Background/Purpose: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by autoantibodies and systemic inflammation, affecting multiple organs especially kidney. Environmental factors, genetic predisposition, and hormone contribute to lupus pathogenesis. One of the environmental factors, obesity is now considered as a state of chronic low-grade inflammation, but the role of obesity in SLE remains controversial. Studies have shown that adipose tissue contributes to systemic inflammatory status in obese individuals by secreting adipokines, complement components, and other pro-inflammatory mediators. Our recent published studies showed that a high-fat diet exacerbated lupus development and autoimmunity in MRL/lpr lupus-prone mice. Here we compared the clinical features, lab parameters, and autoimmunity in obese and non-obese lupus patients.

Methods: For data abstraction, the AI software Deep6 was used for query building in patients diagnosed with SLE (ICD-10 code: M32.9). Using Slicer Dicer (via EPIC) and Microsoft Excel, data organization resulted in 1126 SLE patients in 2022, with 133 being obese (BMI >30) and 913 being non-obese control (BMI< 25). In a representative sample of patients with SLE in 2022, BMI levels, SLE disease activity (SLEDAI), lupus nephritis involvement, creatinine level, levels of autoantibodies including antinuclear antibody (ANA) and anti-dsDNA antibody, levels of C-reactive protein (CRP) and complement (C3 and C4), levels of triglyceride and cholesterol in patients’ serum were extracted from EPIC to REDCap and exported as Excel file. Unpaired Student’s t-test and multi-variable ANOVA were used for statistical significance analysis among the groups. Two-tailed p< 0.05 was considered significant.

Results: Ninety-nine lupus patients were included in this study; 49% were obese (BMI ≥ 30 kg/m²) with a significantly higher ratio of total cholesterol/HDL and higher triglyceride level, in comparing to the 21% were non-obese (BMI< ![if !msEquation] > < ![endif] >25kg/m²) patients. A significantly higher frequency of lymphocytes was observed in the blood of obese lupus patients compared to non-obese lupus patients (p< 0.01). There is no difference in SLEDAI, CRP, and ANA levels between obese and non-obese lupus patients. However, anti-dsDNA titer (p< 0.05) and C3 level (p< 0.005) were significantly increased in the obese lupus patients comparing to non-obese patients. Additionally, significant higher level of creatinine (p< 0.005) and significantly increased incidence of lupus nephritis (p< 0.05) and were found in obese patients compared to non-obese lupus patients.

Conclusion: Our results showed that obese lupus patients had a dysfunctional clinical and immunological phenotype with worse outcomes, indicating that obesity may directly influence SLE pathogenesis and autoimmunity. Further study in cellular and molecular levels in obese lupus patients may help us understand the complex mechanism underlying the relationship between SLE and obesity, providing better preventive and treatment strategies for obese lupus patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/retrospective-study-of-obesity-on-clinical-and-immunological-features-in-systemic-lupus-erythematosus-using-ai-software-deep-6-and-epic-slicer-dicer/