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: to assess relationship between smoking exposure and organ damage accrual measured by Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index for Systemic Lupus Erythematosus score (SLICC-SDI) in consecutive patients with systemic lupus erythematosus (SLE) from Argentina.
Methods: 623 consecutive SLE patients (fulfilling ≥4, 1997 ACR criteria) were included in this cross-sectional study. Sociodemographic and disease related variables including SLICC-SDI score and smoking status were collected.
Patients currently smoking were considered “smokers”, and “non-smokers” those who never smoked and previous smokers.
SLICC-SDI was divided into 2 categories < 3 and ≥ 3 severe damage (this cut off was previously reported in the literature).
Descriptive statistics and frequency distributions were used to describe the population studied. Chi-square was used to test differences between groups for categorical variables. Continuous variables were examined using student´s t-test and Mann-Whitney (Wilcoxon) test for non-normally distributed variables. Univariate analyses and multivariate logistic regression model were calculated.
Results:
623 patients were included in the analysis, 89% women, and median age was 38 (IQR 30-46) years. Eighty-four per cent were non-smokers and 16 % were current smokers. Fifty seven per cent were white, and 43% were non-white (mestizo and Amerindian). Seventy four per cent had >12 years of formal education.
Median disease duration was 9 years (IQR4-13). Median number ACR criteria met were 6 (IQR 5-7), mean SLICC-SDI score was 1.16 (SD 1.75) for non-smokers and 1.43 (SD 1.89) for current smokers (p 0.915).
Table 1 describes ACR criteria in smokers and non-smokers. Discoid lupus was significantly associated with smoking exposure.
|
SLE criteria |
All patients n:623 |
Non-smokers n: 515 |
Current smokers n: 108 |
p |
|
Malar rash, n(%) |
445 (71) |
372 (71) |
73 (75) |
0.465 |
|
Discoid lupus, n (%) |
67 (11) |
51 (10) |
16 (16) |
0.053 |
|
Photosensivity, n (%) |
432 (69) |
366 (70) |
66 (67) |
0.641 |
|
Arthritis/ arthralgias, n(%) |
529 (85) |
444 (85) |
85 (87) |
0.610 |
|
Ulcers, n(%) |
268 (43) |
220 (42) |
48 (49) |
0.194 |
|
Neurologic, n(%) |
79 (13) |
64 (12) |
15 (15) |
0.395 |
|
Hematologic disorder, n (%) |
304 (49) |
254 (48) |
50 (51) |
0.631 |
|
Serositis, n (%) |
197 (32) |
170 (32) |
27 (28) |
0.345 |
|
Renal disease, n(%) |
279 (45) |
240 (46) |
39 (40) |
0.273 |
|
Immunologic, n(%) |
454 (74) |
384 (74) |
72 (73) |
0.90 |
|
Antinuclear antibodies, n (%) |
615 (99) |
517 (99) |
98(99) |
0.905 |
Eighty-three per cent of patients had SLICC-SDI <3 and 17 % had ≥ 3. In patients with SLICC-SDI ≥ 3: 21% were smokersand 15% of patients with <3 SLICC-SDI were current smokers (p 0.081).
Univariate analysis comparing demographical and clinical characteristics of both groups are described in Table 2.
|
All patients N=623 |
SLICC<3 N= 515 |
SLICC≥3 N=108 |
p |
|
|
Female, n (%) |
556 (89) |
461(89) |
95 (88) |
0.636 |
|
White race, n (%) |
317 (57) |
271 (58) |
45 (55) |
0.639 |
|
Age, years (median IQR) |
38 (30-46) |
36 (29-45) |
43 (33-54) |
<0.001 |
|
SLE ACR criteria (median IQR) |
6 (5-7) |
6 (5-7) |
7 (6-8) |
<0.001 |
|
Disease duration years (median IQR) |
7 (4-13) |
7 (3-12) |
10 (6-16) |
<0.001 |
|
Age at diagnosis, years (median IQR) |
28 (21-37.5) |
28 (21-36) |
30 (21-37.5) |
0.05 |
|
Education>12 years, n (%) |
461 (74) |
381 (74) |
78 (72) |
0.655 |
|
Current smokers, n (%) |
98 (16) |
77 (15) |
23 (21) |
0.081 |
|
Hydroxychlroquine (HCQ) , n (%) |
579 (93) |
479 (93) |
100 (93) |
0.761 |
|
Steroids, n (%) |
467 (75) |
386 (75) |
85 (79) |
0.409 |
|
Cyclophosphamide (CF), n (%) |
149 (24) |
103 (20) |
46 (43) |
< 0.01 |
|
Azathioprine (AZA), n (%) |
181 (29) |
134 (26) |
49 (45) |
< 0.01 |
|
Micofenolate mofetil, (MMF), n (%) |
255 (21) |
108 (21) |
18 (17) |
0.254 |
In the multiple regression analysis considering SLICC-SDI score ≥3 as dependent variable (adjusting by smoking exposure, age, sex,race, disease duration, > 12 years of education, corticosteroids, CF, AZA and HCQ exposure), we found that smoking (OR 1. 90, CI 95% 1.04- 3.46, p 0.035), age (OR 1.33, CI 95% 1.00-1.75, p 0.044), and CF exposure (OR 2.64, CI 95% 1.41-4.97, p 0.002) were associated to SLICC ≥3 .
Conclusion: Tobacco exposure, older age and cyclophosphamide use were associated to SLICC-SDI ≥3.
To cite this abstract in AMA style:
Cosatti MA, Muñoz S, Tamborenea N, García MA, Curti A, Capuccio AM, Rillo O, Imamura P, Schneeberger E, Dal Pra F, Ballent M, Cousseau ML, Velasco Zamora J, Saurit V, Toloza SMA, Danielsen M, Bellomio V, Graf C, Paira S, Cavallasca J, Pons-Estel B, Moreno J, Diaz MP, Alba P, Verando M, Tate G, Mysler E, Sarano J, Civit E, Risueño F, Alvarez Sepúlveda P, Larroude MS, Mendez M, Conforti A, Sohn D, Medina Bornachera D, Malm- Green S, Alvarez A, Helling CA, Roverano S, Pendón G, Mayer M, Marin J, Catoggio C, Eimon A, Pisoni CN. Tobacco Exposure and Relationship with Severe Damage in Systemic Lupus Erythematosus Patients [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/tobacco-exposure-and-relationship-with-severe-damage-in-systemic-lupus-erythematosus-patients/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/tobacco-exposure-and-relationship-with-severe-damage-in-systemic-lupus-erythematosus-patients/