While the incidence of TE remains increased during later-stage disease, no study has assessed the risk factors for late-onset TE. The purpose of this study is to: a) assess the characteristics and risk factors associated with late-onset TE (> 5 years after diagnosis) in SLE; and b) compare these with early-onset TE (< 5 years after diagnosis). 

Methods: One hundred and fifty-one SLE patients who developed TE after enrolment in a prospective lupus cohort from 1970 to 2014 were identified. They were matched for age, sex and disease duration with non-TE SLE patients (early-onset TE controls: n=151; and late- onset TE controls: n=77). The demographic (age, ethnicity), clinical (disease duration, ACR criteria, SLE manifestations), lab (anti-dsDNA antibody, C3, C4, nuclear antigens, lupus anticoagulant, anti-cardiolipin antibody), disease activity (SLEDAI-2K), disease damage [SLICC Damage Index with cardiovascular items removed (mod-SDI)] and treatment (prednisone, immunosuppressants, antimalarials, anti-inflammatories), as well as TE type [arterial (ATE), venous (VTE)] and traditional TE risk factor (smoking, cholesterol levels and hypertension) variables were recorded. 

Results: Fifty (33%) patients developed late-onset and 101 (67%) early-onset TE. In comparison with early- onsetTE, late-onset TE were predominantly ATE (62.0% vs 45%, P=0.02). In univariate analysis, significant variables associated with late-onset TE were hypertension (OR 3.97, P<0.01), oral/nasal ulcers (OR 2.56, P=0.03), CNS manifestations (OR 5.40, P=0.01), vasculitis (OR 3.48, P<0.01), elevated total cholesterol (OR 2.58, p<0.01), and prednisone dose within 3 years of TE (OR 1.07, P=0.02).

In multivariate analysis, significant predictors of late-onset TE were hypertension (OR 2.85, P=0.03), CNS manifestations (OR = 6.66, P=0.04), vasculitis (OR = 2.96, P=0.049), lupus anti-coagulant (OR = 4.73, P=0.02). Risk factors associated with late ATE included a combination of traditional TE risk factor and lupus-related factors; whereas in late VTE risk factors included predominantly lupus-related factors. Variables associated with early-onset TE were also a mixture of traditional and lupus-related risk-factors. 

Conclusion: Late-onset TE in SLE is predominantly arterial, and result from both traditional and SLE-related risk factors. The risk of thrombosis remains elevated throughout the course of SLE, resulting from the combination of traditional and SLE-related risk factors. In order to reduce the burden of TE, these risk factors need to be continuously evaluated and controlled throughout the disease course.

Disclosure: K. Al-Ghanim, None; J. Su, None; S. E. Morrison, None; S. Alharbi, None; M. Attar, None; D. Gladman, None; M. Urowitz, None; J. Sánchez-Guerrero, None.

To cite this abstract in AMA style:

Al-Ghanim K, Su J, Morrison SE, Alharbi S, Attar M, Gladman D, Urowitz M, Sánchez-Guerrero J. Risk Factors for Late-Onset Thrombosis in Systemic Lupus Erythematosus (SLE) [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/risk-factors-for-late-onset-thrombosis-in-systemic-lupus-erythematosus-sle/. Accessed .

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