Session Information
Date: Sunday, November 8, 2015
Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment Poster Session I
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Serositis is one of the classification criteria for systemic lupus erythematosus and a common type of extra renal flare. Comparison of associates of pleurisy and pericarditis separately has not been previously done in Caucasians and African Americans.
Methods: 2,390 SLE patients in the Hopkins Lupus Cohort were analyzed for demographic, clinical and serologic associates of pleurisy or pericarditis, defined using the SELENA revision of the SLE Disease Activity Index (SLEDAI). We reported associates with a p-value of less than 0.05 for both and for pleurisy or pericarditis separately.
Results: 43% had pleurisy and 22% had pericarditis. African-American ethnicity was associated with pericarditis. Renal lupus and seizure were associated only with pericarditis, whereas arthritis was associated only with pleurisy. Only pericarditis was associated with anti-RNP and anti-Sm. Both pleurisy and pericarditis are associated with anti-dsDNA and low complement.
Table 1. Demographic Characteristics Associated with Serositis in SLE (p<0.0001)
|
Characteristics |
Subgroup |
Negative |
Positive |
OR |
95% CI |
P-value |
|
Factors significantly associated with only Pericarditis |
||||||
|
African-American ethnicity |
Pericarditis |
38.54% |
53.64% |
1.85 |
1.51-2.26 |
<0.0001 |
|
Factors significantly associated with only Pleurisy |
||||||
|
Age at SLE Diagnosis |
Pleurisy |
33.44±13.54 |
31.03±12.01 |
|
|
<0.0001 |
|
Factors significantly associated with both Pericarditis and Pleurisy |
||||||
|
None |
|
|
|
|
|
|
Table 2. Clinical and Laboratory Features Associated with Serositis in SLE (p<0.0001)
|
Characteristics |
Subgroup |
Negative |
Positive |
OR |
95% CI |
P-value |
|
Factors significantly associated with only Pericarditis |
||||||
|
Proteinuria |
Pericarditis |
40.37% |
57.36% |
1.99 |
1.63-2.42 |
<0.0001 |
|
Nephrotic Syndrome |
Pericarditis |
15.33% |
26.78% |
2.02 |
1.60-2.55 |
<0.0001 |
|
Seizure |
Pericarditis |
8.23% |
14.31% |
1.86 |
1.39-2.50 |
<0.0001 |
|
Factors significantly associated with only Pleurisy |
||||||
|
Arthritis |
Pleurisy |
66.32% |
79.48% |
1.97 |
1.63-2.37 |
<0.0001 |
|
Arthralgia |
Pleurisy |
87.66% |
95.85% |
3.25 |
2.30-4.60 |
<0.0001 |
|
Malar Rash |
Pleurisy |
45.75% |
54.26% |
1.41 |
1.20-1.65 |
<0.0001 |
|
Factors significantly associated with both Pericarditis and Pleurisy |
||||||
|
Fever |
Pericarditis |
32.60% |
50.76% |
2.13 |
1.75-2.60 |
<0.0001 |
|
Pleurisy |
29.39% |
45.95% |
2.04 |
1.72-2.42 |
<0.0001 |
|
|
Lymphadenopathy |
Pericarditis |
28.35% |
41.79% |
1.81 |
1.48-2.22 |
<0.0001 |
|
Pleurisy |
26.34% |
37.78% |
1.7 |
1.43-2.02 |
<0.0001 |
|
|
Raynaud’s Syndrome |
Pericarditis |
48.90% |
63.34% |
1.81 |
1.48-2.21 |
<0.0001 |
|
Pleurisy |
47.08% |
58.37% |
1.58 |
1.34-1.86 |
<0.0001 |
|
|
Hemolytic Anemia |
Pericarditis |
8.34% |
16.37% |
2.15 |
1.61-2.87 |
<0.0001 |
|
Pleurisy |
7.91% |
12.87% |
1.72 |
1.31-2.26 |
<0.0001 |
|
Table 3. Serologic Features Associated with Serositis in SLE (p<0.0001)
|
Characteristics |
Subgroup |
Negative |
Positive |
OR |
95% CI |
P-value |
|
Factors significantly associated with only Pericarditis |
||||||
|
Anti-RNP |
Pericarditis |
25.89% |
37.82% |
1.74 |
1.41-2.14 |
<0.0001 |
|
Anti-Sm |
Pericarditis |
17.97% |
28.80% |
1.85 |
1.47-2.32 |
<0.0001 |
|
Factors significantly associated with only Pleurisy |
||||||
|
None |
|
|
|
|
|
|
|
Factors significantly associated with both Pericarditis and Pleurisy |
||||||
|
Anti-DNA |
Pericarditis |
58.74% |
73.09% |
1.91 |
1.54-2.36 |
<0.0001 |
|
Pleurisy |
58.01% |
66.99% |
1.47 |
1.24-1.74 |
<0.0001 |
|
|
Low C3 |
Pericarditis |
51.86% |
65.46% |
1.76 |
1.44-2.15 |
<0.0001 |
|
Pleurisy |
50.81% |
60.10% |
1.46 |
1.24-1.72 |
<0.0001 |
|
|
Low C4 |
Pericarditis |
44.85% |
57.63% |
1.67 |
1.38-2.04 |
<0.0001 |
|
Pleurisy |
43.77% |
52.75% |
1.43 |
1.22-1.69 |
<0.0001 |
|
|
ESR |
Pericarditis |
71.71% |
83.85% |
2.05 |
1.59-2.64 |
<0.0001 |
|
Pleurisy |
70.40% |
79.51% |
1.63 |
1.35-1.98 |
<0.0001 |
|
Conclusion: Pleurisy is more common than pericarditis. There are specific associates of pericarditis (African-American ethnicity, renal lupus, seizure, anti-RNP and anti-Sm) and pleurisy (arthritis). This challenges the dogma that serositis has one mechanism in SLE.
To cite this abstract in AMA style:
Ryu S, Petri M. Associates of Pleurisy of Pericarditis in Systemic Lupus Erythematosus (SLE) [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/associates-of-pleurisy-of-pericarditis-in-systemic-lupus-erythematosus-sle/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/associates-of-pleurisy-of-pericarditis-in-systemic-lupus-erythematosus-sle/