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: the complement system plays a major role in autoimmune diseases, and in particular in systemic lupus erythematosus (SLE). Complement deficiencies are a genetic risk factor for SLE. Also a reduction in complement levels has been associated with an increase in SLE activity, with certain organ involvement (ie glomerulonephritis) and as a predictor of a SLE flare. Our objective was to analyze clinical course of SLE patients with permanent low complement levels, and compare them with those with fluctuant levels or persistently normal levels.
Methods: complement determinations (C3 and C4 levels) were analyzed in patients with SLE (fulfilling ACR or SLICC criteria) seen at a University hospital between 2000 and 2013. Patients were grouped in those with permanent C3 and/or C4 low values (low complement group) those with C3 and C4 constant normal values (normal complement group), and those with fluctuant values (periods of normal and periods of low values, during follow up: fluctuant group). Mortality, clinical characteristics, organ involvement and antibodies were analyzed and compared between groups.
Results: Two hundred and seventy SLE patients were included (242 females, 89.6%), mean age at diagnosis was 34.2 years (SD 15.8). Patients were divided according to complement levels during follow up in 3 groups: persistent low complement levels (n=79), normal complement levels (n=116), and fluctuant levels (n=75). Demographics, clinical and serological characteristics are shown in table 1. Mortality was similar between the three groups (5%, 4% and 7%, respectively). Lupus glomerulonephritis was more frequent in patients with fluctuant levels of complement (both proliferative and membranous glomerulonephritis). Patients with normal complement had less frequency of hematological involvement and antiDNA antibodies. On multivariable analysis persistent low complement levels were neither associated with mortality nor with organ damage as measured by SLICC (SLICC>0). Only increased age was associated with mortality, and increased age and neurologic involvement with SLICC >0.
Conclusion: Different behavior of complement levels in SLE patients was not associated with differences in outcomes (mortality and organ damage). Although there were some differences in organ involvement (higher prevalence of glomerulonephritis in fluctuant levels group, and hematological involvement and anti DNA antibodies in low and fluctuant levels groups), do not appear to represent clear different sub-groups of patients.
Table 1. SLE patients grouped by behavior of complement levels during follow up.
|
|
Normal complement (n=116) |
Persistent Low complement (n=79) |
Fluctuant complement (n=75) |
P value |
|
Females, n (%) |
107 (92.2) |
70 (88.6) |
65 (86.7) |
0.439 |
|
Age at diagnosis, average, years (SD) |
36.4 (16.5) |
32.4 (14.7) |
32.7 (15.8) |
0.1397 |
|
Follow-up, median, years (IQR) |
6.4 (8.2) |
6.1 (7.6) |
9.2 (5.6) |
0.345 |
|
Fulfilling ACR criteria, n (%)
|
76 (65.5)# |
64 (81)* |
66 (88)& |
0.001 * and & vs # |
|
Fulfilling SLICC criteria, n (%)
|
96 (82.7)# |
73 (92.4) |
74 (98.7)& |
0.001 & vs # |
|
Cutaneous Lupus, n (%) |
76 (65.5) |
50 (63.3) |
44 (58.7) |
0.773 |
|
Oral ulcers, n (%) |
24 (20.7) |
19 (24.1) |
20 (26.7) |
0.624 |
|
Serositis, n (%) |
37 (31.9) |
15 (18.9) |
17 (22.7) |
0.102 |
|
Artritis, n (%) |
59 (50.9) |
47 (59.5) |
35 (46.7) |
0.261 |
|
Neurologic, n (%)
|
15 (12.9) |
7 (8.9) |
7 (9.3) |
0.598 |
|
Renal, n (%) |
57 (49)# |
44 (56)* |
56 (75)& |
0.002 & vs # and * |
|
Leukopenia or lymphopenia, n (%) |
35 (30.2)# |
39 (49.4)* |
34 (45.3)& |
0.007 * vs # and 0.033 & vs # |
|
Thrombocytopenia |
20 (17.2)# |
28 (35.4)* |
25 (33.3)& |
0.026 * and & vs # |
|
ANA positive, n (%) |
109 (94) |
77 (97.5) |
68 (90.7) |
0.202 |
|
DNA positive, n (%) |
52 (44.8)# |
54(68.3)* |
57 (76)& |
<0.001 * and & vs # |
|
Sm positive, n (%) |
12 (10.3) |
10 (12.7) |
8 (10.7) |
0.882 |
|
Lupus anticoagulant positive, n (%) |
14 (12.1) |
16 (20.2) |
11 (14.7) |
0.254 |
|
Anticardiolipins positive, n (%) |
17 (14.7) |
20 (25.3) |
13 (17.3) |
0.405 |
|
SLICC at the end of follow up, mean (SD) |
0.98 (1.4) |
1 (1.4) |
1.33 (1.7) |
0.2345 |
To cite this abstract in AMA style:
Gandino IJ, Scolnik M, Bertiller E, Scaglioni V, Soriano ER. Behavior of Complement Levels and Risk of Organ Involvement in SLE Patients [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/behavior-of-complement-levels-and-risk-of-organ-involvement-in-sle-patients/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/behavior-of-complement-levels-and-risk-of-organ-involvement-in-sle-patients/