Session Information
Date: Tuesday, November 10, 2015
Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment Poster Session III
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Across the spectra of autoimmune diseases RA stands out, as biomarkers present from the onset are associated with severity and can be a guide to therapy. In contrast, in SLE, genetic susceptibility has no clinical applicability, specific autoantibodies do not predict disease course, determinants of target organ remain unknown and clinical outcome is unpredictable for individual patients. In practice, damage accrual is therefore the best measure which is used to define SLE disease severity, found to predict future mortality. The objective of this study was to test the validity of damage determinants in a single-centre cohort.
Methods: Prospectively followed SLE female patients (defined by the identification of at least 4 SLE ACR criteria – fulfillement 100%, n=76) over the past 5 years. Age of onset, ethnicity, disease duration, number of ACR criteria at the end of follow-up, cumulative: renal, neuropsychiatric and articular phenotypes, hypertension, dyslipidemia, smoking, hydroxychloroquine, immunosuppressive use and SLEDAI 2K were correlated to the presence and degree of irreversible damage, as measured by SLICC/SDI in its several domains. Accumulation of ACR criteria was measured in a sub-group of patients followed from disease onset (within a year of the first symptom ascribed to SLE) (n=39 – 51%); SLEDAI and SLICC were performed bi-annualy and annualy, respectively. Univariate statistical analysis was performed using the Wilcoxon Mann-Whitney, Chi-Square tests and bivariate analysis for non-parametric distributed data (Sig. 2-tailed p < 0,05).
Results: SLICC SDI index > 0 was present in 43/76 (56.6%) and significantly associated to a longer disease duration, a higher number of ACR criteria and a neuropsychiatric (NP) phenotype when compared with those with no damage. There was no effect from any other demographic or clinical features (Table I). The final number of ACR criteria accrued was positively correlated to a higher disease activity over the past 5 years of follow-up (Spearman´s rho 0.02). Mean disease activity (SLEDAI 2K ≥ 3) over the past 5 years was not correlated to damage accrual at the end of follow-up according to disease duration: ≤ 5 and < 10y (n=17); ≥ 10 and < 20y (n=32); ≥ 20 (n=27).
| Characteristic | SLICC < 1 (n=43) | SLICC ≥ 1 (n=33) | P value (Sig*) | Statistical Test |
| Age at disease onset (years) (mean ± SD) | 32 ± 11 | 31 ± 13 | 0.653 | Mann Whitney (MW) |
| Non-Caucasian (n, %) | 4 (44.4) | 5 (55.6) | 0.610 | Pearson Chi-square (PCS) |
| Disease Duration (years) (mean ± SD) | 14 ± 7 | 19 ± 8 | 0.007* | MW |
| Hypertension (n, %) | 16 (36.4) | 27 (61.4) | 0.338 | PCS |
| Dyslipidemia (n, %) | 12 (34.3) | 22 (62.9) | 0.201 |
PCS |
| Smoking (n, %) | 7 (43.8) | 9 (56.2) | 1.000 | PCS |
| Malignancy (n, %) | 0 (0) | 6 (100) | 0.111 | PCS |
| Infection (n, %) | 16 (39) | 24 (58.5) | 0.809 | PCS |
| Neuropsychiatric (n, %) | 2 (11.1) | 16 (88.9) | 0.004* | PCS |
| Renal (n, %) | 13 (41.9) | 17 (54.8) | 0.614 | PCS |
| Articular (n, %) | 22 (39.3) | 33 (58.9) | 0.631 | PCS |
| Anti-nuclear Ab (n, %) | 32 (42.1) | 43 (56.6) | 1.000 | PCS |
| Anti-dsDNA (n, %) | 24 (41.4) | 33 (56.9) | 1.000 | PCS |
| Mean SLEDAI (bi-annual, past 5 years) | 2.2 ± 2.0 | 3.6 ± 2.9 | 0.054 | MW |
| Cumulative ACR criteria – first 6 months after disease onset (n available) | 4.1 ± 1.3 (n=21) | 3.7 ± 1.5 (n=18) | 0.280 | MW |
| Cumulative ACR criteria – end of follow-up | 5.0 ± 1.1 | 5.6 ± 1.4 | 0.046* | MW |
Conclusion: Disease duration and number of ACR criteria predict SLICC SDI as previously reported1. In our cohort, NP disease has a major impact on damage accrual.
References: 1Bruce IN et al. doi:10.1136/annrheumdis-2013-2051-71
To cite this abstract in AMA style:
Moraes-Fontes MF, Silva E, Riso N, Jacinto M. Determinants of Damage in an SLE Cohort: Real World Data [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/determinants-of-damage-in-an-sle-cohort-real-world-data/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/determinants-of-damage-in-an-sle-cohort-real-world-data/