ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1635

Cachexia in Systemic Lupus Erythematosus- an Underrecognized Syndrome

George Stojan1, Laurence S Magder2,3 and Michelle Petri4, 1Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, 2Epidemiology and Public Health, Johns Hopkins University School of Medicine, Baltimore, MD, 3Epidemiology and Public health, University of Maryland School of Medicine, Baltimore, MD, 4Medicine (Rheumatology), Division of Rheumatology, Johns Hopkins University School of Medicine, MD, USA, Baltimore, MD

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords:

Session Information

Date: Monday, November 6, 2017

Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment Poster II: Damage and Comorbidities

Session Type: ACR Poster Session B

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

Background/Purpose:

Cachexia is a syndrome that may accompany a range of diseases, including cancer, chronic heart failure, chronic obstructive pulmonary disease, and rheumatoid arthritis. It is associated with central and systemic increases of pro-inflammatory factors, and with decreased quality of life, poor responses to pharmacological treatment and shortened survival. Despite an abundance of data from other inflammatory diseases, cachexia in systemic lupus erythematosus remains a largely undescribed syndrome.

Methods:

2406 patients in a prospective SLE cohort had their weight assessed at each visit. Patients were categorized into five predetermined groups based on weight: low (BMI<20 kg/m2), normal weight (reference, BMI 20-24.9 kg/m2), overweight (25-29.9 kg/m2), obese (BMI 30-34.9 kg/m2), and severely obese (BMI>35 kg/m2). Cachexia was defined based on modified Fearon criteria as 5% stable weight loss in 6 months without starvation relative to the average weight in all prior cohort visits AND/OR weight loss >2% without starvation relative to the average weight in all prior cohort visits and a BMI <20. Risk of cachexia within 5 years of cohort entry was based on Kaplan Meier estimates. Differences by patient characteristics were based on log-rank test.

Results:

Table 1: Risk of Cachexia within 5 years of cohort entry

Patient Characteristic

Risk of Cachexia within 5 years of cohort entry (95% CI)1

P-value for difference by patient characteristic2

All (n=2452)

53% (51%, 56%)

Age Group

<30 (n=805)

30-44 (n=987)

45-59 (n=528)

60+ (n=132)

60% (56%, 64%)

51% (47%, 55%)

46% (41%, 52%)

57% (46%, 67%)

<0.0001

Race

White (n=1309)

Black (n=183)

Other (n=960)

53% (50%, 57%)

63% (54%, 72%)

52% (48%, 55%)

0.050

Sex

Female (n=2266)

Male (n=186)

53% (51%, 56%)

51% (42%, 60%)

0.62

Initial BMI

<20 (n=220)

20-24.9 (n=782)

25-29.9 (n=632)

30+ (n=635)

73% (66%, 79%)

59% (55%, 68%)

64% (59%, 68%)

37% (33%, 41%)

<0.0001

1Based on Kaplan-Meier estimates

2Based on a log-rank test.

Table 2: Rate ratio comparing those with prior disease manifestation to those without with respect to incidence of cachexia

Prior Disease Manifestation

Rate Ratio (95% CI)

P-value

Malar Rash

1.1 (0.9, 1.2)

0.41

Discoid Rash

0.8 (0.7, 0.9)

0.0002

Photosensitivity

0.9 (0.8, 1.0)

0.013

Oral Ulcers

1.0 (0.9, 1.1)

0.82

Musculoskeletal

0.8 (0.7, 0.9)

0.0023

Serositis

1.1 (1.0, 1.3)

0.027

Neurologic

1.1 (0.9, 1.4)

0.22

Renal

1.2 (1.1, 1.4)

0.0004

Hematologic

1.0 (0.9, 1.2)

0.59

Immunologic

1.1 (0.9, 1.3)

0.22

ANA

0.9 (0.7, 1.2)

0.68

Table 3: Rate ratio comparing those with recent activity to those without with respect to incidence of cachexia

Disease Activity in preceding 3 months as measured by components of SLEDAI

Rate Ratio (95% CI)

P-value

Skin activity

1.1 (0.9, 1.3)

0.25

Musculoskeletal activity

0.9 (0.8, 1.1)

0.51

Renal activity

1.3 (1.1, 1.5)

0.0048

Hematologic Activity

0.9 (0.7, 1.1)

0.34

Serositis Activity

1.2 (0.9, 1.7)

0.20

CNS activity

0.9 (0.6, 1.3)

0.53

Vasculitis Activity

1.2 (0.7, 1.9)

0.52

Constitutional Activity

1.3 (0.6, 2.9)

0.44

Conclusion:

Within five years of cohort entry, half of the Hopkins Lupus cohort patients develop cachexia as defined by Fearon criteria; those younger than 30 years of age and those with a BMI below 20 are at highest risk of cachexia.

While patients with discoid rash and musculoskeletal manifestations were less likely to develop cachexia, renal lupus carried the highest cachexia risk.

Cachexia is an underrecognized syndrome in patients with lupus which is predominantly seen in patients with lupus nephritis. Further studies are needed to elucidate the implications of cachexia in the response to treatment, long term outcomes, quality of life, as well as its role as a potential cardiovascular risk factor in SLE.

Disclosure: G. Stojan, None; L. S. Magder, None; M. Petri, Anthera Inc, 5,GlaxoSmithKline, 5,EMD Serono, 5,Eli Lilly and Company, 5,Bristol Meyer Squibb, 5,Amgen, 5,United Rheumatology, 5,Global Academy, 5,Exagen, 2.

To cite this abstract in AMA style:

Stojan G, Magder LS, Petri M. Cachexia in Systemic Lupus Erythematosus- an Underrecognized Syndrome [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/cachexia-in-systemic-lupus-erythematosus-an-underrecognized-syndrome/. Accessed .

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