Date: Sunday, November 8, 2015
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Acute articular involvement is an important feature of childhood systemic lupus erythematosus (cSLE) and adult-onset (aSLE) patients, and it has been described in up to 70% of children and 90% of adults. In contrast, evaluation of chronic arthritis (CA) has been restricted to case reports or small series in cSLE and aSLE patients. Moreover, comparison of clinical and laboratorial parameters in both SLE groups with CA is lacking in the literature. Therefore, the objective of the present study was to determine the overall prevalence of CA, and to compare clinical/laboratorial features and treatment in a large population of children and adult lupus patients.
Methods: This retrospective study evaluated medical charts of 336 cSLE and 1,830 aSLE patients (ACR criteria) followed in the same tertiary hospital. Demographic data, arthritis characteristics, clinical features, disease activity (SLEDAI-2K) and treatment were recorded. CA was defined as synovitis with least 6 weeks duration. Rhupus syndrome was characterized as the association of SLE and juvenile idiopathic arthritis/rheumatoid arthritis with erosion. Jaccoud’s arthropathy was defined as a non-erosive subluxation leading to severe deformity of the hands and feet, mild aching and little or no evidence of synovitis.
Results: Frequencies of CA were similar in cSLE and aSLE patients (2.3% vs. 3.7%,p=0.261). Hands (62% vs. 58%,p=1.000), wrists (62% vs. 48%,p=0.480) and knees (50% vs. 17%,p=0.053) were the most frequently involved joints in both groups. Ankles were significantly more involved in cSLE (100% vs. 16%,p<0.001). The median of disease duration until CA diagnosis was shorter in cSLE (0 vs. 10 years,p<0.001). Children presented more polyarthritis than adults (75% vs. 32%,p=0.024), as well as median number of joints with arthritis [8.5(1-18) vs. 3(1-9),p=0.017] and number of joints with limitation on motion [1.5(0- 24) vs. 0(0-4),p=0.004]. Further analysis of cSLE and aSLE patients at CA diagnosis revealed higher frequencies of hepatomegaly (25% vs. 0,p=0.009), splenomegaly (25% vs. 0,p=0.009), alopecia (37% vs. 1.4%,p=0.002), pericarditis (25% vs. 0, p=0.009), nephritis (37% vs. 3%,p=0.006), hematuria (37% vs. 1.4%,p=0.002), lupus anticoagulant (40% vs. 1.6%, p=0.012) and anticardiolipin IgM (40% vs. 1.5%,p=0.012) and higher median of SLEDAI-2K [10.5(1-20) vs. 6(4-16),p=0.029] in the former group. Frequencies of rhupus syndrome (12% vs. 17%,p=1.0) and concomitant Jaccoud’s arthropathy (0 vs. 17%,p=0.343) were similar in cSLE and aSLE patients at CA diagnosis. The frequencies of glucocorticoid, antimalarials and methotrexate use were similar in both groups (p>0.05).
Conclusion: We identified that chronic arthritis in SLE has distinct features in children with very early onset, polyarticular involvement and often associated with active disease. We further demonstrated that rhupus is not a relevant cause of CA in cSLE and aSLE patients, suggesting that CA represents a distinct manifestation of lupus.
To cite this abstract in AMA style:Gormezano NW, Silva CA, Aikawa NE, Barros DL, da Silva MA, Otsuzi CI, Kozu KT, Seguro L, Pereira RMR, Bonfá E. Chronic Arthritis in Systemic Lupus Erythematosus: Distinct Features in 336 Pediatric and 1,830 Adult Patients [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/chronic-arthritis-in-systemic-lupus-erythematosus-distinct-features-in-336-pediatric-and-1830-adult-patients/. Accessed September 25, 2021.
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