Gastrointestinal Disease in SLE: Does It Indicate a Worse Prognosis?

Beatriz Tejera Segura¹, Irene Altabás González², Iñigo Rúa-Figueroa³, Natalia Pérez Veiga⁴, Victor del Campo Pérez⁵, Alejandro Olivé-Marqués⁶, Maria Galindo-Izquierdo⁷, Jaime Calvo-Alén⁸, Juan Ovalles-Bonilla⁹, Antonio Fernandez-Nebro¹⁰, Raul Menor Almagro¹¹, Eva Tomero Muriel¹², N. Del-val-del-amo¹³, Maria Esther Uriarte¹⁴, VM Martínez Taboada¹⁵, Jose Luis Andreu Sanchez¹⁶, Alina Lucica Boteanu¹⁷, Francisco Javier Narváez¹⁸, A Morasat¹⁹, Carlos Montilla Morales²⁰, JM Senabre Gallego²¹, Blanca Hernández Cruz²², Mariano Andrés²³, Eva Salgado Pérez²⁴, Mercedes Freire-González²⁵, Sergio Ramon Machin Garcia¹, Clara Moriano²⁶, Lorena Expósito²⁷, Clara E. Perez-Velasquez²⁸, ML Velloso-Feijoo²⁹, Ana Paula Cacheda³⁰, Nuria Lozano Rivas³¹, Gema Bonilla³², Marta Arévalo³³, Inmaculada Jimenez³⁴, VE Quevedo-Vila³⁵, Francisco Manero-Ruiz³⁶, Paloma García de la Peña³⁷, TR Vázquez-Rodríguez³⁸, J Ibáñez-Ruan³⁹, Tatiana Cobo-Ibañez⁴⁰ and Jose Maria Pego-Reigosa⁴¹, ¹Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain, ²Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain, ³Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain, ⁴Grupo IRIDIS, Universidad de Vigo, Vigo, Pontevedra, ⁵Hospital Universitario Meixoeiro, Vigo, Vigo, Pontevedra, Spain, ⁶Hospital Germans Trias i Pujol, Barcelona, Spain, ⁷Hospital Universitario 12 de Octubre, Madrid, Spain, ⁸Hospital Universitario Araba, Vitoria-Gasteiz, Pais Vasco, Spain, ⁹Hospital General Universitario Gregorio Marañón, Madrid, Spain, ¹⁰University of Malaga, Malaga, Spain, ¹¹Hospital General Universitario de Jerez de la Frontera, Puerto De Santa Mar�a, Spain, ¹²Hospital Universitario de la Princesa, Madrid, Madrid, Spain, ¹³Complejo Hospitalario de Navarra, Pamplona, Spain, ¹⁴Hospital Universitario Donostia, San Sebastian, Spain, ¹⁵Hospital Universitario Marqués de Valdecilla, Santander, Spain, ¹⁶Hospital Universitario Puerta de Hierro, Majadahonda, Spain, ¹⁷PRINTO, Istituto Giannina Gaslini, Genova, Italy, ¹⁸Hospital Bellvitge, BARCELONA, Spain, ¹⁹Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain, ²⁰Hospital Universitario de Salamanca, Salamanca, Spain, ²¹Hospital Marina Baixa, Alicante, Spain, ²²Universidad de Sevilla, Sevilla, Spain, ²³Hospital General Universitario de Alicante, Alicante, Spain, ²⁴Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain, ²⁵CHU Coruña, Coruña, Spain, ²⁶Complejo Asistencial Universitario de León, León, Spain, ²⁷Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain, ²⁸Basurto University Hospital, Bilbao, Spain, ²⁹Hospital Universitario de Valme, Sevilla, Spain, ³⁰Hospital son LLátzer, Palma de Mallorca, Spain, ³¹Hospital Clínico Universitario Virgen de Arrixaca, Murcia, Spain, ³²Rheumatology, La Paz University Hospital-IdiPAZ, Madrid, Spain, ³³Hospital Universitari Parc Taulí I3PT, Sabadell, Spain, ³⁴Hospital Clínico San Ceciio Granada, Granada, Spain, ³⁵Hospital Comarcal de Monforte, Lugo, Spain, ³⁶Hospital Universitario Miguel Servet, Zaragoza, Spain, ³⁷Hospital HM, Madrid, Spain, ³⁸Hospital Universitario Lucus Augusti, Lugo, Spain, ³⁹Hospital Povisa, Vigo, Pontevedra, Spain, ⁴⁰Hospital Infanta Sofia, Madrid, Spain, ⁴¹University Hospital of Vigo, Galicia Sur Health Research Institute, Vigo, Spain

Meeting: ACR Convergence 2020

Keywords: Damage Index, glucocorticoids, Mortality, prognostic factors, Systemic lupus erythematosus (SLE)

Session Information

Date: Friday, November 6, 2020

Title: SLE – Diagnosis, Manifestations, & Outcomes Poster I: Clinical Manifestations

Session Type: Poster Session A

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

Background/Purpose: To describe the GI manifestations of SLE in the RELESSER (Registry of Systemic Lupus Erythematosus Patients of the Spanish Society of Rheumatology) cohort and to determine if those are associated with a more severe disease, damage accrual and a worse prognosis.

