Session Information
Date: Monday, November 6, 2017
Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment Poster II: Damage and Comorbidities
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose:
Obesity is more common in patients with SLE compared to the general population. The prevalence of obesity among SLE patients is between 28 and 50 percent. Despite the high prevalence of obesity in this population, the effect of weight on future organ damage in SLE has not been studied. We hypothesized that the body mass index at cohort entry was predictive of future organ damage as measured by the SLICC Damage Index.
Methods:
2406 patients in a prospective SLE cohort had their weight assessed at each visit. Patients were categorized into five predetermined groups based on weight: low (BMI<20 kg/m2), normal weight (reference, BMI 20-24.9 kg/m2), overweight (25-29.9 kg/m2), obese (BMI 30-34.9 kg/m2), and severely obese (BMI>35 kg/m2). A Poisson regression analysis was used to estimate association between damage after cohort entry defined as the SLICC damage index and categorical BMI at cohort entry.
Results:
Table 1. SLICC damage index over time based on BMI at entry into the cohort
|
Damage |
Low |
Overweight |
|
Obesity |
Severely Obesity |
|
||
|
OR (95% CI) |
P value |
OR (95% CI) |
P value |
OR (95% CI) |
P value |
OR (95% CI) |
P value |
|
|
Any Cataract Ever |
1.08(0.68,1.74) |
0.7363 |
1.31(0.95,1.79) |
0.0958 |
1.68(1.19,2.36) |
0.0031 |
1.59(1.1,2.3) |
0.014 |
|
Retinal Change OR optic atrophy |
2.86(1.15,7.15) |
0.0243 |
1.6(0.71,3.63) |
0.2569 |
1.36(0.5,3.69) |
0.5524 |
1.93(0.74,5.02) |
0.1754 |
|
Cognitive impairment OR Major Psychosis |
1.53(0.6,3.94) |
0.3735 |
1.67(0.85,3.31) |
0.138 |
1.61(0.73,3.59) |
0.2411 |
0.59(0.17,2.04) |
0.4069 |
|
Seizures requiring therapy for 6 months |
2.39(0.68,8.37) |
0.1742 |
1.23(0.4,3.8) |
0.7148 |
1.51(0.43,5.3) |
0.5235 |
0.46(0.06,3.81) |
0.4719 |
|
Cerebral Vascular Accident ever or resection not for malignancy |
0.25(0.06,1.02) |
0.0541 |
1.11(0.66,1.85) |
0.7026 |
1.17(0.64,2.15) |
0.6161 |
1.05(0.53,2.06) |
0.8915 |
|
Cranial or peripheral neuropathy |
0.96(0.43,2.18) |
0.9293 |
1.47(0.88,2.45) |
0.137 |
1.13(0.59,2.17) |
0.7144 |
1.38(0.72,2.64) |
0.3287 |
|
Transvese myelitis |
3.58(0.22,56.95) |
0.3664 |
1.23(0.08,19.67) |
0.8819 |
4.52(0.41,49.62) |
0.2175 |
2.76(0.17,44.01) |
0.4716 |
|
Estimated or measured GFR < 50% |
1.99(0.67,5.86) |
0.2126 |
1.23(0.49,3.09) |
0.6537 |
0.75(0.21,2.76) |
0.6685 |
1.23(0.38,3.95) |
0.7301 |
|
Proteinuria 3.5gm/24 hours |
1.19(0.24,5.86) |
0.8279 |
1.03(0.32,3.35) |
0.9635 |
1.51(0.43,5.3) |
0.5235 |
1.38(0.35,5.48) |
0.6455 |
|
End-Stage renal disease |
1.1(0.36,3.34) |
0.8645 |
1.14(0.52,2.47) |
0.743 |
1.56(0.68,3.62) |
0.2961 |
0.64(0.18,2.22) |
0.4795 |
|
Pulmonary hypertension |
1.02(0.42,2.5) |
0.9608 |
0.76(0.39,1.51) |
0.4384 |
0.97(0.45,2.09) |
0.9339 |
1.97(1.03,3.77) |
0.039 |
|
Pulmonary fibrosis |
1.19(0.59,2.39) |
0.6194 |
1.07(0.64,1.78) |
0.7985 |
1.36(0.77,2.39) |
0.2941 |
1.38(0.76,2.52) |
0.2921 |
|
Pleural fibrosis |
1.28(0.47,3.5) |
0.633 |
1.67(0.85,3.31) |
0.138 |
0.65(0.21,1.94) |
0.4362 |
0.99(0.36,2.71) |
0.9798 |
|
Pulmonary infarction OR resection not for malignancy |
3.58(0.22,56.95) |
0.3664 |
1.23(0.08,19.67) |
0.8819 |
/ |
/ |
/ |
/ |
|
Angina OR coronary artery bypass |
0.55(0.13,2.42) |
0.4293 |
1.23(0.58,2.64) |
0.5884 |
2.78(1.35,5.7) |
0.0053 |
2.34(1.06,5.15) |
0.0349 |
|
Myocardial infarction ever |
1.28(0.47,3.5) |
0.633 |
0.97(0.44,2.12) |
0.9374 |
1.94(0.91,4.13) |
0.0878 |
1.38(0.56,3.38) |
0.4788 |
|
Cardiomyopathy |
0.89(0.26,3.14) |
0.8621 |
0.62(0.23,1.63) |
0.3305 |
1.13(0.43,2.98) |
0.8059 |
2.3(1.01,5.26) |
0.0477 |
|
