Background/Purpose: Cachexia is a syndrome that may accompany a range of diseases, including cancer, chronic heart failure, chronic obstructive pulmonary disease, and rheumatoid arthritis. It is associated with central and systemic increases of pro-inflammatory factors, and with decreased quality of life, poor responses to pharmacological treatment and shortened survival. Despite an abundance of data from other inflammatory diseases, cachexia in systemic lupus erythematosus remains a largely undescribed syndrome. Using the Fearon criteria for defining cachexia (5% stable weight loss in 6 months without starvation relative to the average weight in all prior cohort visits AND/OR weight loss >2% without starvation relative to the average weight in all prior cohort visits and a BMI < 20), we have previously shown that more than half of the Hopkins Lupus Cohort patients met cachexia criteria within the first five years of cohort entry. We decided to revisit this analysis using the Evans criteria for defining cachexia, criteria which are more specific, more extensive, and have been shown to have a better prediction of survival.

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). Cachexia was defined based on modified Evans criteria as 5% stable weight loss in 12 months without starvation relative to the average weight in all prior cohort visits AND/OR BMI< 20 and 3 out of the following criteria: ESR >20mm/h, hemoglobin < 12g/dL, albumin < 3.2g/dl, and anorexia. Risk of cachexia within 5 years of cohort entry was based on Kaplan Meier estimates.

Results: See Table 1 and Table 2

Conclusion: Within five years of cohort entry, more than half of the Hopkins Lupus cohort patients develop cachexia as defined by Evans criteria. This prevalence of cachexia is higher than the one reported in breast cancer (25%) or hematological malignancies (40%), and similar to the rates reported for lung cancer (50%). The highest risk of cachexia was seen among African Americans, while those with a BMI< 20 had the lowest risk. Cachexia is an under recognized syndrome in patients with lupus affecting a large proportion of patients regardless of the criteria used for its definition. Further studies are needed to elucidate the implications of cachexia in the response to treatment, long term outcomes, quality of life, as well as its role as a potential cardiovascular risk factor in SLE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cachexia-in-systemic-lupus-erythematosus/