Methods: We conducted a nationwide, retrospective, multicenter, cross-sectional cohort study of 3658 SLE patients who fulfill ≥ 4 ACR-97 criteria. Data on demographics, disease characteristics, activity (SELENA-SLEDAI), damage (SLICC/ACR/DI) and therapies were collected. Table 1 shows the different gastrointestinal manifestations among the RELESSER cohort. Demographic and clinical characteristics were compared between lupus patients with and without GI damage to establish whether GI damage is associated with a more severe disease (Table 2). χ2 tests for categorical variables and Student t-test for continuous variables were used. For non-continuous variables, either Mann-Whitney U test or logarithmic transformation were used (data expressed as median and interquartile range – IQR). Univariate linear and multivariate logistic regression analyses were performed to establish the relation of demographics, different SLE clinical manifestations, damage and GI manifestations.

Results: From 3654 lupus patients, 3.7% developed GI damage (Table 1). Patients in this group (group 1) were older (53.1 vs 46 years; p< 0.001), they had longer disease duration (16.4 vs 11.7 years; p=0.001) and were more likely to have vasculitis (14.1% vs 8.7% p=0.056), renal disease (56.1% vs 42.4% p=0.003) and serositis (40.5% vs 28.5% p=0.005) than patients without GI damage (group 2). With regard to treatment, there were statistically significant differences between both groups in terms of glucocorticoids (96.9% vs 88.6% p=0.001), azathioprine (44.2% vs 33.9% p=0.01), mycophenolate mofetil (23.7% vs 14.9% p=0.009) and cyclophosphamide (37.4% vs 21.8% p< 0.001).The use of hydroxychloroquine was more common among SLE patients with no GI manifestations related to damage (83.4% vs 75.2%, p=0.022). Hospitalizations and mortality were significantly higher in group 1 suggesting that having GI damage is linked to a worse prognosis. Moreover, patients in group 1 had higher modified SDI (2; IQR 1-4; p< 0.001) (Table 2). After the multivariable analysis, older age, high daily dose of glucocorticoids (≥ 30 mg prednisone) and higher SDI remained significant. Interestingly, even the prevalence of oral ulcers was slightly similar in both groups, the multivariable analysis revealed that the presence of oral ulcers reduced risk of developing damage in 30% of patients (Table 3).

Conclusion: Having GI damage is associated with clinical involvement of other target organs in lupus and with a worse prognosis. Patients on high dose of glucocorticoids are at higher risk of developing GI damage which reinforces the strategy of minimizing glucocorticoids. Oral ulcers are common in SLE and seem to be protective from GI damage.

Table 1. GI manifestations in the RELESSER cohort

Table 2. Demographics and clinical characteristics. *Modified SLICC/SDI was calculated excluding gastrointestinal damage manifestations

Table 3. Multivariable analysis. Variables independently associated with GI damage

Disclosure: B. Tejera Segura, None; I. Altabás González, None; I. Rúa-Figueroa, None; N. Pérez Veiga, None; V. del Campo Pérez, None; A. Olivé-Marqués, None; M. Galindo-Izquierdo, None; J. Calvo-Alén, None; J. Ovalles-Bonilla, None; A. Fernandez-Nebro, Roche, 1, Nordic, 1, Stada, 1, Sanofi, 1, Janssen, 1, Pfizer, 1, Abbvie, 1, Novartis, 1, Gedeon, 1, Lilly, 1; R. Menor Almagro, None; E. Tomero Muriel, None; N. Del-val-del-amo, None; M. Uriarte, None; V. Martínez Taboada, None; J. Andreu Sanchez, None; A. Boteanu, AbbVie, 8, Novartis, 8, Roche, 8; F. Narváez, None; A. Morasat, None; C. Montilla Morales, None; J. Senabre Gallego, None; B. Hernández Cruz, None; M. Andrés, None; E. Salgado Pérez, None; M. Freire-González, None; S. Machin Garcia, None; C. Moriano, None; L. Expósito, None; C. Perez-Velasquez, None; M. Velloso-Feijoo, None; A. Cacheda, None; N. Lozano Rivas, None; G. Bonilla, None; M. Arévalo, None; I. Jimenez, None; V. Quevedo-Vila, None; F. Manero-Ruiz, None; P. García de la Peña, None; T. Vázquez-Rodríguez, None; J. Ibáñez-Ruan, None; T. Cobo-Ibañez, None; J. Pego-Reigosa, None.

To cite this abstract in AMA style:

Tejera Segura B, Altabás González I, Rúa-Figueroa I, Pérez Veiga N, del Campo Pérez V, Olivé-Marqués A, Galindo-Izquierdo M, Calvo-Alén J, Ovalles-Bonilla J, Fernandez-Nebro A, Menor Almagro R, Tomero Muriel E, Del-val-del-amo N, Uriarte M, Martínez Taboada V, Andreu Sanchez J, Boteanu A, Narváez F, Morasat A, Montilla Morales C, Senabre Gallego J, Hernández Cruz B, Andrés M, Salgado Pérez E, Freire-González M, Machin Garcia S, Moriano C, Expósito L, Perez-Velasquez C, Velloso-Feijoo M, Cacheda A, Lozano Rivas N, Bonilla G, Arévalo M, Jimenez I, Quevedo-Vila V, Manero-Ruiz F, García de la Peña P, Vázquez-Rodríguez T, Ibáñez-Ruan J, Cobo-Ibañez T, Pego-Reigosa J. Gastrointestinal Disease in SLE: Does It Indicate a Worse Prognosis? [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/gastrointestinal-disease-in-sle-does-it-indicate-a-worse-prognosis/. Accessed .

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