Valvular disease |
0.67(0.2,2.28) |
0.5224 |
0.62(0.27,1.43) |
0.26 |
0.28(0.07,1.22) |
0.0903 |
1.21(0.5,2.9) |
0.6708 |
|
Pericarditis OR pericardiectomy |
3.58(0.73,17.58) |
0.1164 |
1.64(0.37,7.32) |
0.5135 |
1.51(0.25,8.96) |
0.6529 |
0.92(0.1,8.81) |
0.9432 |
|
Claudication |
1.19(0.24,5.86) |
0.8279 |
1.64(0.57,4.71) |
0.3541 |
1.13(0.28,4.48) |
0.8628 |
0.46(0.06,3.81) |
0.4719 |
|
Significant tissue loss ever |
7.16(1.32,38.77) |
0.0224 |
0.62(0.06,6.78) |
0.6928 |
/ |
/ |
2.76(0.39,19.51) |
0.308 |
|
Venous thrombosis with swelling, ulceration, OR venous stasis |
/ |
/ |
2.88(0.75,11.08) |
0.1242 |
4.52(1.14,17.94) |
0.0321 |
2.76(0.56,13.6) |
0.2111 |
|
Infarction or resection of bowel |
1.49(0.73,3.06) |
0.2761 |
1.7(1.02,2.83) |
0.0436 |
1.51(0.81,2.79) |
0.1938 |
1.61(0.85,3.06) |
0.1449 |
|
Stricture OR Upper GI tract surgery ever |
/ |
/ |
1.23(0.25,6.09) |
0.7966 |
1.51(0.25,8.96) |
0.6529 |
/ |
/ |
|
Pancreatic insufficiency |
1.79(0.16,19.63) |
0.6339 |
1.23(0.17,8.73) |
0.8335 |
/ |
/ |
1.38(0.13,15.17) |
0.7913 |
|
Muscle atrophy or weakness |
/ |
/ |
1.23(0.17,8.73) |
0.8335 |
4.52(0.83,24.52) |
0.0806 |
/ |
/ |
|
Deforming or erosive arthritis |
2.62(1.23,5.62) |
0.0129 |
1.32(0.66,2.64) |
0.439 |
1.2(0.52,2.81) |
0.6666 |
1.29(0.53,3.12) |
0.573 |
|
Osteoporosis w/ fracture or vertebral collapse |
1(0.64,1.58) |
0.9925 |
1.05(0.77,1.44) |
0.7484 |
0.81(0.54,1.23) |
0.3315 |
0.96(0.63,1.46) |
0.8419 |
|
Avascular necrosis |
1.15(0.58,2.31) |
0.6846 |
1.07(0.65,1.78) |
0.7799 |
0.95(0.5,1.78) |
0.8665 |
0.89(0.44,1.79) |
0.7468 |
|
Osteomyelitis |
1.19(0.12,11.4) |
0.8782 |
0.41(0.04,3.94) |
0.4409 |
1.51(0.25,8.96) |
0.6529 |
/ |
/ |
|
Ruptured Tendon |
0.83(0.24,2.87) |
0.7634 |
1.42(0.68,2.96) |
0.3458 |
1.04(0.4,2.72) |
0.9322 |
1.06(0.38,2.95) |
0.9067 |
|
Extensive scarring of panniculum other than scalp and pulp space |
0.72(0.08,6.09) |
0.7596 |
0.74(0.18,3.08) |
0.6793 |
1.36(0.33,5.63) |
0.6759 |
/ |
/ |
|
Skin ulceration |
/ |
/ |
1.23(0.17,8.73) |
0.8335 |
3.39(0.57,20.17) |
0.18 |
/ |
/ |
|
Premature Gonadal Failure |
1.99(0.67,5.86) |
0.2126 |
0.96(0.36,2.56) |
0.934 |
1.25(0.42,3.71) |
0.6817 |
1.23(0.38,3.95) |
0.7301 |
|
Diabetes |
1.19(0.48,2.96) |
0.7036 |
1.3(0.69,2.46) |
0.4148 |
1.63(0.81,3.28) |
0.1706 |
1.69(0.81,3.52) |
0.1624 |
|
Malignancy |
1.42(0.83,2.42) |
0.2052 |
1.58(1.08,2.31) |
0.0194 |
1.31(0.82,2.11) |
0.2591 |
1.09(0.64,1.88) |
0.7485 |
/ : data is not sufficient for calculating odds ratios
Conclusion:
Patients with low BMI at cohort entry are almost three times more likely to have retinal change and two times more likely to develop deforming or erosive arthritis.
Overweight patients at cohort entry are 70% more likely to have Infarction or resection of bowel and 58% more likely to develop cancer.
Obese patients at cohort entry are 68% more likely to develop cataract; almost three times more likely to have angina or coronary artery bypass; almost five times more likely to have venous thrombosis.
Severely obese patients at cohort entry are 59% more likely to develop cataract; almost two times more likely to have pulmonary hypertension; two times more likely to have angina or coronary artery bypass, and two times more likely to have cardiomyopathy.
To cite this abstract in AMA style:
Stojan G, Fu W, Petri M. Body Mass Index at Disease Onset Is Predictive of Future Organ Damage in Systemic Lupus Erythematosus [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/body-mass-index-at-disease-onset-is-predictive-of-future-organ-damage-in-systemic-lupus-erythematosus/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/body-mass-index-at-disease-onset-is-predictive-of-future-organ-damage-in-systemic-lupus-erythematosus/