Antineutrophil Cytoplasmic Antibodies in Systemic Lupus Erythematosus: Incidence, Outcome and Prognosis

Abdullah Almutlaq¹, Murray Urowitz¹, Jiandong Su² and Dafna D Gladman³, ¹Rheumatology, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada, ²Rheumatology, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada, ³University of Toronto, Toronto, ON, Canada

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: ANCA and systemic lupus erythematosus (SLE)

Session Information

Date: Tuesday, November 15, 2016

Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment - Poster III: Biomarkers and Nephritis

Session Type: ACR Poster Session C

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

Background/Purpose: The presence of ANCA in SLE had been known for over 25 years with a reported prevalence as high as 31%. However, the relationship between the presence of ANCA and disease activity in SLE has yet to be understood. We aimed to evaluate the prevalence of ANCA in SLE patients and correlate it with lupus activity, organ involvement, association with vasculitis, and prognosis.

Methods: SLE patients have been followed prospectively in the lupus clinic at 2-6 month intervals according to a standard protocol, which includes a detailed clinical history, physical examination and laboratory evaluation. Only patients who were tested at least twice for c and p-ANCA were included. ANCA was considered positive if either c or p-ANCA was detected on at least two occasions. All information necessary to complete the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and the SLICC/ ACR damage index (SDI) is collected prospectively. Vasculitis is defined by SLEDAI-2K vasculitis definition which includes ulceration, gangrene, tender finger nodules, periungual infarction, splinter hemorrhages, biopsy or angiogram proof of vasculitis, retinal hemorrhage or vasculitis found in renal biopsy. Damage increase was defined by the first increase of SDI score after baseline. Baseline was defined as first ANCA positive or second negative of ANCA tests. Univariate and multivariable Weibull regression was used to analyse the effect of positive ANCA on the outcomes of vasculitis and organ damage.

Results: Features for 1212 SLE patients who were tested at least twice for ANCA are shown:

Positive ANCA

(127)

Negative ANCA

(893)

P valve

Mean age (years)

38.64 ± 14.64

38.93 ± 13.83

0.823

Mean disease duration (years) at baseline

9.51 ± 9.25

8.46 ± 7.95

0.173

SLEDAI at baseline

5.80 ± 5.17

4.82 ± 5.00

0.04

Mean follow up from baseline to last date (years)

13.30 ± 7.08

7.36 ± 6.35

<0.001

Low complement at baseline

64 (50.4%)

338 (37.8%)

0.007

SLEDAI DNA positive at baseline

72 (56.7%)

405 (45.4%)

0.017

Vasculitis incidence

34 (26.8%)

97 (10.9%)

<0.001

SDI increase

81 (63.8%)

307 (34.4%)

<0.001

Regression analyses showed that patients with positive ANCA had more vasculitis (hazard ratio 1.67, CI 1.10-2.55). Furthermore, SDI increase after index was also more frequent in patients with positive ANCA (hazard ratio 1.39, CI 1.13-1.72) adjusted for patients’ demographic/disease characteristics/treatment effects. Similar results were observed when analysing c-ANCA and p-ANCA separately.

Conclusion: Positive ANCA was detected on at least 2 occations in 10.5% of the lupus patients. Patients had two or more positive ANCA tests have higher risk of vasculitis and organ damage compared to ANCA negative patients.

Disclosure: A. Almutlaq, None; M. Urowitz, None; J. Su, None; D. D. Gladman, AbbVie, Amgen, BMS, Celgene Corporation, Janssen, Novartis, Pfizer, UCB, 2,AbbVie, Amgen, BMS, Celgene Corporation, Janssen, Novartis, Pfizer, UCB, 5.

To cite this abstract in AMA style:

Almutlaq A, Urowitz M, Su J, Gladman DD. Antineutrophil Cytoplasmic Antibodies in Systemic Lupus Erythematosus: Incidence, Outcome and Prognosis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/antineutrophil-cytoplasmic-antibodies-in-systemic-lupus-erythematosus-incidence-outcome-and-prognosis/. Accessed .

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